DOI: 10.12890/2026_007426

Ulcerative pancreatic panniculitis complicated by secondary infection and delayed wound healing in a patient undergoing haemodialysis

Authors

  • Kodai Nakahara Division of General Internal Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Mitsumasa Okano Division of General Internal Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Ryusuke Ono Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
  • Ken Goda Division of General Internal Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Center for Promoting Education, Kobe University Graduate School of Medicine, Kobe, Japan
  • Yohei Kanzawa Division of General Internal Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Kazunori Otsui Division of General Internal Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Kazuhiko Sakaguchi Division of General Internal Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Medical and Health Policy Science, Department of Future Social Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

mokano@med.kobe-u.ac.jp

Keywords

Pancreatic panniculitis, fat necrosis, subcutaneous nodules, secondary infection

Abstract

Introduction: Pancreatic panniculitis is a rare cutaneous manifestation of pancreatic disease.
Case description: A 75-year-old man on maintenance haemodialysis with a history of IgG4-related autoimmune pancreatitis presented with painful subcutaneous nodules on the lower extremities and a purulent leg ulcer. Elevated pancreatic enzyme levels and imaging findings suggested an exacerbation of chronic pancreatitis. Histopathological examination of a skin biopsy revealed lobular panniculitis with fat necrosis and ghost-like adipocytes, confirming the diagnosis of pancreatic panniculitis. Subcutaneous nodules regressed with conservative treatment for pancreatitis; however, the ulcer became secondarily infected and showed delayed wound healing.
Discussion: In patients undergoing haemodialysis, susceptibility to infection and impaired wound healing may complicate the course of ulcerative pancreatic panniculitis.
Conclusion: This case highlights the importance of early recognition of pancreatic panniculitis because secondary infection and delayed wound healing may complicate its clinical course in patients receiving maintenance haemodialysis.

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References

  1. Dahl PR, Su WP, Cullimore KC, Dicken CH. Pancreatic panniculitis. J Am Acad Dermatol. 1995;33(3):413-7. doi: 10.1016/0190-9622(95)91385-8.
  2. Requena L, Sánchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol. 2001;45(3):325-61; quiz 362-4. doi: 10.1067/mjd.2001.114735.
  3. Dalrymple LS, Johansen KL, Chertow GM, Cheng SC, Grimes B, Gold EB, et al. Infection-related hospitalizations in older patients with ESRD. Am J Kidney Dis. 2010;56(3):522-30. doi: 10.1053/j.ajkd.2010.04.016. Erratum in: Am J Kidney Dis. 2012;60(2):334.
  4. Pomerantz ER, Hackley MA, Lawlor CE, Lee D, Thampy D, Brownstone ND, et al. A Scoping Literature Review of Pancreatic Panniculitis. Cureus. 2025;17(1):e78000. doi: 10.7759/cureus.78000.
  5. Narváez J, Bianchi MM, Santo P, de la Fuente D, Ríos-Rodriguez V, Bolao F, et al. Pancreatitis, panniculitis, and polyarthritis. Semin Arthritis Rheum. 2010;39(5):417-23. doi: 10.1016/j.semarthrit.2008.10.001.
  6. Miulescu R, Balaban DV, Sandru F, Jinga M. Cutaneous Manifestations in Pancreatic Diseases-A Review. J Clin Med. 2020;9(8):2611. doi: 10.3390/jcm9082611.
  7. Pérez-Garza DM, Chavez-Alvarez S, Ocampo-Candiani J, Gomez-Flores M. Erythema Nodosum: A Practical Approach and Diagnostic Algorithm. Am J Clin Dermatol. 2021;22(3):367-378. doi: 10.1007/s40257-021-00592-w.
  8. Nigwekar SU, Thadhani R, Brandenburg VM. Calciphylaxis. N Engl J Med. 2018;378(18):1704-1714. doi: 10.1056/NEJMra1505292.
  9. Takanashi S, Akiyama M, Nishina N, Kaneko Y, Takeuchi T. Characteristics and prognosis of IgG4-related skin disease: A case report and systematic literature review. Autoimmun Rev. 2021;20(5):102805. doi: 10.1016/j.autrev.2021.102805.
  10. Selvaraj V, Dapaah-Afriyie K. A Tale of Two Ps: Panniculitis Secondary to Acute Pancreatitis. Cureus. 2021;13(12):e20504. doi: 10.7759/cureus.20504.

Published

2026-10-14

Issue

2026: LATEST ONLINE

Categories

How to Cite

1.
Nakahara K, Okano M, Ono R, Goda K, Kanzawa Y, Otsui K, et al. Ulcerative pancreatic panniculitis complicated by secondary infection and delayed wound healing in a patient undergoing haemodialysis. EJCRIM [Internet]. 2026 Oct. 14 [cited 2026 Nov. 3];13. Available from: https://ejcrim.com/index.php/ejcrim/article/view/7426