Ewha Med J.  2022 Jan;45(1):17-19. 10.12771/emj.2022.45.1.17.

Pancreatic Panniculitis: A Case Report

Affiliations
  • 1Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea

Abstract

Pancreatic panniculitis is a rare skin complication in which subcutaneous fat necrosis occurs in association with pancreatic disorders, most commonly acute or chronic pancreatitis. Erythematous subcutaneous nodules develop on the legs and spontaneously ulcerate or exude an oily substance. A 32-year-old Korean female patient presented with a 2-week-history of tender nodules with erythematous crusts on her left shin. She had a history of alcoholic liver cirrhosis and, 5 weeks earlier, had been diagnosed with acute pancreatitis. The histopathologic findings from a skin biopsy were consistent with lobular panniculitis, without signs of vasculitis, and diffuse fat necrosis. Basophilic calcium deposits were present in the dermis and subcutaneous fat. These findings were suggestive of pancreatic panniculitis. The skin lesion had a chronic course corresponding to repeated exacerbations of the patient’s pancreatitis. Thus, in the differential diagnosis of subcutaneous nodules, clinicians should consider pancreatic panniculitis as a cutaneous manifestation of pancreatic disease.

Keyword

Panniculitis; Acute pancreatitis; Fat necrosis

Figure

  • Fig. 1 Clinical images at the initial visit. Multiple tender nodules and erythematous crusted papules are seen on the patient’s left shin. Written informed consent was obtained for publication of this case report and accompanying images.

  • Fig. 2 Computed tomography of the abdomen reveals an increased pancreatic volume and a peripancreatic infiltration (arrows) of the pancreas from head to tail. Written informed consent was obtained for publication of this case report and accompanying images.

  • Fig. 3 Histopathologic images. (A) The biopsy shows lobular panniculitis with fat necrosis and basophilic calcium deposition in the deep dermis (H&E, ×40), (B) Focal areas of fat necrosis show anucleated adipocytes with a shadowy wall (H&E, ×400). (C) Fine basophilic calcium deposits (arrows) are present in the dermis (H&E, ×400) Written informed consent was obtained for publication of this case report and accompanying images.


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