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Pichler H, Stumpner T, Schiller D, Bischofreiter M, Ortmaier R. Pancreatitis, panniculitis and polyarthritis syndrome: A case report. World J Clin Cases 2023; 11:4412-4418. [PMID: 37449214 PMCID: PMC10337007 DOI: 10.12998/wjcc.v11.i18.4412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/07/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare form of pancreatic disease. It is characterized by bullous erythematous skin lesions and arthritis, and both are triggered by pancreatic malfunction. Few cases have been described in the literature thus far. Due to the inconsistency in its clinical presentation, its diagnosis can be a challenge. Early therapy initiation is essential to reduce mortality; however, there is currently no gold standard for treatment.
CASE SUMMARY A 66-year-old polymorbid male patient presented with several superficial abscesses on both lower legs and painful swelling in the knee. Treatment for septic arthritis and septic skin infection over several weeks failed. His general condition deteriorated gradually and worsened with sudden onset of abdominal pain. A diagnosis of necrotizing pancreatitis was made. He subsequently underwent a laparotomy and drainage of the pancreas. Eventually, our patient improved, and his abdominal complaints, knee pain, and dermal lesions resolved.
CONCLUSION PPP syndrome is rare and easily misdiagnosed, as abdominal symptoms may be delayed or absent. Clinicians should consider PPP syndrome if they encounter refractory panniculitis in combination with joint infection.
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Affiliation(s)
- Hannes Pichler
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital, Paracelsus Medical University Salzburg, Linz 4010, Austria
| | - Thomas Stumpner
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital, Paracelsus Medical University Salzburg, Linz 4010, Austria
| | - Dietmar Schiller
- Department of Gastroenterology, Ordensklinikum Linz Barmherzige Schwestern, Linz 4010, Austria
| | - Martin Bischofreiter
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital, Paracelsus Medical University Salzburg, Linz 4010, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital, Paracelsus Medical University Salzburg, Linz 4010, Austria
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2
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Song X, Dai W, Wu YJ, Wu YX, Fan YM. A case of pancreatitis-panniculitis-polyarthritis syndrome due to pancreatic neuroendocrine tumor. Int J Dermatol 2022. [PMID: 36512720 DOI: 10.1111/ijd.16554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/24/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Xuan Song
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Wei Dai
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yong-Jun Wu
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yan-Xia Wu
- Department of Pathology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yi-Ming Fan
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.,Dermatology, Plastic and Cosmetic Surgery Center, First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, Guangdong, China
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3
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Induchoodan PS, Nizarudeen A, Preethamol S, Mohammed F. A Rare Complication of Pancreatitis — PPP Syndrome (Pancreatitis, Panniculitis, Polyarthritis). Indian J Surg 2022. [DOI: 10.1007/s12262-021-03253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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4
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Pan W, Wang Q, Yang M, Zhang L, Wang J, Sun K. Pancreatic carcinoma presented with panniculitis and polyarthritis: A rare case. J Cancer Res Ther 2021; 17:1751-1754. [PMID: 35381750 DOI: 10.4103/jcrt.jcrt_2386_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Extrapancreatic manifestations can complicate pancreatic disorders. Pancreatic panniculitis, characterized by subcutaneous fat necrosis, develops in 0.3%-3% of patients with pancreatic disorders. Occasionally, pancreatic panniculitis and polyarthritis occur in the same patient with pancreatic diseases, a rare symptomatic triad known as pancreatitis, panniculitis, and polyarthritis (PPP) syndrome. PPP syndrome is primarily caused by acute or chronic pancreatitis and pancreatic carcinoma. Almost half of the patients with PPP syndrome do not present with gastrointestinal signs, which may lead to a delayed diagnosis of underlying pancreatic disease. The skin and arthritic symptoms may be mistaken for rheumatic diseases. The histological finding of skin lesions is a valuable clue for diagnosing pancreatic diseases. Due to the high mortality rate when PPP syndrome is associated with pancreatic carcinoma, we highlight that the pancreas should be thoroughly examined if a skin biopsy indicates pancreatic panniculitis.
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Affiliation(s)
- Wenping Pan
- Department of Rheumatology, First Affiliated Hospital of Shandong First Medical University, Shandong Province, Jinan, China
| | - Qing Wang
- Department of Rheumatology, First Affiliated Hospital of Shandong First Medical University, Shandong Province, Jinan, China
| | - Min Yang
- Department of Pathology, First Affiliated Hospital of Shandong First Medical University, Shandong Province, Jinan, China
| | - Li Zhang
- Department of Ultrasonography, First Affiliated Hospital of Shandong First Medical University, Shandong Province, Jinan, China
| | - Jun Wang
- Department of Oncology, First Affiliated Hospital of Shandong First Medical University, Shandong Province, Jinan, China
| | - Kai Sun
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Shandong First Medical University, Shandong Province, Jinan, China
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Ku S, Balijepally R, Horomanski A, Fairchild R, Brown RA, Liao CE. Painful Panniculitis and Polyarthritis in Pancreatic Adenocarcinoma: A Case Report. J Clin Rheumatol 2021; 27:e278-e280. [PMID: 32496359 DOI: 10.1097/rhu.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Seul Ku
- From the Department of Medicine
| | | | | | | | - Ryanne A Brown
- Dermatology and Pathology, Stanford School of Medicine, Stanford, CA
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Miksch RC, Schiergens TS, Weniger M, Ilmer M, Kazmierczak PM, Guba MO, Angele MK, Werner J, D'Haese JG. Pancreatic panniculitis and elevated serum lipase in metastasized acinar cell carcinoma of the pancreas: A case report and review of literature. World J Clin Cases 2020; 8:5304-5312. [PMID: 33269263 PMCID: PMC7674712 DOI: 10.12998/wjcc.v8.i21.5304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/28/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic panniculitis is an extremely rare condition associated with different underlying pancreatic disorders and characterized by subcutaneous fat necrosis induced by elevated serum lipase levels. These lesions usually affect the lower extremities and may precede abdominal symptoms of pancreatic disease. Acinar cell carcinoma (ACC) of the pancreas is a rare pancreatic neoplasm, accounting for only 1%-2% of pancreatic tumors in adults.
CASE SUMMARY We present the case of a 72-year-old man with ACC of the pancreatic head and synchronous liver metastases. Both the primary tumor and liver metastases were resected. Serum lipase was elevated before surgery and decreased to normal postoperatively. Rising serum lipase levels at follow-up led to the diagnosis of hepatic recurrence. This disease progression was then accompanied by pancreatic panniculitis, with subcutaneous fat necrosis and acute arthritis. To the best of our knowledge, only 4 cases have been reported in the literature and each showed a similar association of serum lipase levels with pancreatic panniculitis and progression of ACC.
CONCLUSION Clinical symptoms and progression of ACC may correlate with serum lipase levels, suggesting potential usefulness as a follow-up biomarker.
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Affiliation(s)
- Rainer Christoph Miksch
- Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany
| | - Tobias S Schiergens
- Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany
| | - Maximilian Weniger
- Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany
| | - Matthias Ilmer
- Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany
| | - Philipp M Kazmierczak
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich 81377, Germany
| | - Markus O Guba
- Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany
| | - Martin K Angele
- Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany
| | - Jan G D'Haese
- Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany
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Phillips AE, Paniccia A, Dasyam A. A Rare Complication of Chronic Pancreatitis. Gastroenterology 2020; 159:e16-e17. [PMID: 32311364 DOI: 10.1053/j.gastro.2020.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Anna Evans Phillips
- Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Alessandro Paniccia
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anil Dasyam
- Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Yamashita Y, Joshita S, Ito T, Maruyama M, Wada S, Umemura T. A case report of pancreatic panniculitis due to acute pancreatitis with intraductal papillary mucinous neoplasm. BMC Gastroenterol 2020; 20:286. [PMID: 32831035 PMCID: PMC7445916 DOI: 10.1186/s12876-020-01430-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pancreatic panniculitis is a rare skin manifestation in pancreatic disease patients that most frequently develops on the lower legs. We report the unique case of a 68-year-old man who suffered from pancreatic panniculitis on his trunk associated with acute pancreatitis due to an intraductal papillary mucinous neoplasm. CASE PRESENTATION A 68-year-old man complained of a 2-day history of a tender subcutaneous nodule on his trunk. Laboratory tests and abdominal contrast computed tomography were consistent with acute pancreatitis due to an intraductal papillary mucinous neoplasm. A skin biopsy of the nodule histologically displayed lobular panniculitis with characteristic "ghost cells", which indicated pancreatic panniculitis. CONCLUSIONS In order to avoid a missed or delayed diagnosis, clinicians should bear in mind that pancreatic panniculitis can be the first manifestation of pancreatic disease when encountering subcutaneous nodules on the trunk.
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Affiliation(s)
- Yuki Yamashita
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Satoru Joshita
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Tetsuya Ito
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Masafumi Maruyama
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Shuichi Wada
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Takeji Umemura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Clinical characteristics, treatment, and outcome of pancreatitis, panniculitis, and polyarthritis syndrome: a case-based review. Clin Rheumatol 2020; 40:1625-1633. [PMID: 32776311 DOI: 10.1007/s10067-020-05333-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022]
Abstract
A 42-year-old Caucasian female presented with lower limb panniculitis and bilateral ankle arthritis in the absence of abdominal or other localizing symptoms. Abdominal imaging revealed subacute pancreatitis with pseudocyst formation. The clinical manifestations were compatible with pancreatitis, panniculitis, and polyarthritis syndrome (PPP syndrome), a very rare complication of pancreatic disease. The patient improved with conservative treatment for the pancreatic disease and systemic corticosteroids for the cutaneous and articular manifestations. We identified 59 patients with the PPP syndrome from the literature, the majority of patients being male (74.6%) with a median age of 49 (IQR 41-63.5) years. Acute pancreatitis is the most frequent underlying disorder (54.2%), but gastrointestinal symptoms are absent in 45.8% of patients. Pancreatic panniculitis has a predilection for the lower limbs, which are affected in 98.3% of cases. However, the cutaneous lesions may also involve the upper limbs and trunk. Arthritis is typically symmetric and polyarticular in nature, affecting both large and small joints. Of all patients who received treatment, 78.6% had a poor response. Death occurred in 27.1% of cases after a median duration of 8 (IQR 3.5-14) weeks.
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Castro JP, Atanásio G, Canelas MA, Ferreira A, Barbosa AR, Barbedo M, Abreu R. A case report of pancreatitis-panniculitis-polyarthritis syndrome - an unusual but serious presentation of pancreatic disease. Scott Med J 2019; 65:19-23. [PMID: 31886735 DOI: 10.1177/0036933019897373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The clinical triad of peripheral cutaneous erythematous nodules, oligo or polyarthritis with intraosseous fat necrosis in the setting of pancreatic disease defines a rare entity called pancreatitis-panniculitis-polyarthritis syndrome. The early recognition of this triad is critical due to its high mortality rate and the rapid onset of osseous and articular disabilities. We describe the clinical course of a 54-year-old patient with complaints of weight loss and fever who presented to our hospital with signs of polyarthritis and appendicular erythematous cutaneous nodules. Clinical investigation revealed high inflammatory and pancreatic enzymes levels. Cutaneous biopsy and articular MRI showed evidence of peripheral necrosis. After a thorough investigation, a diagnosis of panniculitis-polyarthritis-pancreatitis syndrome was established. Treatment was initiated, and a slow but steady improvement was observed. Further complications of the disease process were observed. This case highlights the importance of recognising the association between panniculitis and polyarthritis with pancreatic disease in order to improve outcomes.
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Affiliation(s)
- João Paulo Castro
- Medical Doctor, Physical and Rehabilitation Medicine, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.,Medical Doctor, Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal
| | - Gabriel Atanásio
- Medical Doctor, Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Maria Ana Canelas
- Medical Doctor, Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - André Ferreira
- Medical Doctor, Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal
| | - Ana Rita Barbosa
- Medical Doctor, Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Marta Barbedo
- Medical Doctor, Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Regina Abreu
- Medical Doctor, Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
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11
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Jo S, Song S. Pancreatitis, panniculitis, and polyarthritis syndrome caused by pancreatic pseudocyst: A case report. World J Clin Cases 2019; 7:2808-2814. [PMID: 31616696 PMCID: PMC6789386 DOI: 10.12998/wjcc.v7.i18.2808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/17/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Panniculitis, polyarthritis, and pancreatitis (PPP) syndrome is a triad comprising an extremely rare extra-pancreatic complication of pancreatic disease. Herein, we describe a patient with PPP syndrome caused by fistula formation between the inferior vena cava (IVC) and pancreatic pseudocyst.
CASE SUMMARY A 64-year-old man visited the hospital with bilateral leg pain that began one week prior. He had no specific diseases, except hypertension. His vital signs were normal. Blood test revealed the following findings: White blood cell count, 28690/µL; amylase level, 9055 U/L; lipase level, 2089 U/L; and C-reactive protein level, 12.94 mg/dL. Computed tomography of the pancreas revealed recent acute pancreatitis. Nonsteroidal anti-inflammatory drugs were administered with no improvement. After steroid administration, pain slightly improved. Skin lesions were diagnosed as panniculitis. Bone scan and knee magnetic resonance imaging revealed osteoarthritis and bone marrow infarctions. Surgical treatment was considered; total pancreatectomy with splenectomy was performed. A pseudocyst was present posterior to the head of the pancreas, forming a fistula with the suprarenal IVC. After surgery, amylase and lipase levels decreased. However, the patient died of an uncontrolled infection on the 13th postoperative day.
CONCLUSION PPP syndrome should be suspected when accompanied by skin and joint lesions. Delays in diagnosis could have catastrophic consequences.
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Affiliation(s)
- Sungho Jo
- Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheoan 31116, South Korea
| | - Sanghyun Song
- Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheoan 31116, South Korea
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Kim EJ, Park MS, Son HG, Oh WS, Moon KW, Park JM, Kang CD, Lee S. Pancreatitis, Panniculitis, and Polyarthritis Syndrome Simulating Cellulitis and Gouty Arthritis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 74:175-182. [DOI: 10.4166/kjg.2019.74.3.175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/28/2019] [Accepted: 06/15/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Ee Jin Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Min Soo Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hyung-Gon Son
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Won Sup Oh
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ki Won Moon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jin Myung Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Chang Don Kang
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seungkoo Lee
- Department of Anatomic Pathology, Kangwon National University School of Medicine, Chuncheon, Korea
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Fordham T, Sims HM, Farrant T. Unusual presentation of pancreatitis with extrapancreatic manifestations. BMJ Case Rep 2018; 2018:bcr-2018-226440. [PMID: 30219783 DOI: 10.1136/bcr-2018-226440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pancreatitis, panniculitis and polyarthritis syndrome (PPP syndrome) is a rare and complex manifestation of pancreatitis that is currently reported in few cases. We present this case regarding a 77-year-old man who presented unusually with a 6-week history of bilateral lesions on his lower limbs. During this time, he experienced increasing fatigue, joint pain, and reported fevers and significant weight loss. An incidental serum amylase was found to be significantly elevated and remained elevated throughout his 2-month hospital stay. He never complained of abdominal pain or other typical symptoms of pancreatitis. Histological examination of the leg lesions reported evidence of fat necrosis and changes consistent with pancreatic panniculitis. An abdominal CT scan revealed a well-defined lesion posterior to the neck of the pancreas. Further examination by endoscopic ultrasound revealed chronic inflammatory changes. The patient experienced a long admission and was managed supportively until he was well enough to be discharged home.
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Affiliation(s)
- Tony Fordham
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Helen Marie Sims
- Department of Elderly Care Medicine, Royal United Hospital Bath NHS Foundation Trust, Bath, UK
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Affiliation(s)
- Sanminder Singh
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Farzam Gorouhi
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Thomas Konia
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Barbara Burrall
- Department of Dermatology, University of California, Davis, Sacramento, California
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Guillochon-Petitcuenot C, Herrscher H, Sachs C, De Briel D, Schutte M, Spielmann L, Moreau P, Messer L. Lésions cutanées et polyarthrite. Rev Med Interne 2017; 38:853-855. [DOI: 10.1016/j.revmed.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
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16
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Plier M, Durez P, Komuta M, Raptis A. Severe panniculitis and polyarthritis caused by acinar cell carcinoma arising from an ectopic pancreas. BMJ Case Rep 2017; 2017:bcr-2017-222241. [PMID: 29167188 DOI: 10.1136/bcr-2017-222241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The pancreatitis, panniculitis and polyarthritis (PPP) syndrome is a rare condition caused by pancreatic diseases, such as acute or chronic pancreatitis or pancreatic carcinoma. We report the first case of PPP syndrome caused by metastatic acinar cell carcinoma from an ectopic pancreas. The symptoms were successfully managed by the treatment of the metastatic carcinoma. Pancreatic cytosteatonecrosis should be always considered in a patient who is showing symptoms of panniculitis and polyarthritis.
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Affiliation(s)
- Marc Plier
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Patrick Durez
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Mina Komuta
- Department of Pathology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Alexandros Raptis
- Department of Pathology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
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Plier M, Durez P, Komuta M, Raptis A. Severe panniculitis and polyarthritis caused by acinar cell carcinoma arising from an ectopic pancreas. BMJ Case Rep 2017. [PMID: 29167188 DOI: 10.1136/bcr-2017-222241]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The pancreatitis, panniculitis and polyarthritis (PPP) syndrome is a rare condition caused by pancreatic diseases, such as acute or chronic pancreatitis or pancreatic carcinoma. We report the first case of PPP syndrome caused by metastatic acinar cell carcinoma from an ectopic pancreas. The symptoms were successfully managed by the treatment of the metastatic carcinoma. Pancreatic cytosteatonecrosis should be always considered in a patient who is showing symptoms of panniculitis and polyarthritis.
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Affiliation(s)
- Marc Plier
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Patrick Durez
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Mina Komuta
- Department of Pathology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Alexandros Raptis
- Department of Pathology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
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20
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Kim HR, Ahn JS, Noh JH, Jeon HJ, Oh JS, Choi SW, Lim DH. Pancreatic Neuroendocrine Tumor Presenting with Arthritis and Panniculitis. JOURNAL OF RHEUMATIC DISEASES 2017. [DOI: 10.4078/jrd.2017.24.5.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Hyung Rae Kim
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jae-Sung Ahn
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jin-Hee Noh
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hee-jeong Jeon
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ji Seon Oh
- Division of Rheumatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Seung Won Choi
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Doo-Ho Lim
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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