EC Gastroenterology and Digestive System

Pancreatic panniculitis is a rare pathology, corresponding to a cutaneous condition which can be associated with acute or chronic pancreatitis. Its pathophysiology is not yet fully understood, but the release of pancreatic enzymes into the circulation may be responsible for this condition. Typical histological features include adipocyte necrosis with an inflammatory infiltrate. Treatment, clinical progression, and prognosis are generally linked to pancreatic disease.

We present the case of a 62-year-old female, hospitalized for acute pancreatitis and presenting an erythematous plaque suggestive of bilateral fistulized dermohypodermatitis extending to the lower limbs. A Skin biopsy of lesions on the lower limbs revealed subcutaneous lobular panniculitis.

 Keywords: Pancreatic Panniculitis; Adipocyte Necrosis; Dermohypodermatitis; Lobular Panniculitis

1. Zélia Neves., et al. “Panniculitis - A rare manifestation of acute pancreatitis”. Portuguese Journal of Gastroenterology3 (2015): 117-120.
2. Zundler S., et al. “Pancreatic panniculitis in a patient with pancreatic-type acinar cell carcinoma of the liver - case report and review of literature”. BMC Cancer 16 (2016): 130.
3. Lucy Webber. Clinical Fellow in Dermatology, Department of Dermatology, University Hospitals Bristol NHS Foundation Trust, UK. Panniculitis associated with pancreatic disease (2017).
4. Kunovsky L., et al. “Skin manifestations of pancreatic diseases”. Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czech Republic 4 (2022): 353-358.
5. Selvaraj V and Dapaah-Afriyie K. “A tale of two Ps: Panniculitis secondary to acute pancreatitis”. Cureus12 (2021): e20504.
6. Ferri V., et al. “Pancreatic disease, panniculitis, polyarthrtitis syndrome successfully treated with total pancreatectomy: Case report and literature review”. International Journal of Surgery Case Reports 28 (2016): 223-226.
7. Saoraya Lueangarun., et al. “Pancreatic panniculitis: a cutaneous presentation as an initial clue to the diagnosis of pancreatic cancer”. Journal of the Medical Association of Thailand 1 (2011): 253-257.
8. Requena L and Yus ES. “Panniculitis. Part II. Mostly lobular panniculitis”. Journal of the American Academy of Dermatology3 (2001): 325-364.
9. Bruno CM., et al. “Necrotizing panniculitis as an uncommon manifestation of acute pancreatitis”. European Journal of Case Reports in Internal Medicine 3 (2017): 000540.
10. Singh S., et al. “Pancreatic acinar cell carcinoma-induced panniculitis”. JAAD Case Reports7 (2018): 719-721.
11. Herrera Sanchez M., et al. “Single-nodule pancreatic panniculitis”. Dermatology3 (1996): 269.
12. Kaiser F Kabir and Saran Lotfollahzadeh. “Pancreatic Panniculitis”. National Library of medicine (2023).
13. Franciosi AN., et al. “Alpha-1 antitrypsin deficiency-associated panniculitis”. Journal of the American Academy of Dermatology 4 (2022): 825-832.
14. Makhoul E., et al. “Pancreatic panniculitis: A rare complication of pancreatitis secondary to ERCP”. Arab Journal of Gastroenterology1 (2014): 38-39.
15. Mederos MA., et al. “Acute pancreatitis: A review”. Journal of the American Medical Association4 (2021): 382-390.
16. Dahl PR., et al. “Pancreatic panniculitis”. Journal of the American Academy of Dermatology3 (1995): 413-417.
17. Lambiase P., et al. “Resolution of panniculitis after placement of pancreatic duct stent in chronic pancreatitis”. American Journal of Gastroenterology 9 (1996): 1835-1837.
18. Lee CL., et al. “Germline BRCA2 variants in advanced pancreatic acinar cell carcinoma: A case report and review of literature”. World Journal of Gastroenterology 45(2022): 6421-6432.
19. Yoshihiro T., et al. “Pancreatic acinar cell carcinoma presenting with panniculitis, successfully treated with FOLFIRINOX: A case report”. Molecular and Clinical Oncology6 (2017): 866-870.
20. Price-Forbes AN., et al. “Progression of imaging in pancreatitis panniculitis polyarthritis (PPP) syndrome”. Scandinavian Journal of Rheumatology1 (2006): 72-74.