Paniculite pancreática como a primeira manifestação de doença visceral: relato de caso

Souza, Fernanda de Mello de Homem; Siqueira, Elisa Beatriz Dalledone; Mesquita, Lismary; Fabricio, Lincoln Zambaldi; Tuon, Felipe Francisco

doi:10.1590/s0365-05962011000700033

Cited by 5 publications

(4 citation statements)

References 6 publications

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“… 13 [ 61 ] 68 f metastatic pancreatic ACC death six months after first skin lesion 14 [ 62 ] 61 f acute pancreatitis resolution 15 [ 63 ] 63 f acute pancreatitis resolution 16 [ 64 ] 49 m acute pancreatitis resolution 17 [ 47 ] 69 m hepatic metastasis of previous-ly resected pancreatic ACC resolution after metastasectomy, follow-up n.r. 18 [ 65 ] 71 f chronic pancreatitis with pseudocyst n.r. 19 [ 66 ] 66 f serous cystadenoma of the pancreas n.r.…”

Section: Case Presentationmentioning

confidence: 99%

Pancreatic panniculitis in a patient with pancreatic-type acinar cell carcinoma of the liver – case report and review of literature

et al. 2016

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BackgroundPancreatic panniculitis is a rare condition, which has only been described in relation with pancreatic diseases up to now. It is characterized by necrotizing subcutaneous inflammation and is thought to be triggered by adipocyte necrosis due to systemic release of pancreatic enzymes with consecutive infiltration of neutrophils. We present the first case of a patient with pancreatic panniculitis caused by pancreatic-type primary acinar cell carcinoma (ACC) of the liver and without underlying pancreatic disease.Case presentationA 73-year old Caucasian female patient was referred to our department with painful cutaneous nodules persisting for eight weeks and with marked lipasemia (~15000 U/l; normal range <60 U/l). Four weeks prior, several liver lesions had been detected. Empiric treatment with steroids did not show any effect. A biopsy of the skin nodules revealed “pancreatic” panniculitis, while abdominal imaging with ultrasound, computed tomography and magnetic resonance imaging detected no abnormal pancreatic findings. Ultrasound-guided biopsy of the liver lesions showed infiltrates of an ACC. The patient died soon thereafter. Autopsy failed to reveal any other primary for the ACC, so that a pancreatic-type ACC of the liver was diagnosed by exclusion.One hundred thirty cases of pancreatic panniculitis published within the last 20 years are reviewed. ACC of the pancreas is the most common underlying neoplastic condition. Patients with associated neoplasm are significantly older, take longer to be diagnosed and have higher lipase levels than patients with underlying pancreatitis.Extrapancreatic pancreatic-type ACC is very rare, but shows the same biological features as ACC of the pancreas. It is believed to develop from metaplastic or ectopic pancreatic tissue. Up to now, no pancreatic panniculitis in extrapancreatic ACC has been described.ConclusionPancreatic panniculitis should always be included in the differential diagnosis of lipolytic panniculitic lesions. It can be regarded as a facultative paraneoplastic phenomenon.When suspected, a thorough work-up for identification of the underlying disease is mandatory and extrapancreatic lesions (e.g. liver) should also be considered. While administration of octreotide or steroids can sometimes alleviate symptoms, immediate treatment of the associated condition is the only effective management option.

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Section: Case Presentationmentioning

confidence: 99%

Pancreatic panniculitis in a patient with pancreatic-type acinar cell carcinoma of the liver – case report and review of literature

et al. 2016

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“…In conclusion, this brief report describes an atypical presentation of Munchausen Syndrome which misleads the clinicians producing a false diagnosis of acute pancreatitis [21]. This resulted in 10 days of investigations and hospitalization that incurred a considerable waste of professional time at huge economic and financial costs.…”

Section: Discussionmentioning

confidence: 95%

Abdominal panniculitis as a presentation of Munchausen Syndrome

Damas¹,

Ricciardi²,

Rossi³

et al. 2013

CRCM

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Factitious disorders including Munchausen's syn drome are encountered by all clinicians. A considerable number of cases of Munchausen's syndrome are under-diagnosed in clinical practice. We present a 34-year-old man who was admitted with symptoms of epigastric pain, vomiting and peri-umbilical ecchymosis. Physical examination showed signs of inflammation in the abdominal wall with tenderness and guarding in the upper abdomen. However, various blood tests were unremarkable. Computed Tomography and demonstrated anterior abdominal wall panniculitis. After many investigations looking into various aetiological factors that could lead to fat necrosis, a diagnosis of Munchausen's syndrome was made and the patient was discharged to the care of the local general doctor practice following psychiatric input.

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“…Panniculitis is an inflammatory cutaneous disorder involving the adipose lobules of subcutaneous tissues. It can be associated with either inflammatory or infectious diseases 7 , 8 and its clinical presentation may be challenging to physicians once there are clinical similarities between different kinds of panniculitis. 8 …”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic panniculitis has extended necrotic areas, affecting mainly the adipose lobules and it has neutrophils predominance in the inflammatory infiltrate, without vasculitis. 8 , 9 Its pathophysiology remains unclear, but the release of pancreatic enzymes, such as trypsin, amylase and lipase seems to be involved in the process. 3 , 5 Trypsin may increase microcirculation permeability, allowing lipase and amylase to penetrate in fatty tissue and hydrolase the lipids, causing necrosis and inflammation.…”

Section: Discussionmentioning

confidence: 99%

Panniculitis – A Rare Manifestation of Acute Pancreatitis

Neves

Segura

Valente

et al. 2015

GE Portuguese Journal of Gastroenterology

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Pancreatic panniculitis is a rare skin disorder that occurs in 2–3% of pancreatic diseases, mostly associated with acute or chronic pancreatitis. Its pathophysiology is still unclear, but the release of pancreatic enzymes in circulation can be responsible for this disorder. The typical histological features are adipocyte necrosis with neutrophils infiltrate and typical “ghost cells”. Its treatment, clinical course and prognosis are usually related with the pancreatic disease.We present a case of a 39-year-old man who presented with fever, abdominal pain, nausea and vomiting after a copious alcohol ingestion. Acute alcohol-induced pancreatitis was diagnosed. 9 days after admission he developed tender erythematous subcutaneous nodules, whose biopsy was consistent with pancreatic panniculitis. There was clinical and laboratory improvement with supportive treatment as well as skin nodules regression.Although pancreatic panniculitis is a rare condition, physicians must be aware of it to avoid delay in the diagnosis.

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Paniculite pancreática como a primeira manifestação de doença visceral: relato de caso

Cited by 5 publications

References 6 publications

Pancreatic panniculitis in a patient with pancreatic-type acinar cell carcinoma of the liver – case report and review of literature

Pancreatic panniculitis in a patient with pancreatic-type acinar cell carcinoma of the liver – case report and review of literature

Abdominal panniculitis as a presentation of Munchausen Syndrome

Panniculitis – A Rare Manifestation of Acute Pancreatitis

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