Fatal Pancreatitis Presenting as Pancreatic Panniculitis without Enzyme Elevation

Jacobson‐Dunlop, Erick; Takiguchi, Rodd; White, Clifton R.; White, Kevin P.

doi:10.1111/j.1600-0560.2011.01725_1.x

Cited by 10 publications

(9 citation statements)

References 4 publications

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“… 3 , 4 Notably, pancreatic panniculitis has been reported to occur in patients with low or normal serum pancreatic enzymes, suggesting a multifactorial process. 5 Zellman 6 suggested that additional factors are required for the development of pancreatic panniculitis, such as increased vessel permeability, allowing the pancreatic enzymes to leak out of the circulation and into subcutaneous fat. Other case reports in the literature support this theory of vascular permeability, for example, pancreatic panniculitis occurring after femoral vein catheterization 7 and paracentesis.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic panniculitis preceding acute pancreatitis and subsequent detection of an intraductal papillary mucinous neoplasm: A case report

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Pancreatic panniculitis preceding acute pancreatitis and subsequent detection of an intraductal papillary mucinous neoplasm: A case report

et al. 2016

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“… 19 [ 66 ] 66 f serous cystadenoma of the pancreas n.r. 20 [ 67 ] 39 m chronic pancreatitis death six weeks after first skin lesion 21 [ 68 ] 20 f pseudopapillary pancreatic tumor, chronic pancreatitis death eleven weeks after first skin lesion 22 [ 8 ] 38 f acute pancreatitis resolution 23 [ 69 ] 56 f acute pancreatitis death within a few days 24 [ 70 ] 79 m pancreatic ACC n.r. 25 [ 71 ] 17 f acute pancreatitis resolution 26 [ 72 ] 54 m pancreatic ACC Response to octreotide, regression of skin lesions after resection, follow-up two months (i.e.…”

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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“…Another plausible explanation would be the elevation of amylase and lipase due to decreased renal function, resulting in enzymatic fat necrosis of the subcutaneous fat. There are reports of pancreatic panniculitis in the setting of pancreatitis absent enzyme elevation …”

Section: Discussionmentioning

confidence: 83%

“…There are reports of pancreatic panniculitis in the setting of pancreatitis absent enzyme elevation. 14 Overall, this case serves to underline the finding that although the majority of SLE patients with panniculitis will be diagnosed with lupus panniculitis, biopsy should be performed to rule out other rarer panniculitides.…”

Section: Clinical Casementioning

confidence: 80%

Pancreatic panniculitis in active systemic lupus erythematosus

et al. 2019

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This report documents the case of a 64‐year‐old African‐American female with new end‐stage renal disease (ESRD), diagnosed with systemic lupus erythematosus (SLE) on renal biopsy and serologies including a positive ANA (>1:2560), positive anti‐Sm antibodies, low titer anti‐RNP antibodies, high titer anti‐Ro antibodies, anti‐dsDNA antibodies, lupus anticoagulant, and hypocomplementemia. She was also noted to have tender nodules on the bilateral shins. Excisional biopsy of one of the nodules showed marked fat necrosis with “ghost cells” and patchy basophilic granular debris consistent with pancreatic panniculitis. Further examination for pancreatic pathology showed an elevated lipase of 585 U/L (reference range 8‐78 U/L) and amylase of 214 U/L (reference range 25‐125 U/L). However, computed tomography imaging showed no evidence of pancreatitis or pancreatic tumors. This is very similar to another case recently reported in the literature. Similarities of these two cases (African‐American females with lupus nephritis on dialysis) may represent a particular subset of SLE patients at increased risk for pancreatic panniculitis.

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Fatal Pancreatitis Presenting as Pancreatic Panniculitis without Enzyme Elevation

Cited by 10 publications

References 4 publications

Pancreatic panniculitis preceding acute pancreatitis and subsequent detection of an intraductal papillary mucinous neoplasm: A case report

Pancreatic panniculitis preceding acute pancreatitis and subsequent detection of an intraductal papillary mucinous neoplasm: A case report

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

Pancreatic panniculitis in active systemic lupus erythematosus

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