MiscellaneousPancreatitis, Panniculitis, and Polyarthritis
Section snippets
Methods
In addition to our case, a literature search (PubMed database, National Library of Medicine, Bethesda, MD) for articles published between January 1970 and February 2008 was performed using the Medline subheadings and key words “pancreatitis” or “pancreatic disease,” “panniculitis,” “arthritis,” and “intraosseous fat necrosis.” Only English-, French-, and Spanish-language reports were selected for review. The references of the studies obtained were then examined to identify additional reports.
Case Report
A 45-year-old man with a 30-year history of heavy alcohol abuse was admitted to our center for alcohol detoxification. On admission, the patient reported that he had experienced mild upper abdominal pain, without nausea or vomiting, for 1 week.
On physical examination the abdomen was soft, tender in the epigastrium and left hypochondrium, with nontender hepatomegaly; joint and skin examination at that time were normal. Laboratory examination revealed an elevated erythrocyte sedimentation rate
Discussion
Lobular panniculitis, together with arthritis and/or bone necrosis, may complicate pancreatic disease. This triad has been described mainly in patients with acute or chronic pancreatitis (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24), as well as in a few cases of pancreatic tumors (25, 26) and ischemic pancreatic disease (27). The acronym PPP syndrome is not widely used and is not entirely accurate as the arthritis is not always polyarticular.
Although this
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