KjG The Korean Journal of Gastroenterology Korean J Gastroenterol 1598-9992 2233-6869 Korean Society of Gastroenterology 10.4166/kjg.2017.69.1.83 kjg-69-83 Case Report Pancreatic Panniculitis in Patients with Chronic Pancreatitis: Case Report and Review of Literature KimEui Joong ChuMin Su SohnKi Chang ChoDong Ho NaGa Hye 1 KimHaak Cheoul ChoEun Young Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea Department of Dermatology, Wonkwang University College of Medicine, Iksan, Korea Correspondence to: Eun Young Cho, Department of Internal Medicine, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Korea. Tel: +82-63-859-2566, Fax: +82-63-855-2025, E-mail: love6970@wonkwang.ac.kr 10 2017 04 10 2017 691 83 86 28082016 08112016 05122016 Copyright © 2017 Korean Ophthalmological Society 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Pancreatic panniculitis is a rare complication characterized by subcutaneous fat necrosis associated with pancreatic disease. It has been postulated that pancreatic panniculitis is caused by the systemic activity of pancreatic enzymes that lead to microcirculatory disturbances. We report a 41-year-old heavy alcoholic woman with pancreatic panniculitis that coexisted with acute and chronic pancreatitis. She was diagnosed with chronic pancreatitis and alcoholic liver cirrhosis 5 years ago. She presented with multiple, tender, erythematous, subcutaneous nodules with heat sensation on both lower legs. Laboratory evaluation revealed an increase in the serum blood amylase and lipase. Histopathologic findings showed fat necrosis with inflammation around the necrotic subcutaneous fat tissue. The lesions subsided gradually with an improvement of acute pancreatitis.

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Low attenuating lesion with multiple calcifications & peripancreatic fat infiltration (arrows) is seen at head portion of pancreas.

Multiple, ill-defined, erythematous to brownish nodules are shown on both lower legs.

The skin biopsy showing focal areas of adipocytes degeneration surrounded by inflammatory cells infiltration (H&E, ×100).

Cases of Pancreatic Panniculitis Published in the Korean Literatures

Patient Age Sex Underlying disease Location of skin lesion Onset of skin lesion (Interval between skin lesion and underlying disease) Resolution of skin lesion
116 67 Female Pancreatic cancer Legs, hip, chest 3 months ago After a month
26 47 Male Chronic pancreatitis Legs 4 days ago After a week
317 50 Male Acute pancreatitis Legs 3 weeks ago Death after17days
42 72 Male Necrotizing pancreatitis Right leg Within a week After treamtment of underlying disease
52 48 Male Pancreatic pseudocyst Legs With 5 days After treamtment of underlying disease
63 63 Female Acute pancreatitis Legs 10 days ago After 3 weeks
79 45 Male Chronic pancreatitis Legs A week ago After treamtment of underlying disease
812 54 Male Pancreatic cancer Legs, arms 9 months ago After operation of underlying disease
919 32 Male Pancreatic pseudocyst, hemorrhagic Abdomen 15 days ago Death after 19 days