A case report of pancreatic panniculitis due to acute pancreatitis with intraductal papillary mucinous neoplasm
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CASE REPORT
Open Access
A case report of pancreatic panniculitis due to acute pancreatitis with intraductal papillary mucinous neoplasm Yuki Yamashita1,2, Satoru Joshita2* , Tetsuya Ito1, Masafumi Maruyama1, Shuichi Wada1 and Takeji Umemura2
Abstract Background: Pancreatic panniculitis is a rare skin manifestation in pancreatic disease patients that most frequently develops on the lower legs. We report the unique case of a 68-year-old man who suffered from pancreatic panniculitis on his trunk associated with acute pancreatitis due to an intraductal papillary mucinous neoplasm. Case presentation: A 68-year-old man complained of a 2-day history of a tender subcutaneous nodule on his trunk. Laboratory tests and abdominal contrast computed tomography were consistent with acute pancreatitis due to an intraductal papillary mucinous neoplasm. A skin biopsy of the nodule histologically displayed lobular panniculitis with characteristic “ghost cells”, which indicated pancreatic panniculitis. Conclusions: In order to avoid a missed or delayed diagnosis, clinicians should bear in mind that pancreatic panniculitis can be the first manifestation of pancreatic disease when encountering subcutaneous nodules on the trunk. Keywords: Pancreatic panniculitis, Intraductal papillary mucinous neoplasm
Background Pancreatic panniculitis is a rare skin manifestation associated with pancreatic disorders that presents in approximately 3% of patients with acute or chronic pancreatic disease [1]. The disorder most commonly develops on the lower legs as ill-defined erythematous subcutaneous nodules. Such nodules are detected in up to 45% of patients with pancreatic panniculitis before recognition of the original pancreatic disease [1]. Accordingly, the chief complaint of the patient is sometimes erythematous nodule detection before abdominal symptoms. Clinicians therefore have the risk of overlooking the underlying pancreatic disease. We herein report the rare case of a 68-year-old man who had pancreatic panniculitis on his * Correspondence: [email protected] 2 Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan Full list of author information is available at the end of the article
trunk associated with acute pancreatitis due to an intraductal papillary mucinous neoplasm (IPMN).
Case presentation A 68-year-old male patient was referred to our hospital by his primary care physician for further evaluation of a painful subcutaneous nodule on his upper middle abdomen, which was suspected to be abdominal cellulitis. Five days before admission, he had suffered from epigastralgia, nausea, and anorexia. Four days before admission, his epigastralgia had improved. Two days prior to admission, he noticed an erythematous nodule on his abdomen. His chief complaint on admission to our hospital was the painful nodule on his abdomen. He had been under medical treatment with aspirin, atorvastatin, colestimide, nicorandil, and famotidine for past medical h
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