Pancreatic Panniculitis—Not Just a Skin Disease

Abstract Pancreatic panniculitis is a rare sequela of pancreatic disease classically presenting with tender, erythematous subcutaneous nodules involving the lower extremities. Rarer associations include involvement of the marrow, intra-abdominal fat, intrathoracic fat, and the clinical finding of joint pain. We present the case of a patient who presented with a 1-year history of intermittent nausea, bloating, and anorexia with computed tomography scan findings of a complex pancreatic cystic lesion, omental findings concerning for carcinomatosis, and ascites. She developed tender, erythematous, and hyperpigmented subcutaneous nodules on bilateral lower extremities that were first noted on admission. Pancreatic biopsy revealed pancreatic pseudocyst and laboratory findings on admission were consistent with pancreatitis and pancreatic ascites. Laparoscopic omental biopsies revealed multifocal, nodular fat necrosis and associated inflammation with no carcinoma identified. Histologically similar to the omental biopsies, a punch biopsy of skin revealed lobular fat necrosis, inflammation, and basophilic stippling by calcium consistent with pancreatic panniculitis. Given the similar histologic findings in the skin and omentum in the setting of pancreatic ascites, her omental findings were attributed to pancreatic panniculitis. This case highlights the importance of recognizing that pancreatic panniculitis can present as a systemic disorder. We highlight the laparoscopic, dermatologic, laboratory, and biopsy findings of pancreatic panniculitis to demonstrate that the pathologic findings are similar in the various organs involved.