SHM Converge Scientific Abstract ePoster Gallery-"Pan"-Positive Review of Systems: Uncovering a Rare Clinical Triad

Pdf Summary

This case report describes pancreatitis, panniculitis, and polyarthritis (PPP) syndrome, a rare and potentially serious extra-pancreatic complication of pancreatitis. The patient was a 31-year-old man with alcohol use disorder and recent pancreatitis who developed recurrent epigastric pain, vomiting, and migratory joint symptoms. He initially presented with right elbow swelling; joint aspiration showed inflammatory fluid but no crystals or infection, and autoimmune testing was negative. He was later discharged on prednisone, but returned with worsening abdominal pain and persistent arthralgias, along with swelling, redness, and tenderness in multiple joints including the bilateral MCPs, left wrist, and right foot.<br /><br />During hospitalization, his lipase was markedly elevated at 15,000 U/L, and abdominal CT revealed a pancreatic pseudocyst. A skin biopsy from the foot lesion showed subcutaneous panniculitis with neutrophils, basophilic debris, saponification, and characteristic “ghost cells,” confirming PPP syndrome. He was treated with supportive care and cyst gastrostomy, with clinical improvement.<br /><br />The report emphasizes that hospitalists should recognize extra-pancreatic manifestations of pancreatitis, including fatigue, chills, arthralgias, and skin findings such as livedo reticularis, acanthosis nigricans, and panniculitis. PPP is thought to result from serum lipase leaking into peripheral tissues, causing fat necrosis and inflammation. Because reported mortality is about 24%, early recognition is important. Treatment focuses on managing the underlying pancreatitis and may include NSAIDs or systemic corticosteroids.

Asset Subtitle

John R. Stephens

Meta Tag

Author List Annika Lintvedt-Miller, John R. Stephens, Mukhtar Adem, Samuel A. Mickel-Hulse

Category Clinical Vignettes

Concept Pancreatitis

Concept Pancreatitis panniculitis and polyarthritis syndrome

Concept Panniculitis

Concept Polyarthritis

Concept Arthralgia

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author John R. Stephens

Track Adult

Keywords

pancreatitis

panniculitis

polyarthritis

PPP syndrome

pancreatic pseudocyst

lipase elevation

ghost cells

arthralgia

alcohol use disorder

extra-pancreatic complications

Pancreatitis

Pancreatitis panniculitis and polyarthritis syndrome

Panniculitis

Polyarthritis

Arthralgia