Acute septal panniculitis. A cutaneous marker of a very early stage of pancreatic panniculitis indicating acute pancreatitis.
BACKGROUND
Pancreatitis may occasionally be complicated by panniculitis as a result of the release of pancreatic enzymes. Pancreatic panniculitis is rare, occurring in 2-3% of all patients with pancreatic disorders, with a higher incidence among alcoholic males.


METHODS
A 29-year-old male was admitted to our Department with acute abdominal pain one day following alcohol consumption. On physical examination, tender erythematous plaques and nodules were present on the left ankle and the pretibial regions of both lower legs, a clinical sign of panniculitis indicating acute pancreatitis common in alcoholic patients. Abdominal ultrasonography showed a diffusely edematous pancreas suggestive of acute pancreatitis. Abdominal contrast enhanced computerized tomography revealed features suggestive of severe acute pancreatitis with pancreatic necrosis. A skin biopsy confirmed the diagnosis of septal panniculitis without vasculitis or fat necrosis, which is indicative of a very early stage of pancreatic panniculitis suggesting acute alcoholic pancreatitis.


CONCLUSIONS
Septal panniculitis without vasculitis or fat necrosis is a cutaneous clinical marker which denotes a very early stage of pancreatic panniculitis associated with acute alcoholic pancreatitis. The treatment of pancreatic panniculitis is primarily supportive and depends on the underlying pancreatic pathology which may include surgery or endoscopic management.
Johnson
Maria Antony
MA
Centre for GI Bleed and Division of Hepato-Biliary Pancreatic Diseases, Department of Surgical Gastroenterology, Government Stanley Medical College Hospital, Affiliated to the Tamilnadu Dr. M.G.R. Medical University, Chennai, India. stanleygastro@yahoo.com
Kannan
Devy Gounder
DG
Balachandar
Tirupporur Govindaswamy
TG
Jeswanth
Satyanesan
S
Rajendran
Shanmugasundaram
S
Surendran
Rajagopal
R
D000208:Acute Disease; D000328:Adult; D006801:Humans; D008297:Male; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging; D019512:Pancreatitis, Alcoholic / Q000175:diagnosis*; D015434:Panniculitis / Q000175:diagnosis* / Q000473:pathology; D014057:Tomography, X-Ray Computed