Pancreatitis, panniculitis and polyarthritis (PPP) syndrome.
Geetha Swarna DevineniNafiya Muhammed ZackariahSudhindran SurendranMalini EapenPublished in: BMJ case reports (2023)
A young male presented with intermittent high-grade fever, asymmetric polyarthritis and erythematous, tender nodules over left shin for 2 months duration. He had a history of alcohol dependence with multiple episodes of acute pancreatitis. With polyarthritis progressing relentlessly, unresponsive to non-steroidal anti-inflammatory drugs and steroids, a provisional diagnosis of sarcoidosis was considered. Indeed, he was treated with azathioprine and rituximab with no effect. Biopsy of the skin nodule revealed subcutaneous fat necrosis, foam cells, deposition of eosinophilic amorphous material and calcification. Synovial fluid aspiration from the arthritic knee obtained purulent but surprisingly culture-negative material, rich in triglycerides. Abdominal CT confirmed chronic pancreatitis. Final diagnosis of pancreatitis, panniculitis and polyarthritis (PPP) syndrome was made. He underwent surgical pancreatic ductal drainage leading to complete remission of symptoms. PPP syndrome triad occurs due to leakage of pancreatic enzymes into systemic circulation and subsequent fat necrosis. Surgical drainage of pancreatic duct is often curative.
Keyphrases
- anti inflammatory drugs
- ultrasound guided
- high grade
- adipose tissue
- case report
- fatty acid
- diffuse large b cell lymphoma
- total knee arthroplasty
- chronic kidney disease
- fine needle aspiration
- magnetic resonance imaging
- single cell
- rheumatoid arthritis
- room temperature
- contrast enhanced
- rectal cancer
- depressive symptoms
- image quality
- ulcerative colitis
- sleep quality