Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome: a case report and review of the literature

Abstract

Panniculitis is an infrequent complication of pancreatitis. The reported incidence of this association is 2-3% of all pancreatic diseases. The triad of pancreatitis, panniculitis and polyarthritis, so called PPP syndrome is a rare disease. There are less than 30 well-documented case reports in the literature. We report a case presented with arthritis both knees and left ankle. Two weeks later, there were crops of multiple small subcutaneous nodules on trunk and both extremities. He had no abdominal symptoms or other pertinent findings. Abnormal laboratory investigations included increased serum lipase and amylase. The histopathology from subcutaneous nodule showed prominent necrotic fat cells (ghost adipocytes) with neutrophilic infiltration and calcification in the subcutaneous tissue which are the characteristic findings of pancreatic panniculitis. The patient was treated with intravenous injectable meropenam and octreotide acetate and kept nil per os. His pancreatitis, panniculitis lesions and the joint symptoms improved.