A Middle-aged Male with Erythema Nodosum and Polyarthritis: What can be the Diagnosis?

Abstract

Pancreatic panniculitis is a rare triad of pancreatitis, panniculitis and polyarthritis. Due to underlying pancreatic disease, there is subcutaneous fat necrosis forming erythematous nodules especially in the lower extremities. This is accompanied with history of multiple joint pain. Timely diagnosis is the key to treatment, as pancreatic disease can progress rapidly causing life threatening complications. Authors hereby presented a rare case of pancreatic panniculitis in a 48-year-old male. Patient had a recent history of acute pancreatitis (alcohol induced) with development of erythema nodosum with pain and swelling in joints. Histopathological examination of the skin nodules revealed panniculitis, associated with elevated pancreatic enzymes on laboratory investigations and patient responded to anti-inflammatory medicines, thereby confirming the diagnosis of pancreatic panniculitis. He was treated with analgesics and steroids which reduced the erythematous nodules.