జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

A Rare Case of Pancreatitis, Panniculitis and Polyarthritis: The P-P-P Syndrome

Dario Fabbri, Davide Campana, Donatella Santini, Riccardo Casadei, Roberto De Giorgio , Paola Tomassetti

A 70-year-old man was admitted to our Unit because of the onset of symmetric joint pain, and multiple cutaneous erythematous nodules localized to the lower extremities and gluteal region. An arthrocentesis excluded a septic arthritis and systemic and local steroid therapy resulted in a modest improvement of symptoms and cutaneous manifestations. For an acute abdominal pain with an elevation of serum amylase and lipase levels, the patient underwent an abdominal CT that showed a 55 mm roundish mass in the head of the pancreas with necrosis and colliquation, associated with dilatation of the main pancratic duct and thrombosis of the superior mesenteric vein. The pancreatic lesion was biopsied during an endoscopic ultrasonography and the histopathological examination documented a chronic obstructive pancreatitis. Taken together, the clinical manifestations shown by this case highlighted a rare condition referred to as “PPP (i.e. pancratitis, panniculitis, polyarthritis) syndrome” which links pancreatitis to extrapancreatic tissue involvement.