Pancreatitis associated panniculitis

Severe pancreatitis can provoke systemic inflamma- tion and even lung injury and shock. Fat necrosis can be observed in peripancreatic, mesenterial and retroperi- toneal fat and at distant foci. Panniculitis is defined as an inflammation of subcutaneous fat that underlies the epi- dermis of the skin. It may involve either the fat lobules themselves or the connective tissue septa between the lobules. Clinically, panniculitis presents as ill-defined, tender, edematous, erythematous and red brown or blue nodules. The differential diagnosis of the clinically non- specific nodules is brought (erythema nodosum, abscess, erythema induratum, lupus profundus, Weber-Christian disease, or cutaneous metastases) but only one type of lobular and septal panniculitis without vasculitis is typi- cally associated to severe pancreatic disease and then called pancreatic panniculitis (1). Clinically the subcuta- neous lesions are painful in about 50% of the cases, requiring analgesics and often precede the clinical symp- toms of pancreatitis (2). They present more typically on the lower limbs but they can also occur on any other part of the body : trunk, abdomen (Fig. 1), arms, thighs and buttocks (Fig. 2).