Pancreatitis, Panniculitis, and Polyarthritis Syndrome Simulating Cellulitis and Gouty Arthritis
김이진, 박민수, 손형곤, 오원섭, 문기원, 박진명, 강창돈, 이승구,
소속 상세정보
김이진 ( Kim Ee-Jin )
Kangwon National University School of Medicine Department of Internal Medicine
박민수 ( Park Min-Soo )
Kangwon National University School of Medicine Department of Internal Medicine
손형곤 ( Son Hyung-Gon )
Kangwon National University School of Medicine Department of Internal Medicine
오원섭 ( Oh Won-Sup )
Kangwon National University School of Medicine Department of Internal Medicine
문기원 ( Moon Ki-Won )
Kangwon National University School of Medicine Department of Internal Medicine
박진명 ( Park Jin-Myung )
Kangwon National University School of Medicine Department of Internal Medicine
강창돈 ( Kang Chang-Don )
Kangwon National University School of Medicine Department of Internal Medicine
이승구 ( Lee Seung-Koo )
Kangwon National University School of Medicine Department of Anatomic Pathology
Abstract
Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare but critical disease with a high mortality rate. The diagnostic dilemma of PPP syndrome is the fact that symptoms occur unexpectedly. A 48-year-old man presented with fever and painful swelling of the left foot that was initially mistaken for cellulitis and gouty arthritis. The diagnosis of PPP syndrome was made based on the abdominal CT findings and elevated pancreatic enzyme levels, lobular panniculitis with ghost cells on a skin biopsy, and polyarthritis on a bone scan. The pancreatitis and panniculitis disappeared spontaneously over time, but the polyarthritis followed its own course despite the use of anti-inflammatory agents. In addition to this case, 30 cases of PPP syndrome in the English literature were reviewed. Most of the patients had initial symptoms other than abdominal pain, leading to misdiagnosis. About one-third of them were finally diagnosed with a pancreatic tumor, of which pancreatic acinar cell carcinoma was the most dominant. They showed a mortality rate of 32.3%, associated mainly with the pancreatic malignancy. Therefore, PPP syndrome should be considered when cutaneous or osteoarticular manifestations occur in patients with pancreatitis. Active investigation and continued observations are needed for patients suspected of PPP syndrome.
키워드
Pancreatitis; Panniculitis; Arthritis; Pancreatic neoplasms
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