C0046 - Panniculitis and Pancreatitis: Inflammation and Necrotic Mechanisms in a Patient With Alcohol Use Disorder and Chronic Pancreatitis

Anas Mahmoud, MD¹, Brooke E. Kania, DO², Moutaz Ghrewati, MD^1
1St. Joseph's University Medical Center, Paterson, NJ; ²Saint Joseph's University Medical Center, Parsippany-Troy Hills, NJ

Introduction: Panniculitis is an inflammatory process localized to subcutaneous tissue, with etiologies including infection, malignancy, external insults, enzymatic destructive processes, and inflammatory disorders. Here, we present a rare case of a patient with chronic pancreatitis with features concerning for myeloma given lytic lesions, who was found to have incidental panniculitis.

Case Description/Methods: A 53-year-old male with a history of T2DM, HTN, DLD, hypothyroidism, MDD, alcohol use disorder, and chronic pancreatitis presented with lower abdominal pain and was found to have acute descending colon diverticulitis with an abscess, with an incidental finding of lytic pelvic lesions. Within the past 2 years, the patient had 2 prior episodes of pancreatitis and endorsed daily alcohol consumption. CT of the abdomen and pelvis demonstrated acute diverticulitis of the descending colon with associated abscess, liver parenchymal disease, chronic pancreatitis, and an incidental finding of lytic pelvic lesions and a posterior L iliac bone/L acetabular cyst sclerotic lesion. Workup for multiple myeloma was negative. A skeletal survey demonstrated lucent lesions within bilateral pelvic bones versus overlying bowel gas and a cortically based sclerotic lesion along the distal femur, with chronic rib fracture of the right 11th posterior rib. Given his findings, the patient’s osteolytic pelvic lesions were considered to be panniculitis secondary to pancreatitis. The patient was treated with antibiotics and intravenous fluids for diverticular abscess and pancreatitis and he was discharged home due to clinical improvement and resolution of his diverticular abscess on repeat imaging.

Discussion: The incidence of panniculitis with subcutaneous fat necrosis with underlying pancreatic diseases is 2-3%, which may encompass associated periarthritis with bone necrosis and panniculitis (PPP syndrome). PPP syndrome results due to systemic activity of pancreatic enzymes, leading to disturbances within the microcirculatory system, and fat necrosis of medullary bone marrow; yet, exact pathophysiology remains unknown. Our patient provided an interesting clinical picture given his alcohol use disorder, and lytic lesions which initially lead the team towards a malignancy workup such as myeloma; however, given his negative studies, his panniculitis was considered to be derived from his chronic pancreatitis. Additional literature is warranted regarding the relationship between panniculitis in patients with chronic pancreatitis.


Disclosures:


Anas Mahmoud, MD¹, Brooke E. Kania, DO², Moutaz Ghrewati, MD¹. C0046 - Panniculitis and Pancreatitis: Inflammation and Necrotic Mechanisms in a Patient With Alcohol Use Disorder and Chronic Pancreatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.