PANNICULITIS OF PANCREATIC DISEASE MASQUERADING AS SYSTEMIC LUPUS-ERYTHEMATOSUS PANNICULITIS

We describe a patient with systemic lupus erythematosus (SLE) who pres ented with severe refractory pannicular lesions diffusely involving th e buttocks and lower extremities. Due to the severity of these lesions , a biopsy was performed, which implicated panniculitis associated wit h pancreatic disease, rather than lupus panniculitis. Serum amylase wa s normal, but the serum ligase was markedly elevated. An abdominal com puterized tomographic scan demonstrated a pancreatic mass? which upon laparotomy was found to be an acinar cell carcinoma. After resection o f the mass, her symptoms improved, where they had not responded to pri or immunosuppressive therapy, She has subsequently remained well witho ut recurrence of the disease. This case illustrates that an uncharacte ristic presentation of panniculitis in a patient with lupus does not n ecessarily imply lupus panniculitis, and a biopsy is imperative to dis tinguish other sometimes life threatening etiologies.