Intraosseous fat necrosis simulating septic arthritis and osteomyelitis ina patient with chronic pancreatitis

A woman with a 20-year history of alcohol abuse and chronic pancreatitis de veloped an osteoarticular involvement of her right ankle in association wit h subcutaneous nodules. Histopathological examination of the tissue samples obtained during surgical revision of the ankle showed necrotic fat and con nective tissue. Microbiological cultures remained negative. The patient was administered long-term antimicrobial treatment without any apparent benefi t. Four months later, she died of pancreatic insufficiency and pneumonia. P ostmortem examination showed numerous foci of intra-abdominal fat necrosis. Histopathological examination of the bone samples from the right ankle sho wed fat necrosis with lipophages. Based on these findings, we consider that the osteoarticular involvement in this patient was caused by intraosseous fat necrosis. This case reminds us of the importance of considering the pos sibility of this condition whenever a patient with chronic pancreatic disea se develops sterile osteoarthritis.