A fatal case of pancreatic panniculitis presenting in a young patient withsystemic lupus

Background: Subcutaneous fat necrosis associated with pancreatic disease is a rare event. The clinical cutaneous findings are non-specific erythematou s nodules with central softening located predominantly on the lower extremi ties. The histopathologic features of these lesions are very characteristic and diagnostic. Methods: We present an unusual case of pancreatic panniculitis associated w ith lupus pancreatitis in a 21-year-old African American female. The patien t presented with lower extremity skin nodules, arthralgia, and serositis pr ior to the diagnosis of systemic lupus and pancreatitis. The skin lesions p rogressed despite normalization of serum pancreatic enzymes. Following femo ral vein catheterization for renal dialysis, she developed a large indurate d area over the left lower quadrant, flank, groin, and upper thigh measurin g 25 cm. She was treated with repeated debridement, tissue grafts, and hype rbaric oxygen because of a clinical suspicion of necrotizing fasciitis. Results: Examination of skin biopsies and debrided tissue revealed the path ogomonic features of pancreatic panniculitis without ally evidence of necro tizing fasciitis. Organisms were not detected by tissue examination or micr obiologic cultures. Conclusions: This case illustrates the potential role of vascular trauma in the pathogenesis of pancreatic panniculitis.