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Korean J Gastroenterol  <  Volume 74(3); 2019 <  Articles

Korean J Gastroenterol 2019; 74(3): 175-182  https://doi.org/10.4166/kjg.2019.74.3.175
Pancreatitis, Panniculitis, and Polyarthritis Syndrome Simulating Cellulitis and Gouty Arthritis
Ee Jin Kim, Min Soo Park, Hyung-Gon Son, Won Sup Oh , Ki Won Moon, Jin Myung Park, Chang Don Kang and Seungkoo Lee1
Departments of Internal Medicine and Anatomic Pathology1, Kangwon National University School of Medicine, Chuncheon, Korea
Correspondence to: Won Sup Oh, Department of Internal Medicine, Kangwon National University School of Medicine, 1 Kangwondaehak-gil, Chuncheon 24341, Korea. Tel: +82-33-258-2013, Fax: +82-33-258-2455, E-mail: onesbi@gmail.com, ORCID: https://orcid.org/0000-0002-4992-4787
Received: February 15, 2019; Revised: May 28, 2019; Accepted: June 15, 2019; Published online: September 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: Pancreatitis; Panniculitis; Arthritis; Pancreatic neoplasms


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