Disordered Presentation of Paraneoplastic Pancreatitis, Polyarthritis and Panniculitis (PPP) Syndrome in a Patient with End-Stage Pancreatic Cancer

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Melody Maarouf
Marilyn Wickenheiser
James Sligh
Keliegh Culpepper
Vivian Shi

Keywords

Abstract

We report a rare case of PPP due to stage IV beta-islet pancreatic cancer presenting with polyarthritis, whose diagnosis was delayed due to an incomplete presentation of PPP syndrome. Following an extensive one-month infectious disease workup, tender erythematous papules began to develop, which prompted the consideration and subsequent biopsy for pancreatic panniculitis. Thus, the diagnosis was delayed due to a lagging cutaneous presentation—a component of the triad that is commonly the initial presentation in most patients. 

References

1. Zhang G, Cao Z, Yang G, Wu W, Zhang T, Zhao Y. Pancreatic panniculitis associated with pancreatic carcinoma: A case report. Medicine (Baltimore). 2016;95(31):e4374.

2. Borowicz J, Morrison M, Hogan D, Miller R. Subcutaneous fat necrosis/panniculitis and polyarthritis associated with acinar cell carcinoma of the pancreas: a rare presentation of pancreatitis, panniculitis and polyarthritis syndrome. J Drugs Dermatol. 2010;9(9):1145-1150.

3. Zundler S, Erber R, Agaimy A, et al. Pancreatic panniculitis in a patient with pancreatic-type acinar cell carcinoma of the liver--case report and review of literature. BMC Cancer. 2016;16:130.

4. Fraisse T, Boutet O, Tron AM, Prieur E. Pancreatitis, panniculitis, polyarthritis syndrome: an unusual cause of destructive polyarthritis. Joint Bone Spine. 2010;77(6):617-618.

5. Garcia-Romero D, Vanaclocha F. Pancreatic panniculitis. Dermatol Clin. 2008;26(4):465-470, vi.

6. Requena L, Sanchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol. 2001;45(3):325-361; quiz 362-324.

7. Narvaez J, Bianchi MM, Santo P, et al. Pancreatitis, panniculitis, and polyarthritis. Semin Arthritis Rheum. 2010;39(5):417-423.

8. Ferri V, Ielpo B, Duran H, et al. Pancreatic disease, panniculitis, polyarthrtitis syndrome successfully treated with total pancreatectomy: Case report and literature review. Int J Surg Case Rep. 2016;28:223-226.

9. Price-Forbes AN, Filer A, Udeshi UL, Rai A. Progression of imaging in pancreatitis panniculitis polyarthritis (PPP) syndrome. Scand J Rheumatol. 2006;35(1):72-74.

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