{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:45:05Z","timestamp":1753875905499,"version":"3.41.2"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T00:00:00Z","timestamp":1737072000000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Severe pancreatitis following retrograde cholangiopancreatography (ERCP) is an infrequent occurrence. Even rarer are the additional non-pancreatic symptoms that can emerge after ERCP-induced pancreatitis, such as panniculitis and polyarthritis. This combination of symptoms is recognized as the pancreatitis, panniculitis, and polyarthritis syndrome (PPPS). PPPS typically manifests as reddish subcutaneous nodules, primarily in the lower extremities. In some cases, the condition may progress into the bones, causing intramedullary fat necrosis\/bone infarcts. Joint complications involve polyarthritis and affect both small and large joints. PPPS tends to develop 3-6\u2009weeks after the peak of clinical pancreatitis. In this report, we present a case of PPPS that occurred as a complication following ERCP. This particular case became further complicated by the presence of bacteraemia and fungaemia, leading to the subsequent development of multi-focal osteomyelitis. The medical imaging included in this report provides a comprehensive overview of the entire clinical course, starting from the initial post-procedural complication and pancreatitis, followed by multi-modal imaging depicting panniculitis using ultrasound and MRI, and finally illustrating the development of multi-focal osteomyelitis. This case serves as an opportunity to explore and understand 2 rare complications associated with pancreatitis: PPPS and multi-focal osteomyelitis.<\/jats:p>","DOI":"10.1093\/bjrcr\/uaaf002","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T17:14:34Z","timestamp":1737134074000},"source":"Crossref","is-referenced-by-count":0,"title":["Rare complications of ERCP\u2014pancreatitis, panniculitis, and polyarthritis syndromeand multifocal osteomyelitis"],"prefix":"10.1093","volume":"11","author":[{"given":"Ratna","family":"Koyyalamudi","sequence":"first","affiliation":[{"name":"Department of Radiology, John Hunter Hospital , Newcastle 2305,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5475-2329","authenticated-orcid":false,"given":"Dominic","family":"Ku","sequence":"additional","affiliation":[{"name":"Department of Radiology, John Hunter Hospital , Newcastle 2305,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirk","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Radiology, John Hunter Hospital , Newcastle 2305,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morgan","family":"Schulze","sequence":"additional","affiliation":[{"name":"Department of Radiology, John Hunter Hospital , Newcastle 2305,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,1,17]]},"reference":[{"key":"2025022420371797400_uaaf002-B1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.semarthrit.2008.10.001","article-title":"Pancreatitis, panniculitis, and polyarthritis","volume":"39","author":"Narv\u00e1ez","year":"2010","journal-title":"Semin Arthritis Rheum"},{"key":"2025022420371797400_uaaf002-B2","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/0190-9622(95)91385-8","article-title":"Pancreatic panniculitis","volume":"33","author":"Dahl","year":"1995","journal-title":"J Am Acad Dermatol"},{"key":"2025022420371797400_uaaf002-B3","doi-asserted-by":"crossref","first-page":"5043","DOI":"10.3748\/wjg.v13.i38.5043","article-title":"Severe acute pancreatitis: clinical course and management","volume":"13","author":"Beger","year":"2007","journal-title":"World J Gastroenterol"},{"key":"2025022420371797400_uaaf002-B4","doi-asserted-by":"crossref","first-page":"4412","DOI":"10.12998\/wjcc.v11.i18.4412","article-title":"Pancreatitis, panniculitis and polyarthritis syndrome: a case report","volume":"11","author":"Pichler","year":"2023","journal-title":"World J Clin Cases"},{"key":"2025022420371797400_uaaf002-B5","first-page":"1436","article-title":"Pancreatitis arthritis with periarticular fat necrosis","volume":"20","author":"Ferrari","year":"1993","journal-title":"J Rheumatol"},{"key":"2025022420371797400_uaaf002-B6","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.ijscr.2017.01.037","article-title":"Pancreatitis, panniculitis and polyarthritis (PPP-) syndrome caused by post-pancreatitis pseudocyst with mesenteric fistula. Diagnosis and successful surgical treatment. Case report and review of literature","volume":"31","author":"Dieker","year":"2017","journal-title":"Int J Surg Case Rep"},{"key":"2025022420371797400_uaaf002-B7","first-page":"1401","article-title":"Intramedullary fat necrosis of multiple bones associated with pancreatitis","volume":"39","author":"Ahn","year":"1998","journal-title":"J Nucl Med"},{"key":"2025022420371797400_uaaf002-B8","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4103\/0971-3026.137049","article-title":"Bone marrow lesions: a systematic diagnostic approach","volume":"24","author":"Del Grande","year":"2014","journal-title":"Indian J Radiol Imaging"},{"key":"2025022420371797400_uaaf002-B9","doi-asserted-by":"crossref","first-page":"83","DOI":"10.5021\/ad.2022.34.1.83","article-title":"Pancreatitis, panniculitis, and polyarthritis syndrome with a fatal course","volume":"34","author":"Shon","year":"2022","journal-title":"Ann Dermatol"},{"key":"2025022420371797400_uaaf002-B10","doi-asserted-by":"crossref","first-page":"387","DOI":"10.2214\/ajr.176.2.1760387","article-title":"Osteomyelitis originating in and around bone infarcts: giant sequestrum phenomena","volume":"176","author":"Blacksin","year":"2001","journal-title":"AJR Am J Roentgenol"}],"container-title":["BJR|Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjrcr\/advance-article-pdf\/doi\/10.1093\/bjrcr\/uaaf002\/61489094\/uaaf002.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjrcr\/article-pdf\/11\/1\/uaaf002\/61489094\/uaaf002.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjrcr\/article-pdf\/11\/1\/uaaf002\/61489094\/uaaf002.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T20:37:34Z","timestamp":1740429454000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjrcr\/article\/doi\/10.1093\/bjrcr\/uaaf002\/7959723"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1,3]]}},"URL":"https:\/\/doi.org\/10.1093\/bjrcr\/uaaf002","relation":{},"ISSN":["2055-7159"],"issn-type":[{"type":"electronic","value":"2055-7159"}],"subject":[],"published-other":{"date-parts":[[2025,1]]},"published":{"date-parts":[[2025,1]]},"article-number":"uaaf002"}}