{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T04:02:13Z","timestamp":1745812933569,"version":"3.40.4"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,9,1]]},"abstract":"<jats:p>Pancreatitis, panniculitis and polyarthritis syndrome (PPP syndrome) is a rare and complex manifestation of pancreatitis that is currently reported in few cases. We present this case regarding a 77-year-old man who presented unusually with a 6-week history of bilateral lesions on his lower limbs. During this time, he experienced increasing fatigue, joint pain, and reported fevers and significant weight loss. An incidental serum amylase was found to be significantly elevated and remained elevated throughout his 2-month hospital stay. He never complained of abdominal pain or other typical symptoms of pancreatitis. Histological examination of the leg lesions reported evidence of fat necrosis and changes consistent with pancreatic panniculitis. An abdominal CT scan revealed a well-defined lesion posterior to the neck of the pancreas. Further examination by endoscopic ultrasound revealed chronic inflammatory changes. The patient experienced a long admission and was managed supportively until he was well enough to be discharged home.<\/jats:p>","DOI":"10.1136\/bcr-2018-226440","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T01:09:57Z","timestamp":1537060197000},"page":"bcr-2018-226440","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Unusual presentation of pancreatitis with extrapancreatic manifestations"],"prefix":"10.1136","volume":"2018","author":[{"given":"Tony","family":"Fordham","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen Marie","family":"Sims","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terence","family":"Farrant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,9,15]]},"reference":[{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.1","doi-asserted-by":"publisher","DOI":"10.4103\/0022-3859.90088"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.2","first-page":"485","article-title":"Chronic calcific pancreatitis presenting as an isolated left perinephric abscess: a case report and review of the literature","volume":"12","author":"Thandassery","year":"2011","journal-title":"JOP"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.3","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.jbspin.2015.05.005","article-title":"Osteomyelitis: a rare complication of pancreatitis and PPP-syndrome","volume":"83","author":"Langenhan","year":"2016","journal-title":"Joint Bone Spine"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.4","doi-asserted-by":"publisher","DOI":"10.1148\/106.1.85"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.5","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.ijscr.2016.09.019","article-title":"Pancreatic disease, panniculitis, polyarthrtitis syndrome successfully treated with total pancreatectomy: case report and literature review","volume":"28","author":"Ferri","year":"2016","journal-title":"Int J Surg Case Rep"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.6","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.epsc.2015.03.014","article-title":"A case of pancreatitis, panniculitis and polyarthritis syndrome: Elucidating the pathophysiologic mechanisms of a rare condition","volume":"3","author":"Loverdos","year":"2015","journal-title":"J Pediatr Surg Case Rep"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.7","first-page":"630","article-title":"Subcutaneous pancreatic fat necrosis associated with acute arthritis","volume":"19","author":"Saag","year":"1992","journal-title":"J Rheumatol"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.8","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1007\/s12664-009-0072-6","article-title":"\u2019Pancreatitis, polyarthritis, panniculitis syndrome' (PPP syndrome) plus prolonged pyrexia--a rare presentation of chronic pancreatitis","volume":"28","author":"Jose","year":"2009","journal-title":"Indian J Gastroenterol"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.9","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1097\/RHU.0000000000000181","article-title":"Polyarthritis and pancreatic panniculitis associated with pancreatic carcinoma: review of the literature","volume":"20","author":"Arbel\u00e1ez-Cort\u00e9s","year":"2014","journal-title":"J Clin Rheumatol"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.10","first-page":"763","article-title":"Cutaneous manifestations of pancreatic diseases","volume":"21","author":"Sibrack","year":"1978","journal-title":"Cutis"},{"key":"2025042706162529000_2018.sep14_2.bcr-2018-226440.11","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3315\/jdcr.2014.1167","article-title":"Pancreatic panniculitis - a cutaneous manifestation of acute pancreatitis","volume":"8","author":"Laureano","year":"2014","journal-title":"J Dermatol Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-226440","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T13:16:37Z","timestamp":1745759797000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-226440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,15]]},"references-count":11,"alternative-id":["10.1136\/bcr-2018-226440"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-226440","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,9,15]]}}}