{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:28:38Z","timestamp":1787840918569,"version":"build-2784847793"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare but serious disease that can be deadly. Its symptoms come on suddenly and unexpectedly. This disease is identified by erythematous bullous skin lesions and arthritis caused by pancreatic dysfunction. A 25-year-old man had an abdominal trauma with no past medical history. A CT scan showed pancreatic inflammation, peripancreatic edema, and mild fluid in the head of the pancreas without any collection and collection of blood in the retroperitoneum. The patient came back to the hospital 2 weeks later with a fever, abdominal pain, tender joints, redness, warmth in arms and legs, and rash on the skin. In addition, their amylase and lipase levels were increased. Based on the symptoms, the patient was referred to a rheumatologist and diagnosed with PPP syndrome with concomitant pancreatitis, panniculitis, and polyarthritis. Despite being prescribed corticosteroids and broad-spectrum antibiotics, the patient passed away. The exact pathophysiology of the additional abdominal symptoms has not yet been determined. However, some researchers have suggested that this disorder may be due to the entry of pancreatic lipase enzymes into the bloodstream. Pancreatic enzymes damage adipose tissue in the lower extremities and cause panniculitis (subcutaneous adipose tissue inflammation). The symptoms of arthritis may vary depending on the clinical case as different joints are affected and the number and symmetry of joints involved may differ. Therefore, PPP syndrome is sporadic and not easily diagnosed.<\/jats:p>","DOI":"10.4103\/abr.abr_324_24","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T11:02:20Z","timestamp":1740654140000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Understanding the PPP Syndrome: A Rare Combination of Pancreatitis, Panniculitis, and Polyarthritis"],"prefix":"10.4103","volume":"14","author":[{"given":"Amin","family":"Bagheri-Ghalehsalimi","sequence":"first","affiliation":[{"name":"Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Jafari","sequence":"additional","affiliation":[{"name":"Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Aria","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athar","family":"Kouchak","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahnaz","family":"Momenzadeh","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,2]]},"reference":[{"key":"R1-20250227","first-page":"419","article-title":"Pancreatic panniculitis","volume":"148","author":"Rongioletti","year":"2013","journal-title":"G Ital Dermatol Venereol"},{"key":"R2-20250227","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":"R3-20250227","first-page":"154","article-title":"Pancreatic disease, panniculitis and polyarthritis (PPP) syndrome: A case report and review of the literature","volume":"5","author":"Opsmer","year":"2001","journal-title":"Belg J Med Oncol"},{"key":"R4-20250227","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":"R5-20250227","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s00383-003-1041-2","article-title":"Pancreatitis with panniculitis and arthritis: A rare association","volume":"20","author":"Menon","year":"2004","journal-title":"Pediatr Surg Int"},{"key":"R6-20250227","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":"R7-20250227","doi-asserted-by":"crossref","first-page":"2808","DOI":"10.12998\/wjcc.v7.i18.2808","article-title":"Pancreatitis, panniculitis, and polyarthritis syndrome caused by pancreatic pseudocyst: A case report","volume":"7","author":"Jo","year":"2019","journal-title":"World J Clin Cases"},{"key":"R8-20250227","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1007\/s10067-020-05333-8","article-title":"Clinical characteristics, treatment, and outcome of pancreatitis, panniculitis, and polyarthritis syndrome: A case-based review","volume":"40","author":"Betrains","year":"2021","journal-title":"Clin Rheumatol"},{"key":"R9-20250227","first-page":"e35768","article-title":"Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome in the setting of severe acute pancreatitis","volume":"15","author":"Ammar","year":"2023","journal-title":"Cureus"},{"key":"R10-20250227","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":"R11-20250227","first-page":"46","article-title":"The pancreatitis, panniculitis, and polyarthritis (PPP) syndrome: Subcutaneous nodular fat necrosis, a cutaneous marker of pancreatic neoplasia","volume":"291","author":"Bernacka","year":"2021","journal-title":"Acta Dermatovenerol Croat"},{"key":"R12-20250227","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4166\/kjg.2019.74.3.175","article-title":"Pancreatitis, panniculitis, and polyarthritis syndrome simulating cellulitis and gouty arthritis","volume":"74","author":"Kim","year":"2019","journal-title":"Korean J Gastroenterol"},{"key":"R13-20250227","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":"R14-20250227","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/0036933019897373","article-title":"A case report of pancreatitis-panniculitis-polyarthritis syndrome-An unusual but serious presentation of pancreatic disease","volume":"65","author":"Castro","year":"2020","journal-title":"Scott Med J"}],"container-title":["Advanced Biomedical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/abr.abr_324_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:32:52Z","timestamp":1787837572000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/abr.abr_324_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/abr.abr_324_24","relation":{},"ISSN":["2277-9175"],"issn-type":[{"value":"2277-9175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]},"assertion":[{"value":"2024-07-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}