Pichler H, Stumpner T, Schiller D, Bischofreiter M, Ortmaier R. Pancreatitis, panniculitis and polyarthritis syndrome: A case report. World J Clin Cases 2023; 11(18): 4412-4418 [PMID: 37449214 DOI: 10.12998/wjcc.v11.i18.4412]
Corresponding Author of This Article
Hannes Pichler, Doctor, Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital, Paracelsus Medical University Salzburg, Seilerstätte 4, Linz 4010, Austria. drhannespichler@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 26, 2023; 11(18): 4412-4418 Published online Jun 26, 2023. doi: 10.12998/wjcc.v11.i18.4412
Pancreatitis, panniculitis and polyarthritis syndrome: A case report
Hannes Pichler, Thomas Stumpner, Dietmar Schiller, Martin Bischofreiter, Reinhold Ortmaier
Hannes Pichler, Thomas Stumpner, Martin Bischofreiter, Reinhold Ortmaier, Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital, Paracelsus Medical University Salzburg, Linz 4010, Austria
Dietmar Schiller, Department of Gastroenterology, Ordensklinikum Linz Barmherzige Schwestern, Linz 4010, Austria
Author contributions: Pichler H wrote the manuscript with the support of Stumpner T and Ortmaier R; Pichler H, Bischofreiter M, and Ortmaier R analyzed and interpreted the patient’s data and documents; Schiller D analyzed the case and gave a crucial clue to finding the diagnosis; Ortmaier R supervised the case; All authors contributed to, read, and approved the final manuscript.
Informed consent statement: The patient provided informed written consent prior to this case report.
Conflict-of-interest statement: Dr. Pichler has nothing to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hannes Pichler, Doctor, Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital, Paracelsus Medical University Salzburg, Seilerstätte 4, Linz 4010, Austria. drhannespichler@gmail.com
Received: April 5, 2023 Peer-review started: April 5, 2023 First decision: April 20, 2023 Revised: May 7, 2023 Accepted: May 30, 2023 Article in press: May 30, 2023 Published online: June 26, 2023 Processing time: 82 Days and 5.9 Hours
Abstract
BACKGROUND
Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare form of pancreatic disease. It is characterized by bullous erythematous skin lesions and arthritis, and both are triggered by pancreatic malfunction. Few cases have been described in the literature thus far. Due to the inconsistency in its clinical presentation, its diagnosis can be a challenge. Early therapy initiation is essential to reduce mortality; however, there is currently no gold standard for treatment.
CASE SUMMARY
A 66-year-old polymorbid male patient presented with several superficial abscesses on both lower legs and painful swelling in the knee. Treatment for septic arthritis and septic skin infection over several weeks failed. His general condition deteriorated gradually and worsened with sudden onset of abdominal pain. A diagnosis of necrotizing pancreatitis was made. He subsequently underwent a laparotomy and drainage of the pancreas. Eventually, our patient improved, and his abdominal complaints, knee pain, and dermal lesions resolved.
CONCLUSION
PPP syndrome is rare and easily misdiagnosed, as abdominal symptoms may be delayed or absent. Clinicians should consider PPP syndrome if they encounter refractory panniculitis in combination with joint infection.
Core Tip: Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare disease. The combination of joint inflammation and abscess-like skin lesions suggests an infectious cause. However, these symptoms are triggered by pancreatic disease. As abdominal symptoms may be delayed or absent, PPP syndrome may be challenging to diagnose and treat. We present our experience in treating a 66-year-old patient with PPP syndrome. In conclusion, PPP syndrome should be considered in cases of hard-to-treat or atypical joint and tissue infections.
