PPP Syndrome Successfully Treated With Total Pancreatectomy:
The symptomatic triad comprising pancreatic disease, panniculitis and polyarthritis is known as PPP syndrome and is characterized by severe chronic sequels and high mortality rate.
A 67-year-old male was admitted presenting multiple painful tender subcutaneous nodules on trunk, arms and legs. He referred neither pain nor fever. In his medical history he reported an alcoholic abuse and an alcoholic chronic pancreatitis within 3 episodes of acute pancreatitis.

A CT scan showed an acute pancreatitis with enlargement of pancreatic head in a context of chronic pancreatitis. Skin biopsy revealed a lobular panniculitis with extensive fat necrosis and areas of saponification. On standard culture an E. Coli was isolated. The patient was discharged with a diagnosis of pancreatic panniculitis.

Patient was readmitted to the hospital 30 days after discharge for panniculitis recurrence and acute arthritis of hands and feets with complete functional impairment. During hospitalization also ankles, knees and right wrist presented signs of acute arthritis that require surgical drainage.

Intraoperatively, a steatonecrosis area in the epiploic retrocavity was found, extending from the posterior wall of the stomach to the ventral surface of the transverse colon: pancreatic gland was atrophic with diffuse peripancreatic inflammation reaction that caused difficult anatomic identification of vascular structures.

Source: https://www.sciencedirect.com/science/article/pii/S2210261216303601#fig0005
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