pancreatic carcinoma, and pancreatic insufficiency have been associated with
Clinical features of the pancreatic, panniculitis,
and polyarthritis syndrome:
Pancreatic, panniculitis, and polyarthritis syndrome
(PPP) is a systemic syndrome occurring in some patients with
pancreatitis or pancreatic acinar cell carcinoma due to release of trypsin,
lipase, and amylase from the diseased pancreas causing fat necrosis.
A good way to
remember the clinical manifestations is the mnemonic PANCREAS:
(60%) and arthralgias, usually of the ankles and knees. Synovial fluid is
typically noninflammatory and creamy in color due to lipid droplets that stain
with Sudan black or oil red O.
that are tender, red, and usually on the extremities. These are frequently
misdiagnosed as erythema nodosum but are areas of lobular (not septal)
panniculitis with fat necrosis. Fasciitis due to subcutaneous fat necrosis can
also be seen.
of the pancreas more commonly causes this syndrome than does pancreatitis.
abnormalities due to osteolytic bone lesions from bone marrow necrosis (10%).
The triad of arthritis, nodules, and eosinophilia is called Schmidt’s triad.
lipase, and trypsin are elevated due to release by a diseased pancreas and
cause the fat necrosis in skin, synovium, and bone marrow.
including pleuropericarditis frequently with fever.
www.omicsonline.org Case Report