Association of polyarthritis, subcutaneous nodules, and pancreatic disease

A patient with nodular liquefying panniculitis, polyarthritis and an occult pancreatic neoplasm is described. The skin lesion was initially mistaken for erythema nodosum. Subcutaneous and synovial fluids demonstrated similar negatively birefringent, rectangular particles, lying in between fat globules. Serum lipase,although continuously elevated, did not fluctuate with disease activity. Biochemical evidence of lipolysis in either the synovial fluid or serum was not demonstrable. Immunologic mechanisms appeared not to be involved in the pathogensis of the panniculitis or the arthritis.