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Cutaneous pseudo abscesses: an unusual presentation of severe pancreatitis
N Manji1, A R Hulyalkar, M A Keroack
1Department of Medicine, Brockton-West Roxbury Veterans Administration Medical Center, Boston, Massachusetts.
Abstract:
In this report, we present a 53-yr-old man with extensive subcutaneous fat necrosis due to acute pancreatitis presenting as fluctuant collections resembling large multiple abscesses. The diagnosis was suggested by examination of the wound aspirate. Findings included absence of organisms on the gram stain, presence of fat globules on wet mount, and an elevated amylase in the wound aspirate. This dramatic presentation preceded any symptoms or signs of overt pancreatitis.
Insights
Subcutaneous fat necrosis from acute pancreatitis can mimic abscesses. Wound aspirate analysis, including fat globules and amylase, aids early diagnosis before overt pancreatitis symptoms appear.
Area of Science:
- Gastroenterology
- Dermatology
- Pathology
Background:
- Acute pancreatitis can lead to extrapancreatic complications.
- Subcutaneous fat necrosis is a recognized, though uncommon, manifestation of pancreatitis.
- Early recognition of these complications is crucial for timely management.
Observation:
- A 53-year-old male presented with extensive subcutaneous collections.
- These collections clinically resembled multiple large abscesses.
- The presentation mimicked infectious processes, delaying the initial diagnosis.
Findings:
- Wound aspirate examination was key to diagnosis.
- Absence of organisms on Gram stain ruled out bacterial infection.
- Presence of fat globules and elevated amylase in aspirate confirmed pancreatic origin.
Implications:
- This case highlights an unusual presentation of acute pancreatitis.
- Diagnosis via wound aspirate can precede overt clinical signs of pancreatitis.
- Early identification of fat necrosis is vital for appropriate patient care and management strategies.