Panniculitis of pancreatic disease masquerading as systemic lupus erythematosus panniculitis

We describe a patient with systemic lupus erythematosus (SLE) who presented with severe refractory pannicular lesions diffusely involving the buttocks and lower extremities. Due to the severity of these lesions, a biopsy was performed, which implicated panniculitis associated with pancreatic disease, rather than lupus panniculitis. Serum amylase was normal, but the serum lipase was markedly elevated. An abdominal computerized tomographic scan demonstrated a pancreatic mass, which upon laparotomy was found to be an acinar cell carcinoma. After resection of the mass, her symptoms improved, where they had not responded to prior immunosuppressive therapy. She has subsequently remained well without recurrence of the disease. This case illustrates that an uncharacteristic presentation of panniculitis in a patient with lupus does not necessarily imply lupus panniculitis, and a biopsy is imperative to distinguish other sometimes life threatening etiologies.