[Pancreatogenic panniculitis based on 2 cases]

The rarest and hardly known complication of pancreas diseases is the subcutaneous nodular fat necrosis, a special type of panniculitides. It is mostly associated with pancreatitis and adenocarcinoma of pancreas. Its diagnostic criteria are (1) red painless or occasionally painful nodules showing a tendency of coalescence, emolition and fistulation on the lower extremities and later anywhere on the body, (2) alcoholic case-history, (3) tense, painful joints, (4) elevated pancreatic enzyme levels in the blood and urine. Since the underlying pancreas diseases may be asymptomatic, the pancreatogen panniculitis should be considered as a noteworthy marker of them. The histologic findings are pathognomic. In pancreatogen panniculitis in all likelihood the remote foci of adiponecrosis are due to the local action of pancreatic lipolytic enzymes carried by the blood. The question has not been settled yet. In this article there are presented two cases of pancreatogen panniculitis, recognized by the consultant dermatologist. Referral diagnoses of both cases were misleading: "erythema nodosum" in the first case and "drug eruption" in the second one. The determinant underlying pancreas disease in both cases was pancreatitis with pseudocyst resulted from alcoholic toxicomany.