Clinical Rheumatology

, Volume 16, Issue 2, pp 199–203 | Cite as

Massive subcutaneous and intraosseous fat necrosis associated with pancreatitis. Natural evolution of the radiographic picture

  • M. Rodriguez
  • G. L. Lopez
  • P. Prieto
  • L. Fernandez
  • A. Willisch
  • M. Arce
Case Report


A 44-year-old man developed high fever, polyarthralgias, erythematous tender nodules and plaques on feet, ankles, knees and dorsum of the hands, as well as swelling of ankles and several joints of hands and feet. Laboratory evaluation showed high serum pancreatic amylase and lipase. Histological study of a subcutaneous nodule demonstrated fat necrosis. X-ray examination revealed numerous lytic lesions involving cancellous and cortical bone in phalanges, metacarpals, radius, tibia, tarsus and metatarsals, with areas of widened bone.

The patient never referred any abdominal symptom. He evolved favourably within the following months. A year later, resolution of most of the bone lesions was observed.

Key words

Pancreatitis Fat Necrosis Panniculitis Bone Necrosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Virshup AM, Sliwinski AJ. Polyarthritis and subcutaneous nodules associated with carcinoma of the pancreas. Arthritis Rheum 1973; 16: 388–92.PubMedGoogle Scholar
  2. 2.
    Tannenbaum H, Anderson LG, Schur PH. Association of polyarthritis, subcutaneous nodules, and pancreatic disease. J Rheumatol 1975; 2: 14–20.Google Scholar
  3. 3.
    Gibson TJ, Schumacher HR, Pascual E, Brighton C. Arthropathy, skin and bone lesions in pancreatic disease. J Rheumatol 1975; 2: 7–13.PubMedGoogle Scholar
  4. 4.
    Radin DR, Colletti PM, Forrester DM, Tang WW: Pancreatic acinar carcinoma with subcutaneous and intraosseous fat necrosis. Radiology 1986; 158: 67–8.PubMedGoogle Scholar
  5. 5.
    Ferrari R, Wendelboe M, Ford PM, Corbett WEN, Anastassiades TP. Pancreatitis arthritis with periarticular fat necrosis. J Rheumatol 1993; 20: 1436–7.PubMedGoogle Scholar
  6. 6.
    Watts RA, Kelly S, Hacking JC, Lomas D, Hazleman BL. Fat necrosis. An unusual cause of polyarthritis. J Rheumatol 1993; 20: 1432–5.PubMedGoogle Scholar
  7. 7.
    Tan A, Morm ME, Baker DA, Sue HK. Pancreatitis arthritis syndrome. South Med J 1979; 72: 739–41.PubMedGoogle Scholar
  8. 8.
    Kushner DS, Szanto PB. Fulminant polyarthritis polyarthritis fever, and cutaneous modules in an alcoholic patient. JAMA 1958; 167: 1525–32.Google Scholar
  9. 9.
    Limkin PA, Brunzell JD, Wisner D, Fiechtner JJ, Carlin JS, Willkens RF. Free fatty acids in the pancreatitis arthritis syndrome. Arthritis Rheum 1983; 26: 127–32.PubMedGoogle Scholar
  10. 10.
    Haller J, Greenway G, Resnick D, Kindynis P, Sik Kang H. Intraosseous fat necrosis associated with acute pancreatitis: MR imaging. Radiology 1989; 173: 193–95.PubMedGoogle Scholar
  11. 11.
    Schutte H, Wackwitz J. Case Report 171. Skeletal Radiol. 1981; 7: 147–49.PubMedGoogle Scholar
  12. 12.
    Smukler NM, Schumacher HR, Pascual E, Brown S, Ryan WE, Sadeghian MR. Synovial fat necrosis associated with ischemic pancreatic disease. Arthritis Rheum 1979; 22: 547–53.PubMedGoogle Scholar
  13. 13.
    Harber RM, Asaad DM. Panniculitis associated with a pancreas divisum. J Am Acad Dermatol 1986; 14: 331–34.PubMedGoogle Scholar
  14. 14.
    Hughes PSH, Apisarnthanarix P, Mullins JF. Subcutaneous fat necrosis associated with pancreatic disease. Arch Dermatol 1975; 111: 506–10.CrossRefPubMedGoogle Scholar
  15. 15.
    Phillips RM Jr, Sulser R, Songcharoen S. Inflammatory arthritis and subcutaneous fat necrosis associated with acute and chronic pancreatitis. Arthritis Rheum 1980; 23: 355–60.PubMedGoogle Scholar
  16. 16.
    Rittenberg G, Korn J, Schabel S, Stahleim R. Rapid osteolysis in pancreatic carcinoma. West Med J 1981; 135: 40811.Google Scholar

Copyright information

© Clinical Rheumatology 1997

Authors and Affiliations

  • M. Rodriguez
    • 1
  • G. L. Lopez
    • 1
  • P. Prieto
    • 1
  • L. Fernandez
    • 1
  • A. Willisch
    • 1
  • M. Arce
    • 1
  1. 1.Rheumatology, Internal Medicine and Radiology servicesOrenseSpain

Personalised recommendations