Pancreatitis, panniculitis, and polyarthritis syndrome presentation, diagnosis, and management

Patient presented with asymmetric polyarthritis and tender skin erythematous lesions over his lower limbs associated with intermittent fever. He has a history of excessive alcohol usage without previous episode of pancreatitis. He subsequently developed abdominal pain and was noted to have elevated lipase levels and computed tomography (CT) of his abdomen showed evidence of acute pancreatitis. Biopsy of a lower limb lesion proved panniculitis. CT scan of his ankle showed arthritis and an insufficiency fracture. The diagnosis of pancreatitis, panniculitis, and polyarthritis (PPP) syndrome was made based on his PPP. He subsequently developed multiple complications of pancreatitis which led to prolonged hospitalization and multiple interventions. PPP syndrome triad is hypothesized to occur due to leakage of pancreatic enzymes into the systemic circulation. Management of the underlying pancreatitis usually helps resolve the other sequalae of PPP syndrome. This is the first case report of PPP syndrome with associated vessel pseudoaneurysm to date.