Atypical chronic leg ulcers revealing pancreatic panniculitis associated with pancreatic adenocarcinoma

Dear Editor, Pancreatic panniculitis (PP) is a rare form of lobular panniculitis associated with pancreatic disorders, including acute and chronic pancreatitis and pancreatic neoplasms. It develops in a small percentage of patients with pancreatic disease and may represent the first manifestation of an occult malignancy. Clinically, PP usually presents with painful erythematous-to-violaceous nodules on the lower extremities, which may ulcerate and discharge oily brown material secondary to liquefactive fat necrosis induced by circulating pancreatic enzymes. Because of its rarity and heterogeneous presentation, diagnosis is frequently delayed or initially misdirected toward more common inflammatory or vascular conditions. [...].