Pancreatic Intrapapillary Mucinous Neoplasm–Superior Mesenteric Vein Fistula Causing Pancreatitis Panniculitis and Polyarthritis Syndrome

Pancreatitis, panniculitis, polyarthritis is a rare syndrome attributed to leak of pancreatic enzyme into systemic circulation. Our patient presented with lower-extremity nodules and polyarthralgia. After extensive negative rheumatologic work-up, pancreatitis, panniculitis, polyarthritis syndrome wa...

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Bibliographic Details
Main Authors: Maryia Vladykina, Sawsan Fathma, Katelyn Norman
Format: Article
Language:English
Published: American College of Physicians 2024-02-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2023.1180
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Summary:Pancreatitis, panniculitis, polyarthritis is a rare syndrome attributed to leak of pancreatic enzyme into systemic circulation. Our patient presented with lower-extremity nodules and polyarthralgia. After extensive negative rheumatologic work-up, pancreatitis, panniculitis, polyarthritis syndrome was suspected. Pancreatic lipase level was greater than 20 000 U/L, without acute pancreatitis on imaging. He was initially managed with octreotide, with significant improvement noted. Ultimately, a fistula between a benign intraductal papillary mucinous neoplasm and the superior mesenteric vein was identified and managed surgically with symptom resolution. We discuss this rare triad, with a description of the diagnostic challenges and conservative management while awaiting definitive surgical treatment.
ISSN:2767-7664