Lobular panniculitis: A manifestation of pancreatic tumor with fatal outcome

Lobular panniculitis is a skin condition that may be the first sign of underlying pancreatic disease. Though rare, the condition has been sufficiently well defined and pathognomonic, thus making differentiation from idiopathic lobular panniculitis quite possible. A 77-year-old woman was in apparently good general health condition when developed skin lesions in a form of erythematous painful fluctuant nodules localized predominantly on the breast, but also present on the arms, thighs, and trunk. Her serum and urinary amylase levels were respectively 3 and 8 fold higher than normal. On histology, skin biopsy showed acute lobular panniculitis with large foci of adipocyte necrosis. Examination of the breast excluded any specific process other than nodular subcutaneous inflammation, but revealed a tumor of the pancreatic head. The nodules spontaneously ulcerated exuding an oily thick brownish material. Her condition deteriorated, and she became progressively debilitated. The patient died before operation, within the next 3 weeks. Subcutaneous fat necrosis was the first manifestation of an otherwise occult pancreatic disease with fatal outcome