report an instance of a 64-year-old man who presented with liquefying

report an instance of a 64-year-old man who presented with liquefying panniculitis associated with intraductal papillary mucinous neoplasm (IPMN) after the Whipple operation. to suppress pancreatic secretion and decrease the risk of pancreatic fistula. On postoperative day 2 on the right lower limb skin a localized erythema appeared which slowly became larger but the subcutaneous lesion did not bulge onto the surface of the skin. Subsequently the localized red-brown erythema was present over the right upper leg and knee joint. On postoperative day 5 the examination showed multiple subcutaneous inflammatory nodules around the legs and the buttock (Physique?2). Physique 2 The photograph showing a large area of the skin lesions on the right lower limber leg and knee joint respectively MK-8245 Some of the bigger lesions had been necrotic and exuded a viscous fatty materials followed by general malaise. On postoperative time 7 the skin doctor was invited by us to examine the individual and produced a medical diagnosis of liquefying panniculitis. Based on the report in the former books the octreotide was effective to liquefying panniculitis.1 2 We increased octreotide intravenous infusion to 0.6 mg each day and simultaneously used the Medrol (glucocorticoid 20 mg/24h) 2 Ulinastatin (protease inhibitors) and antibiotics. No brand-new nodules made an appearance and the initial nodules didn’t change. The individual appeared anastomotic leakages as well as the wound grew worse However. Drainage pipes discharged some yellowish oily mucus chemical. Apr 2010 The individual had to get the next procedure on 1. Introperatively we discovered the pelvic cavity filled up with brown greasy necrotic liquids around 50 mL. The postoperative pathology demonstrated the necrosis of omental fats tissues. Unfortunately several times later brand-new erythemas spread and scattered over his right thigh and right hand wrist. The former nodules grew larger again. The patient died of multiple organ failure on 27 April 2010. Conversation Panniculitis has rarely been reported in the world since the first statement of Weber MK-8245 in 1935.1-6 Most of them were associated with pancreatitis or pancreatic carcinomas and had poor prognosis.1-5 In 2006 Gahr presented the first case of intraductal papillary mucinous adenoma of the pancreas associated with lobular panniculitis.7 Hereon we presented MK-8245 a case of liquefying panniculitis associated with IPMN. Liquefying panniculitis (Rothman’s panniculitis) is usually a special type of nodular panniculitis (Weber-Christian disease).6 In the past 20 years one case of liquefying panniculitis has been reported in China.2 Compared with domestic cases you will find more foreign instances reported. Most of them associated with pancreatic diseases possess poor prognosis. In our case the retinal cells is definitely involved8 and anastomotic leakages appear which lead to a fatal end result. The pathogenesis of pancreatic panniculitis is still unfamiliar. The pancreatic enzymes such as trypsin may increase the permeability of the microcirculation and are involved in the process of excess fat degradation which generates more free fatty acids combining with calcium to form soap.5 However cases of fat necrosis with normal serum lipase levels have also been explained.6 These reports suggest that there should be some other factors which allow the pancreatic enzymes to escape from your circulation and act within the subcutaneous fat. Deficiency of the alpha-1-antitrypsin (AAT) was also pointed Rabbit polyclonal to AADAC. out as a cause of pancreatic panniculitis.9 According to the literature octreotide and methylprednisolone can only slow down the progress of the disease.1 2 The patient’s only preoperative sign is the insomnia which has developed on him for many years 10 so the study on whether the insomnia MK-8245 is associated with liquefying panniculitis becomes crucial which may offer evidence for the early analysis of the panniculitis. In this case skin lesions appeared postoperative and the operation may also be a predisposing risky element for liquefying panniculitis and the exact mechanism needs to be further explored. DECLARATIONS Competing interests None declared Funding Shanghai Committee of Technology and Technology China (give no. 09140902300) Honest authorization Written consent to publication was from the patient or next of kin Guarantor BS Contributorship All authors contributed equally Acknowledgements The authors say thanks to Xiao-chun Wang for the pathological photos and Wang Hui for his help Reviewers John Ajo and Gareth.