Deciphering Pancreatitis, Panniculitis, Polyarthritis (PPP) Syndrome: Case Report

Abstract

Aims: Comprehensive objective: This study aims to comprehensively elucidate the clinical characteristics, intricate diagnostic challenges, and nuanced management strategies encountered in a rare and intricate case of PPP syndrome, encompassing pancreatitis, panniculitis, and polyarthritis. Presentation of Case: An 82-year-old male patient presented with a week-long progressive nodular eruption on the lower limbs, accompanied by bilateral ankle swelling and difficulty walking. Laboratory tests revealed elevated inflammatory markers. Physical examination indicated bilateral ankle arthritis, subcutaneous nodules, and tender knee and elbow joints with limited movement. Imaging and further investigations confirmed the diagnosis of PPP syndrome. Management involved conservative measures, NSAIDs, and systemic corticosteroids. Discussion: PPP syndrome's pathogenesis remains obscure due to its rarity. It involves a complex interplay of pancreatic enzymes leading to fat necrosis and subsequent tissue inflammation. Clinical manifestations encompass joint pain, skin lesions, and potential visceral involvement. Differential diagnoses include erythema nodosum, pancreatic tumors, and other arthritic conditions. Timely diagnosis and interdisciplinary collaboration are crucial in navigating the diagnostic hurdles and initiating appropriate interventions. Conclusion: This case highlights the diagnostic intricacies and therapeutic complexities inherent in managing PPP syndrome. Prompt recognition, comprehensive evaluation, and multidisciplinary collaboration are pivotal for effective treatment. Although prognosis varies, vigilance for associated pancreatic malignancies underscores the necessity for continuous monitoring and tailored interventions. Further research and heightened clinical awareness are imperative for enhancing understanding and managing this multifaceted syndrome.