Case report: Pancreatitis-associated polyarthritis, panniculitis, and bone infarcts in a patient with alcohol use disorder

Musculoskeletal complications secondary to pancreatitis, including polyarthritis, panniculitis, and bone infarction (Pancreatitis Panniculitis Polyarthritis syndrome), are rare and under-recognized. We report a case of a 31-year-old man with alcohol use disorder who initially presented with acute pancreatitis. Two months later, he developed migratory polyarthritis and subcutaneous nodules. Radiographs revealed permeative bone lesions, and MRI demonstrated multiple bone infarcts. Subcutaneous biopsy confirmed panniculitis. His clinical course was complicated by infected pancreatic necrosis and splanchnic vein thromboses. Joint symptoms improved with aggressive treatment of pancreatitis. Early imaging evaluation is essential in patients with pancreatitis and musculoskeletal symptoms. Recognition of bone infarctions and panniculitis should prompt consideration of systemic pancreatic complications.