Arthritis and Skin Lesions Resembling Erythema Nodosum in Pancreatic Disease

The clinical picture of subcutaneous fat necrosis, acute synovitis, and subcutaneous nodules present in some patients with pancreatitis or carcinoma of the pancreas may mimic erythema nodosum. Predominant severe polyarthritis secondary to periarticular fat necrosis or relatively frequent great-toe involvement may make this clinical symptom complex difficult to distinguish from a generalized connective tissue disorder or gouty arthritis. Eosinophilia of 5 to 21% has been noted frequently when subcutaneous fat necrosis accompanies carcinoma of the pancreas. Definitive diagnosis of subcutaneous or periarticular fat necrosis by skin or soft tissue biopsy has been frequently recorded among the 36 patients documented in the literature to date. Unusual subcutaneous nodules often appearing in successive crops and exhibiting a diffuse distribution (buttocks, trunk, back, and even scalp) associated with signs of active synovitis should alert the clinician to the possibility of occult or unconsidered pancreatic disease.