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This 48 year old man developed alcohol induced pancreatitis. During the admission he developed a florid, patchy panniculitis with fluctuent swellings over his elbows, wrists, knees and ankles (figure, top left) and an asymmetric polyarthritis affecting large and small joints. Sterile pus was aspirated from the subcutaneous swellings and several joints; staining of synovial fluid was positive for lipid. Radiographs showed a severe destructive chondropathy, patchy osteoporosis, erosions, osteolytic lesions, and periostitis (figure, right panels).
The bone lesions in pancreatic arthropathy are thought to result from medullary fat necrosis1 secondary to high circulating lipase concentrations. The inflammatory arthropathy may result from excess concentrations of intra-articular free fatty acids derived from lipoproteins or hydrolysis of local adipose tissue.2 Chronic pancreatitis or carcinoma of the pancreas may also cause this rare arthropathy. There is no specific treatment and the locomotor outcome is poor.
Contributors: gary d wright, des green, michael doherty. City Hospital, Nottingham, NG5 1PB, United Kingdom.
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