A Case of Subcutaneous Nodular Fat Necrosis Associated with Intraductal Papillary Mucinous Neoplasm

Abstract

An 84-year-old man presented with painful subcutaneous nodules on both lower legs and feet that had begun to develop a week earlier. Erythema nodosum was suspected and skin biopsy was performed, which revealed the presence of ghost-like cells. Based on this nding, the lesions were diagnosed as subcutaneous nodular fat necrosis. As pancreatic disease was suspected to be involved in this condition, the patient underwent more detailed examinations. Blood examination revealed high serum levels of pancreatic enzymes (serum amylase : 2,244 IU/L, serum lipase : 306 U/L). In addition, abdominal ultrasonography and magnetic resonance cholangiopancreatography (MRCP) revealed cystic lesions in the pancreas and dilatation of the main pancreatic duct. Based on these ndings, the patient was diagnosed with intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Thus, in this case, the diagnosis of subcutaneous nodular fat necrosis led to the diagnosis of IPMN. Subcutaneous nodular fat necrosis sometimes precedes the clinical symptoms of pancreatic diseases. Therefore, early diagnosis of subcutaneous nodular fat necrosis is important for the early detection of pancreatic diseases. Skin Research, 18 : 349-352, 2019