Subcutaneous Fat Necrosis Associated with Chronic Alcoholic Pancreatitis

Abstract

A 57-year-old man presented to the Dermatology Department with a 6-week history of rash on the lower extremities. His medical history included chronic alcoholic pancreatitis, and he continued to drink. Physical examination revealed hot, dark red erythematous lesions on the lower extremities,with admixed purpura on the left lower thighs. All lesions were tender when pressed. We considered erythema nodosum, vasculitis, and subcutaneous fat necrosis. White cell blood count was 12,390/μL and both the amylase and lipase levels were markedly elevated (to 3,622 and 6,996 U/L, respectively). C-reactive protein level was 3.62 mg/dL, but we did not detect antibodies against PR3- or MPO-ANCA. Histopathology revealed mild dermal periadnexal lymphocytic infiltrations and dense lymphocytic and histiocytic infiltrations into the upper subcutaneous tissue. Degeneration and necrosis of lipid cells (including ghost-like cells) were observed in the lower regions of subcutaneous tissue. We diagnosed subcutaneous fat necrosis based on these findings. Three weeks after the initial visit, the cutaneous lesions disappeared without treatment, and pancreatitis improved. Among similar reported cases, males were slightly more frequently affected than females, and all patients developed a rash on the lower thighs. Over 90% of patients had acute or chronic pancreatitis, or primary pancreatic cancer. In terms of diagnosis, the histopathological findings (particularly the ghost-like cells) were the most important, and hyperlipasemia was more useful than hyperamylasemia. A confirmed diagnosis of subcutaneous fat necrosis prompts early treatment for pancreatitis as skin rash preceded pancreatic disorder in 61.7% of reported cases. Therefore, it is important to consider subcutaneous fat necrosis (which is rare) when a patient presents with symptoms similar to those described above. Skin Research, 21 : 226-230, 2022