A 53-year-old Man Presented with Skin Rash on Swollen Right Calf

Abstract

<p>胰臟炎、脂膜炎與多發性關節炎症候群（pancreatitis, panniculitis, and polyarthritis, PPP）是胰臟疾病患者罕見發生於肢體的合併症。雖然PPP症候群罕見，當延遲診斷或缺乏胰臟炎治療時會導致高死亡率。本個案為53歲男性胰臟炎史，此次因右小腿長期反復發紅性皮疹腫脹和復發性雙膝關節炎，經相關檢查後診斷為右小腿膿瘍與多發性膝關節炎住院，於施行右小腿手術中發現與組織病理報告皆有脂膜炎病徵之異常呈現；雖然個案無腹部不適主訴，但回溯先前腹部電腦斷層有滲出性胰臟炎發現，因此於治療後期診斷為PPP症候群，持續給予適當抗生素和抗胰臟炎藥物治療使症狀獲得改善。因此當臨床遇見中年男性胰臟病史患者、伴隨反復性下肢腫脹、發紅性皮疹和復發性膝關節炎症狀，則胰臟炎、脂膜炎與多發性關節炎症候群就必須列入考慮，以避免錯失治療先機。</p><p>The pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a complication that rarely occur inthe limbs of patients with pancreatic diseases. Although PPP syndrome is rare, the mortality rate is high due to late diagnosis, or the lack of pancreatitis treatment. The case is about a 53-year-old man with a history of pancreatitis. This time the patient was hospitalized due to long-term recurrent skin rashes, swelling of the right calf, and bilateral knee arthritis. After necessary examinations, he was initially diagnosed with right lower leg abscess and knee polyarthritis. However, there were abnormal signs of panniculitis from operative findings and histopathological reports. Although the patient had no complaint of abdominal discomfort, but exudative pancreatitis was discovered through backtrack-ing the computer tomography. Therefore, he was diagnosed with PPP syndrome at the later stage of the treatment and continued to undergo appropriate antibiotics and anti-pancreatitis medications until the symptoms were improved. Consequently, when a middle-aged man with a history of pancreatic disease is encountered clinically, accompanied with repetitive lower limb swelling, skin rashes and recurrent knee arthritis, the PPP syndrome must be considered to quire early treatment opportunity.</p> <p> </p>