Pancreatitis, Panniculitis, and Polyarthritis Syndrome Presenting With Gouty Arthritis: A Case Report

Abstract

     Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome combined with gouty arthritis has never been reported in the literature. A 49-year-old male with a history of heavy alcohol abuse for at least 20 years, chronic pancreatitis, and gouty arthritis, presented with pain, swelling, and erythema involving the right thumb, right 4th metatarsophalangeal (MTP) joint, and left heel for one week. Following examination of the synovial fluid positive for monosodium urate (MSU) crystals, he was treated for gouty arthritis and the polyarthritis progressed. A skin biopsy revealed pancreatic panniculitis. Abdominal computed tomography (CT) also showed swelling of the pancreas with peripancreatic fat infiltrations. The secondary arthrocentesis was performed and the synovial fluid showed amylase 1,970 U/L, lipase 1,260 U/L, cholesterol 79 mg/dL, and triglycerides 78 mg/dL. We report this case to remind physicians that the first manifestation of PPP syndrome can be mistaken for gouty arthritis.




doi:10.4021/jmc178w