Kohanzadeh Avraham, Sher Ariel, Wind Olivia, Liu Qiang, Srivastava Pooja, Amin Bijal, Mann Ranon
Internal Medicine, Albert Einstein College of Medicine, New York City, USA.
Dermatology, New York Medical College, New York City, USA.
Cureus. 2024 Jan 25;16(1):e52925. doi: 10.7759/cureus.52925. eCollection 2024 Jan.
We present a unique case of pancreatic panniculitis (PP) in a 42-year-old male with a history of pancreas-after-kidney (PAK) transplant. The patient developed PP due to acute pancreas allograft rejection. Clinical manifestations included fevers, myalgias, arthralgias, and tender erythematous subcutaneous nodules on the lower extremities. A recent hospital admission was noted for acute pancreas allograft rejection related to low tacrolimus levels. Rheumatological and infectious disease workups were negative. Skin nodule punch biopsy confirmed PP with lobular panniculitis, necrotic adipocytes, basophilic debris, and calcification. Pancreatic biopsy showed evidence of parenchymal acute cellular rejection. Lipase and amylase levels were elevated (1781 U/L and 881 U/L, respectively). Treatment involved pulse solumedrol and thymoglobulin for pancreatic rejection, alongside adjustments to immunosuppressive medications. This case highlights the rarity of PP in a PAK recipient and its association with acute pancreas allograft rejection. Importantly, it is the first reported case of PP occurring solely in the context of pancreas transplant rejection, without concurrent kidney damage or rejection. Prompt diagnosis and management led to the resolution of skin and systemic symptoms. In conclusion, this report presents a clinically relevant and unique case of PP resulting from acute pancreas allograft rejection in a PAK transplant recipient. The findings underscore the importance of early diagnosis and management for positive patient outcomes, serving as a reminder to consider underlying pancreatic pathology when encountering PP in transplant recipients.
我们报告了一例42岁男性胰腺移植术后患者发生胰腺性脂膜炎（PP）的独特病例。该患者因急性胰腺移植排斥反应而发生PP。临床表现包括发热、肌痛、关节痛以及下肢压痛性红斑皮下结节。近期因他克莫司水平低导致急性胰腺移植排斥反应而入院。风湿免疫及感染性疾病检查均为阴性。皮肤结节穿刺活检确诊为PP，表现为小叶性脂膜炎、坏死脂肪细胞、嗜碱性碎屑及钙化。胰腺活检显示实质急性细胞排斥反应的证据。脂肪酶和淀粉酶水平升高（分别为1781 U/L和881 U/L）。治疗包括使用甲泼尼龙冲击疗法和抗胸腺细胞球蛋白治疗胰腺排斥反应，同时调整免疫抑制药物。该病例突出了PP在胰腺移植术后患者中的罕见性及其与急性胰腺移植排斥反应的关联。重要的是，这是首例仅在胰腺移植排斥反应背景下发生PP的病例，无并发肾脏损害或排斥反应。及时诊断和处理使皮肤及全身症状得到缓解。总之，本报告展示了一例胰腺移植术后患者因急性胰腺移植排斥反应导致PP的临床相关独特病例。这些发现强调了早期诊断和处理对于患者良好预后的重要性，提醒在移植受者中遇到PP时要考虑潜在的胰腺病变。
