Po Xiang Yuen
General Surgery Department, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia.
J Surg Case Rep. 2025 May 15;2025(5):rjaf305. doi: 10.1093/jscr/rjaf305. eCollection 2025 May.
Patient presented with asymmetric polyarthritis and tender skin erythematous lesions over his lower limbs associated with intermittent fever. He has a history of excessive alcohol usage without previous episode of pancreatitis. He subsequently developed abdominal pain and was noted to have elevated lipase levels and computed tomography (CT) of his abdomen showed evidence of acute pancreatitis. Biopsy of a lower limb lesion proved panniculitis. CT scan of his ankle showed arthritis and an insufficiency fracture. The diagnosis of pancreatitis, panniculitis, and polyarthritis (PPP) syndrome was made based on his PPP. He subsequently developed multiple complications of pancreatitis which led to prolonged hospitalization and multiple interventions. PPP syndrome triad is hypothesized to occur due to leakage of pancreatic enzymes into the systemic circulation. Management of the underlying pancreatitis usually helps resolve the other sequalae of PPP syndrome. This is the first case report of PPP syndrome with associated vessel pseudoaneurysm to date.
患者表现为不对称性多关节炎，下肢有压痛性皮肤红斑病变，并伴有间歇性发热。他有过量饮酒史，既往无胰腺炎发作史。随后他出现腹痛，脂肪酶水平升高，腹部计算机断层扫描（CT）显示有急性胰腺炎的迹象。下肢病变活检证实为脂膜炎。踝关节CT扫描显示有关节炎和应力性骨折。根据其临床表现诊断为胰腺炎、脂膜炎和多关节炎（PPP）综合征。随后他出现了胰腺炎的多种并发症，导致住院时间延长和多次干预。推测PPP综合征三联征是由于胰腺酶漏入体循环所致。治疗潜在的胰腺炎通常有助于解决PPP综合征的其他后遗症。这是迄今为止第一例伴有血管假性动脉瘤的PPP综合征病例报告。
