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Subcutaneous Nodular Fat Necrosis in Pancreatitis

ROBERT W. SCHRIER, MD; KENNETH L. MELMON, MD; L. FREDERICK FENSTER, MD
Arch Intern Med. 1965;116(6):832-836. doi:10.1001/archinte.1965.03870060030007.
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ACUTE PANCREATITIS is a common disorder which, in the vast majority of instances, can be readily diagnosed by the alert physician. It is, however, one of medicine's great mimics and is not infrequently associated with one or more of a variety of atypical peripheral manifestations which may dominate the clinical picture and confuse the diagnostician. Thus, a patient may present not only with abdominal pain but with massive pleural effusions,1 ascites,2 hyperlipemia,3 hemolytic anemia,4 venous thrombosis,5 common duct obstruction with jaundice,6 acute renal failure7 or unexplained shock.8 Perhaps one of the rarest but most striking manifestations of the disease is subcutaneous nodular fat necrosis. The purpose of this paper is to present the 13th recorded case of acute pancreatitis in which the most prominent peripheral manifestation was subcutaneous nodular fat necrosis which, for some time, was mistaken for "erythema nodosum." A brief review of the literature is included.

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