Pancreatic Panniculitis: Silent Conundrum?

Pancreatic panniculitis is a rare cutaneous manifestation of pancreatic disease, most commonly occurring in patients with acute or chronic pancreatitis or pancreatic neoplasms. In most reported cases, pancreatic pathology is recognized before or concurrent with the onset of skin lesions; less commonly, panniculitis precedes the diagnosis. Histology demonstrates a lobular panniculitis with saponified fat necrosis and anucleate "ghost" adipocytes, findings that are pathognomonic. Clinically, pancreatic panniculitis presents as tender subcutaneous nodules, most often on the lower extremities, and may be accompanied by systemic manifestations such as fever and inflammatory arthritis. We report 2 cases of pancreatic panniculitis occurring in patients without abdominal pain.