Pancreatic Panniculitis Complicated by Asymptomatic Acute Pancreatitis with Biliary Stricture: Analysis of a Misdiagnosed Case.

This report describes a case of pancreatic panniculitis secondary to acute pancreatitis caused by biliary stricture following multiple biliary surgeries. The aim is to highlight the importance of recognizing atypical presentations. The patient, a 46-year-old woman, presented with erythematous macules and nodules on the extremities accompanied by polyarthralgia. She had a history of multiple biliary surgeries over the past decade. Histopathological examination of the skin lesions revealed no significant epidermal abnormalities but demonstrated perivascular neutrophilic infiltration in the dermis and subcutaneous fat, with evidence of adipocyte necrosis, calcification, and ghost cell formation. Laboratory findings indicated hyperamylasemia; however, the initial imaging did not suggest pancreatitis and there are no relevant clinical symptoms, which contributed to the misdiagnosis. This case underscores the need for heightened awareness of atypical clinical manifestations in pancreatic-related conditions.