By Gary M. White, MD

A panniculitis mimicking erythema nodosum may occur in association with pancreatic disease, most commonly pancreatitis secondary to alcoholism. It may also occur secondary to pancreatic cancer.


An acute eruption of tender erythematous nodules on the shins and legs in a patient with pancreatic disease. Lesions may ulcerate, discharging an oily brown liquid (liquefied fat?). Fat of the body may be affected, leading to systemic signs and symptoms, e.g., arthritis, pleural effusion.

Schmid's triad--a poor prognostic sign--is panniculitis, polyarthritis, and eosinophilia in a patient with pancreatic cancer.

Differential Diagnosis

Workup usually includes biopsy, culture of any draining liquid, and pancreatic enzymes. See panniculitis differential.


Any pancreatic disease should be treated. The skin lesions may be more easily tolerated if rest, elevation, and pain medication are prescribed. As the pancreatitis improves, so should the skin lesions.


A 61-year-old woman presented with 3 occasions over 2 months of multiple tender erythematous nodules on both lower limbs extending to the thighs. Biopsy was consistent with pancreatic panniculitis which was then found on further workup. JAAD Case Rep. 2016 May; 2(3): 244–246

CMAJ February 7, 2012 vol. 184 no. 2 E159


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