A 51 year old male presented to the dermatology department for 6-7 days with nodular, erythematous-violaceous, painful lesions on the legs and dorsum of the feet, accompanied by swelling of the ankles.

The patient was in good general health, with no other accompanying symptoms. His personal history included three episodes of acute pancreatitis secondary to chronic ethylism, the last one a year ago. The magnetic resonance cholangiography performed at that time had detected chronic pancreatitis, as well as two pancreatic pseudocysts, for which he was being monitored by the Digestive Service. A skin biopsy and analytical study were performed and treatment was started with non-steroidal anti-inflammatory drugs and omeprazole. Histopathology of one of the skin lesions showed an intense inflammatory infiltrate in the fatty lobule consisting of neutrophilic polymorphonuclear cells, soaps secondary to fat necrosis and areas of haemorrhage.

The analytical study showed pancreatic amylase values of 469 IU/L. In view of these findings, compatible with the diagnosis of pancreatic panniculitis, the patient was admitted to the hospital to be studied and monitored for a possible exacerbation of his chronic pancreatitis. The evolution of the skin lesions was good, despite the fact that the patient had discontinued anti-inflammatory treatment due to epigastralgia. However, the epigastralgia did not subside and even became more continuous and intense, and was subsequently accompanied by nausea and vomiting. The clinical manifestations and amylase levels were controlled during admission by conservative measures, but the control CT scan showed an enlargement of the pancreatic head, with dilatation of the duct of Wirsung, partial destruction of the pancreatic gland, peripancreatic, celiac and gastrohepatic ligament adenopathies, together with portal vein thrombosis, which required anticoagulant treatment. Five months after the diagnosis of pancreatic panniculitis, the control CT scan reported resolution of the pancreatic pathology, with portal cavernomatous transformation and persistence of small lymphadenopathies with no clear pathological significance, so that the picture was finally interpreted as an exacerbation of his chronic pancreatitis.