A 51-year-old man came to the emergency department complaining of nodular, erythematous-vioceae and painful lesions on his ankles for 6-7 days, accompanied by swelling of the back of his feet.
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The patient was in good general condition with no other accompanying symptoms.
His personal history included three episodes of acute pancreatitis secondary to chronic alcoholism, the last one year ago.
A chronic pancreatitis, as well as two pancreatic pseudocysts, was detected at the magnetic resonance cholangiography performed at that time and was being followed up by the Digestive Service.
Skin biopsy and analytical study were performed and treatment with nonsteroidal anti-inflammatory drugs was initiated.
Histopathology of one of the cutaneous lesions showed an intense inflammatory infiltrate in the fatty lobule consisting of polymorphonuclear neutrophils, soaps secondary to fat necrosis and areas of hemorrhage.
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The analytical study showed pancreatic amylase values of 469 UI/L consistent with the diagnosis of pancreatic pancreatitis. The patient was admitted for study and monitoring of possible chronic exacerbation.
The evolution of the cutaneous lesions was good, although the antimalarial treatment discontinued due to epigastric pain.
However, epigastric pain did not subside and was even more continuous and intense, followed by nausea and vomiting.
The clinical features and levels of amylase were controlled during admission by conservative measures, but in the control computerized tomography (CT) an increase in the size of the head of the pancreas was observed, with destruction of the pancreatic duct of Wirsung.
Five months after the diagnosis of pancreatic pancreatitis, a control CT scan reported resolution of pancreatic pathology, with portal cavernous transformation and persistence of small lymph nodes without clear pathological significance.
