Symptoms of pancreatitis, panniculitis, and polyarthritis (PPP) syndrome
PPP syndrome is a systemic syndrome occurring in some patients with pancreatitis or pancreatic acinar cell carcinoma. Its clinical manifestations can be remembered by the following mnemonic:
- P = Pancreatitis
- A = Arthritis (60%) and arthralgias, usually of the ankles and knees (synovial fluid is typically noninflammatory and creamy in color as a result of lipid droplets that stain with Sudan black or oil red O)
- N = Nodules that are tender, red, and usually on extremities (frequently misdiagnosed as erythema nodosum but really are areas of lobular panniculitis with fat necrosis)
- C = Cancer of the pancreas (a more common cause than pancreatitis)
- R = Radiologic abnormalities caused by osteolytic bone lesions from bone marrow necrosis (10%)
- E = Eosinophilia
- A = Amylase, lipase, and trypsin released by the diseased pancreas (causes fat necrosis in skin, synovium, and bone marrow)
- S = Serositis, including pleuropericarditis, frequently with fever
