Disordered Presentation of Paraneoplastic Pancreatitis, Polyarthritis and Panniculitis (PPP) Syndrome in a Patient with End-Stage Pancreatic Cancer

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Melody Maarouf
Marilyn Wickenheiser
James Sligh
Keliegh Culpepper
Vivian Shi



We report a rare case of PPP due to stage IV beta-islet pancreatic cancer presenting with polyarthritis, whose diagnosis was delayed due to an incomplete presentation of PPP syndrome. Following an extensive one-month infectious disease workup, tender erythematous papules began to develop, which prompted the consideration and subsequent biopsy for pancreatic panniculitis. Thus, the diagnosis was delayed due to a lagging cutaneous presentation—a component of the triad that is commonly the initial presentation in most patients. 


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