Late pancreatic panniculitis in a simultaneous pancreas kidney transplant patient with failed allografts

Mirza M. Baig, Muhammad Yaqub, Tim Taber, Jonathan Fridell, Asif Sharfuddin

Research output: Contribution to journalArticle

Abstract

We present a rare case of pancreatic panniculitis in a 59-year-old male simultaneous pancreas–kidney (SPK) recipient with failed allografts. The patient presented with fever and painful erythematous nodules on his leg 1 month after stopping all immunosuppression. A thorough infectious and rheumatological workup was negative. He had pancreas rejection 4 years after SKP transplant and was restarted on dialysis after 14 years when his renal allograft failed due to chronic allograft nephropathy. His chronic immunosuppression (tacrolimus, azathioprine) was stopped and prednisone was weaned over 3 months at that time. A skin biopsy revealed saponification of the subcutaneous fat with inflammation pathognomonic of pancreatic panniculitis. Concurrent allograft pancreatitis confirmed with elevated lipase and a computed tomography scan finding of peripancreatic graft stranding and atrophic native pancreas. He was started on pulse steroid therapy for 3 days followed by oral taper. This resulted in dramatic resolution of all skin lesions and normalization of lipase levels within 1 week, followed by resumption of low-dose tacrolimus and azathioprine. This is an extremely rare occurrence of panniculitis in pancreas allograft after 10 years of pancreatic failure associated with stopping immunosuppression.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Panniculitis
Allografts
Pancreas
Transplants
Kidney
Immunosuppression
Azathioprine
Tacrolimus
Lipase
Skin
Subcutaneous Fat
Prednisone
Pancreatitis
Dialysis
Leg
Fever
Steroids
Tomography
Inflammation
Biopsy

Keywords

  • acute
  • clinical research/ practice
  • complication
  • diabetes
  • immunosuppression/immune modulation
  • immunosuppressive regimens – maintenance
  • insulin/C-peptide
  • medical/metabolic
  • pancreas/simultaneous pancreas-kidney transplantation
  • pathology/histopathology
  • rejection
  • type 1

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

@article{a9ad99f0560f43119c9666601a4a1fb4,
title = "Late pancreatic panniculitis in a simultaneous pancreas kidney transplant patient with failed allografts",
abstract = "We present a rare case of pancreatic panniculitis in a 59-year-old male simultaneous pancreas–kidney (SPK) recipient with failed allografts. The patient presented with fever and painful erythematous nodules on his leg 1 month after stopping all immunosuppression. A thorough infectious and rheumatological workup was negative. He had pancreas rejection 4 years after SKP transplant and was restarted on dialysis after 14 years when his renal allograft failed due to chronic allograft nephropathy. His chronic immunosuppression (tacrolimus, azathioprine) was stopped and prednisone was weaned over 3 months at that time. A skin biopsy revealed saponification of the subcutaneous fat with inflammation pathognomonic of pancreatic panniculitis. Concurrent allograft pancreatitis confirmed with elevated lipase and a computed tomography scan finding of peripancreatic graft stranding and atrophic native pancreas. He was started on pulse steroid therapy for 3 days followed by oral taper. This resulted in dramatic resolution of all skin lesions and normalization of lipase levels within 1 week, followed by resumption of low-dose tacrolimus and azathioprine. This is an extremely rare occurrence of panniculitis in pancreas allograft after 10 years of pancreatic failure associated with stopping immunosuppression.",
keywords = "acute, clinical research/ practice, complication, diabetes, immunosuppression/immune modulation, immunosuppressive regimens – maintenance, insulin/C-peptide, medical/metabolic, pancreas/simultaneous pancreas-kidney transplantation, pathology/histopathology, rejection, type 1",
author = "Baig, {Mirza M.} and Muhammad Yaqub and Tim Taber and Jonathan Fridell and Asif Sharfuddin",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/ajt.15485",
language = "English (US)",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Late pancreatic panniculitis in a simultaneous pancreas kidney transplant patient with failed allografts

AU - Baig, Mirza M.

AU - Yaqub, Muhammad

AU - Taber, Tim

AU - Fridell, Jonathan

AU - Sharfuddin, Asif

PY - 2019/1/1

Y1 - 2019/1/1

N2 - We present a rare case of pancreatic panniculitis in a 59-year-old male simultaneous pancreas–kidney (SPK) recipient with failed allografts. The patient presented with fever and painful erythematous nodules on his leg 1 month after stopping all immunosuppression. A thorough infectious and rheumatological workup was negative. He had pancreas rejection 4 years after SKP transplant and was restarted on dialysis after 14 years when his renal allograft failed due to chronic allograft nephropathy. His chronic immunosuppression (tacrolimus, azathioprine) was stopped and prednisone was weaned over 3 months at that time. A skin biopsy revealed saponification of the subcutaneous fat with inflammation pathognomonic of pancreatic panniculitis. Concurrent allograft pancreatitis confirmed with elevated lipase and a computed tomography scan finding of peripancreatic graft stranding and atrophic native pancreas. He was started on pulse steroid therapy for 3 days followed by oral taper. This resulted in dramatic resolution of all skin lesions and normalization of lipase levels within 1 week, followed by resumption of low-dose tacrolimus and azathioprine. This is an extremely rare occurrence of panniculitis in pancreas allograft after 10 years of pancreatic failure associated with stopping immunosuppression.

AB - We present a rare case of pancreatic panniculitis in a 59-year-old male simultaneous pancreas–kidney (SPK) recipient with failed allografts. The patient presented with fever and painful erythematous nodules on his leg 1 month after stopping all immunosuppression. A thorough infectious and rheumatological workup was negative. He had pancreas rejection 4 years after SKP transplant and was restarted on dialysis after 14 years when his renal allograft failed due to chronic allograft nephropathy. His chronic immunosuppression (tacrolimus, azathioprine) was stopped and prednisone was weaned over 3 months at that time. A skin biopsy revealed saponification of the subcutaneous fat with inflammation pathognomonic of pancreatic panniculitis. Concurrent allograft pancreatitis confirmed with elevated lipase and a computed tomography scan finding of peripancreatic graft stranding and atrophic native pancreas. He was started on pulse steroid therapy for 3 days followed by oral taper. This resulted in dramatic resolution of all skin lesions and normalization of lipase levels within 1 week, followed by resumption of low-dose tacrolimus and azathioprine. This is an extremely rare occurrence of panniculitis in pancreas allograft after 10 years of pancreatic failure associated with stopping immunosuppression.

KW - acute

KW - clinical research/ practice

KW - complication

KW - diabetes

KW - immunosuppression/immune modulation

KW - immunosuppressive regimens – maintenance

KW - insulin/C-peptide

KW - medical/metabolic

KW - pancreas/simultaneous pancreas-kidney transplantation

KW - pathology/histopathology

KW - rejection

KW - type 1

UR - http://www.scopus.com/inward/record.url?scp=85068354471&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068354471&partnerID=8YFLogxK

U2 - 10.1111/ajt.15485

DO - 10.1111/ajt.15485

M3 - Article

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

ER -