Lipomatous pseudohypertrophy of pancreas with chronic calcific pancreatitis presenting with nutritional dermatosis and type 3c diabetes

A woman in her early 50s presented with a 4-month history of erythema and scaling of the limbs, weight loss, anasarca and chronic foul-smelling diarrhoea, suggestive of nutritional dermatosis with steatorrhoea due to malabsorption. She was non-obese and had no prior history of diabetes or exocrine deficiency. During admission, she experienced abdominal pain and hyperglycaemia consistent with diabetic ketoacidosis. CT of the abdomen revealed a diffusely enlarged, entirely fatty pancreas with preserved shape and a dilated main pancreatic duct containing intraductal calculi, indicating lipomatous pseudohypertrophy (LPH) with chronic calcific pancreatitis (CCP). Clinical and imaging findings confirmed exocrine insufficiency, while coexisting diabetes mellitus, which can be attributed to CCP, suggested a type 3 c diabetes mellitus. She developed sepsis and despite intensive medical management, she died of refractory septic shock. Enlarged pancreatic volume distinguishes LPH from the usual degenerative fatty replacement commonly seen in older patients or patients with obesity or diabetes.