Pancreatic panniculitis is an uncommon complication of pancreatic disease, most frequently pancreatitis and pancreatic carcinoma. The pathogenesis of the process remains unknown, but possibly the release of pancreatic enzymes may induce permeability of the microcirculation and cause fat necrosis. Clinically, pancreatic panniculitis presents with tender, ill-defined, red-brown nodules in the lower extremities that may ulcerate and drain an oily substance and usually precedes pancreatic disease. The histopathologic picture consists of a mostly lobular panniculitis without vasculitis, with the presence of the typical ghost cells that correspond to necrotic and calcified adipocytes. Treatment should be directed at the underlying pancreatic disease.