Aggressive multiple myeloma presenting as mesenteric panniculitis

Abstract

Mesenteric panniculitis is a rare disease of the bowel mesentery, characterized by tumor-like infiltration by chronic inflammatory cells, fat necrosis, and fibrosis. Reported cases cited clinical presentation ranging from abdominal pain to fever of unknown origin, the majority of which were idiopathic and associated with a benign prognosis. We report the case of a 43-yr-old male who presented with malaise, weight loss, microcytic anemia, and a high erythrocyte sedimentation rate. Radiographic and histological investigations revealed typical features of mesenteric panniculitis. Initial treatment with high-dose oral prednisolone led to rapid and complete resolution of symptomatology, radiographic, and laboratory anomalies. Within 6 months, the patient presented again with anemia, renal failure, and hypercalcemia. A diagnosis of IgA kappa chain myeloma was made. Despite chemotherapy and restoration of normocalcemia, he died from refractory pulmonary edema. This is the first report of a hematological malignancy initially presenting with features of mesenteric panniculitis culminating in an aggressive course and a fatal outcome.

Mesenteric panniculitis: US and CT features

“…A variety of possible causative factors have been proposed, such as autoimmune disorders, ischemia and prior abdominal surgery. In addition, it has also been suggested that mesenteric panniculitis might represent a paraneoplastic response [1,8,9]. This latter possible association with a concomitant malignancy has recently been highlighted in a study by Daskalogiannaki [1], reporting the presence of a coexisting abdominal or distal malignancy in 69% of patients with CT features of mesenteric panniculitis.…”

Multiple Myeloma Involving the Porta Hepatis and Peritoneum Causing Biliary Obstruction and Malignant Ascites

“…Others may also be affected including the gallbladder, adrenals, bladder, mesentery, and reproductive organs. (4,6,7). When affecting the liver, myeloma is typically a diffusely infiltrative process, leading to intrahepatic cholestasis and jaundice.…”

A Pictorial Review on Extraosseous Manifestations of Multiple Myelomas

“…11) or permeative and infiltrative tumor growth. The extraosseous myeloma present as mesenteric panniculitis (9). Under these conditions, abdominal CT scans showed mesenteric thickening and inhomogeneous areas of fat interspersed with soft-tissue attenuation.…”