Malignant peritoneal mesothelioma presenting with persistent high fever

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare tumor that develops in the peritoneum. In this paper, we describe an extremely rare case of MPM metastasizing to the appendix in a 48-year-old female who initially presented with a persistent high fever. The woman reported a slight lower abdominal discomfort which had been relieved by urination for four months. She had lost 5 kg of weight. There was no nausea, vomiting, diarrhea, abdominal pain, or abdominal distension. Many broad spectrum antibiotics were given without relief of fever. Computed tomography (CT) scans revealed a thickened omentum majus and diffused multiple omental nodules. An omentectomy, appendectomy, and adnexectomy were carried out. A gross pathologic specimen of omentum tissue revealed a firm gray-white mass. Microscopic and immunohistochemical examinations confirmed the diagnosis of appendiceal and bilateral adnexal metastases of an MPM. These results suggest that MPM should be considered in the differential diagnosis of unexplained persistent high fever. Awareness of such atypical presentations of mesothelioma may help to make a correct diagnosis.

Malignant Peritoneal Mesothelioma Presenting with Polymyalgia Rheumatica-like Syndrome

“…Asbestos exposure is evident in 80% of malignant pleural mesothelioma cases but in only 33% to 50% of MPM cases. ( 18 - 20 ) Because the clinical symptoms of abdominal pain, abdominal distension, weight loss, and fever are not specific to MPM ( 21 ), MPM in the early stages is difficult to diagnose, especially in the absence of any risk factors.…”

Fever of unknown origin: a clinical mask of malignant peritoneal mesothelioma

“…Pain, increasing abdominal girth, anorexia and weight loss, and recurrent ascites are the most frequent and non-specific presenting symptoms of peritoneal mesothelioma. Less common signs, such as persistent fever, night sweats [8] and mechanical bowel obstruction [9], are regarded as poor prognostic factors. Mesothelioma can be also associated with such paraneoplastic signs as thrombocytosis, hypoglycaemia, thrombophlebitis and liver failure [4].…”

Coexistence of Diffuse Malignant Peritoneal Mesothelioma andCandida norvegensisPeritonitis

“…Persistent high-grade fever as the clinical presentation of DMPM has been described in only six instances. No fungal infection was detected in those patients but, characteristically, all of them received broad-spectrum antibiotic therapy or fluconazole without defervescence [11][12][13][14]. Given the strong analogies with our patient, who received similar medication, it is tenable to posit that those patients also suffered from an undiagnosed peritoneal or invasive infection attributable to C. norvegensis.…”

“…We would like to pique interest by offering our experience with a case of proved peritonitis caused by C. norvegensis-an event rare in itself-associated with diffuse malignant peritoneal mesothelioma (DMPM), an uncommon cancer of the abdomen having a poor prognosis [9,10]. We investigated the possible relations between these two infrequent diseases by reviewing the literature [11][12][13][14].…”