Sclerosing mesenteritis as an unusual cause of fever of unknown origin: a case report and review

Avelino‐Silva, Vivian Iida; Leal, Fábio E.; Coelho-Netto, Caio; Cotti, Guilherme Cutait de Castro; Souza, Ricardo A. S.; Azambuja, Rodrigo; Rocha, Manoel de Souza; Kallas, Esper G.

doi:10.6061/clinics/2012(03)16

Cited by 9 publications

(4 citation statements)

References 13 publications

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“…In some patients, especially those having an acute presentation of the disease, a viral mesenteritis is likely. Fever of unknown origin[13] and chylous ascites have also been described in patients with MP. CT imaging of the abdomen in these patients demonstrates a mass of the mesentery, characterized by fat enhancement and multiple soft tissue nodules along the root of the small bowel without vascular compromise; these are distinguishing radiographic features of MP.…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of mesenteric panniculitis-like abnormalities on abdominal computerized tomography in patients with malignant neoplasms

Ehrenpreis

Roginsky

Gore

2016

WJG

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AIMTo clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography (CT).METHODSAll abdominal CT scans performed at NorthShore University HealthSystem showing mesenteric panniculitis from January 2005 to August 2010 were identified in the Radnet (RadNet Corporation, Los Angeles, CA) database. Patients with a new or known diagnosis of a malignancy were included for this analysis. Longitudinal clinical histories were obtained from electronic medical records.RESULTSIn total, 147794 abdominal CT scans were performed during the study period. Three hundred and fifty-nine patients had mesenteric panniculitis (MP)-like abnormalities on their abdominal CT. Of these patients, 81 patients (22.6%) had a known history of cancer at the time of their CT scan. Nineteen (5.3%) had a new diagnosis of cancer in concurrence with their CT, but the majority of these (14/19, 74%) were undergoing CT as part of a malignancy evaluation. Lymphomas were the most common cancers associated with MP-like findings on CT (36 cases, 36%), with follicular lymphoma being the most frequent subtype (17/36). A variety of solid tumors, most commonly prostate (7) and renal cell cancers (6) also were seen. CT follow up was obtained in 56 patients. Findings in the mesentery were unchanged in 45 (80%), worsened in 6 (11%), and improved in 5 patients (9%). Positron emission tomography (PET) scans performed in 44 patients only showed a positive uptake in the mesenteric mass in 2 patients (5%).CONCLUSIONA new diagnosis of cancer is uncommon in patients with CT findings suggestive of MP. MP-like mesenteric abnormalities on CT generally remain stable in patients with associated malignancies. PET scanning is not recommended in the evaluation of patients with mesenteric panniculitis-like findings on CT.

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Section: Introductionmentioning

confidence: 99%

Clinical significance of mesenteric panniculitis-like abnormalities on abdominal computerized tomography in patients with malignant neoplasms

Ehrenpreis

Roginsky

Gore

2016

WJG

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“…Aside from autoimmune disease, infectious diseases including but not limited to tuberculosis, cholera, malaria and influenza have been described with MP. 22,23 As mentioned previously (see Pathophysiology), MP is associated with several idiopathic inflammatory and fibrotic disorders, as well as with some chronic gastrointestinal diseases. ►Table 2 is a list of diagnoses associated with MP.…”

Section: Other Conditions and Associationsmentioning

confidence: 86%

Mesenteric Panniculitis, Sclerosing Mesenteritis and Mesenteric Lipodystrophy: Descriptive Review of a Rare Condition

Wagner

Dachman

Ehrenpreis

2022

Clin Colon Rectal Surg

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Mesenteric panniculitis (MP) is the preferred nomenclature for a continuum of inflammatory diseases of the mesentery. The diagnosis of MP is often based on the appearance of a mass-like structure at the root of the mesentery. Characteristic histology includes focal fat necrosis, chronic inflammation, and sometimes mesenteric fibrosis. At present, robust literature related to diagnosis and management of MP are limited. MP is postulated to be an immune-mediated chronic inflammatory and/or a paraneoplastic disease. A personal or family history of other autoimmune diseases is commonly apparent. Several inciting events have been identified that possibly act as triggers in the development of the disease. Trauma, abdominal surgery, infection, and various cancers have been associated with mesenteric panniculitis.There are several diagnostic and histologic criteria that aid in making the diagnosis of MP. The differential diagnosis for a mesenteric mass includes neoplastic disease, and a biopsy may be indicated to rule out other conditions.While cases of MP with a short duration of symptoms, or spontaneously regression may occur, some patients experience prolonged periods of pain, fever, and alterations in bowel habit, causing significant morbidity. A variety of medical therapies have been suggested for MP. Only two, thalidomide and low-dose naltrexone, have been prospectively evaluated. For patients with chronic MP, good responses to prolonged corticosteroid treatment have been reported. Novel therapies include thalidomide and low-dose naltrexone. Hormonal and immunomodulatory therapies are also used based on small case series, but these treatments may have significant side effects. Surgical intervention is not curative and is avoided except for relief of focal bowel obstruction secondary to fibrotic forms of the disease.

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“…Abdominal CT revealed parasigmoid mural thickening with nodular densities in the adjacent adipose tissue. Numerous enlarged lymph nodes were seen surrounding the inferior mesenteric vessels 13. Diagnostic laparoscopy with rectosigmoidectomy and lymphadenectomy was performed due to suspicion of intestinal lymphoma.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric panniculitis as a possible cause of fever of unknown origin

Lombana,

Patel,

High

2023

BMJ Case Rep

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Mesenteric panniculitis is a non-neoplastic condition involving inflammation and fibrosis of the small bowel mesentery. We describe a man in his 60s who presented with 3 months of febrile episodes, confusion and weight loss. The diagnosis of mesenteric panniculitis had been established 2 weeks prior based on an abdominal computerized tomography scan. Extensive diagnostic investigations during his hospitalisation were unrevealing, and the symptoms were ultimately attributed to the mesenteric panniculitis. The fevers resolved over several weeks, and no further episodes have occurred since discharge. This case suggests that mesenteric panniculitis merits consideration in the differential diagnosis of fever of unknown origin.

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Sclerosing mesenteritis as an unusual cause of fever of unknown origin: a case report and review

Cited by 9 publications

References 13 publications

Clinical significance of mesenteric panniculitis-like abnormalities on abdominal computerized tomography in patients with malignant neoplasms

Clinical significance of mesenteric panniculitis-like abnormalities on abdominal computerized tomography in patients with malignant neoplasms

Mesenteric Panniculitis, Sclerosing Mesenteritis and Mesenteric Lipodystrophy: Descriptive Review of a Rare Condition

Mesenteric panniculitis as a possible cause of fever of unknown origin

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