Aggressive multiple myeloma presenting as mesenteric panniculitis
1Department of Gastroenterology, Mater Misericordiae Hospital and University College, Dublin, Ireland.
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.
Insights
Mesenteric panniculitis, a rare bowel condition, can sometimes mask aggressive hematological malignancies. This case highlights a patient initially diagnosed with mesenteric panniculitis who later developed IgA kappa chain myeloma.
Area of Science:
- Gastroenterology and Oncology
- Pathology and Immunology
Background:
- Mesenteric panniculitis is a rare idiopathic inflammatory condition of the bowel mesentery.
- It typically presents with abdominal pain or fever and has a generally benign prognosis.
Observation:
- A 43-year-old male presented with malaise, weight loss, microcytic anemia, and elevated erythrocyte sedimentation rate.
- Radiographic and histological findings confirmed mesenteric panniculitis, which initially responded well to high-dose oral prednisolone.
Findings:
- The patient relapsed within six months with anemia, renal failure, and hypercalcemia.
- A diagnosis of IgA kappa chain myeloma was established.
- This case represents the first documented instance of a hematological malignancy initially presenting as mesenteric panniculitis with a fatal outcome.
Implications:
- Mesenteric panniculitis may be an initial manifestation of underlying hematological malignancies.
- Further investigation is warranted for patients with unexplained or recurrent mesenteric panniculitis.
- This case underscores the importance of considering systemic diseases in the differential diagnosis of mesenteric panniculitis.
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