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Sclerosing mesenteritis successfully treated with a TNF antagonist.

Lisa R Rothlein¹, Amy W Shaheen, John P Vavalle

¹Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.

BMJ Case Reports

|July 18, 2012

Summary

Sclerosing mesenteritis with sacroiliitis, a rare condition, was effectively treated with infliximab. This suggests a potential role for tumor necrosis factor alpha in the disease process, offering new hope for patients.

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Area of Science:

Gastroenterology
Rheumatology
Immunology

Background:

Sclerosing mesenteritis is a rare chronic inflammatory condition affecting the mesentery.
Co-occurrence of sacroiliitis with sclerosing mesenteritis is uncommon.
Standard treatments for sclerosing mesenteritis have shown limited efficacy in some cases.

Observation:

A 29-year-old female presented with symptoms of sclerosing mesenteritis including nausea, vomiting, fever, and abdominal pain.
Imaging and histopathology confirmed chronic inflammation and fibrosis of the mesentery.
The patient also developed sacroiliitis, a form of inflammatory arthritis affecting the spine.

Findings:

Despite conventional therapies (prednisone, azathioprine, sulfasalazine, narcotics), the patient experienced persistent debilitating abdominal pain.
Treatment with intravenous infliximab (a tumor necrosis factor alpha inhibitor) resulted in significant improvement of both abdominal and back symptoms.
Inflammatory markers (erythrocyte sedimentation rate, anemia, leukocytosis) and radiographic findings also improved post-infliximab therapy.

Implications:

Infliximab is a potential therapeutic option for refractory sclerosing mesenteritis, particularly when associated with sacroiliitis.
The successful treatment suggests that tumor necrosis factor alpha may play a significant role in the pathogenesis of sclerosing mesenteritis.
This case highlights the importance of considering systemic inflammatory conditions in patients with sclerosing mesenteritis.