Limited systemic sclerosis initially presenting with mesenteric panniculitis

Area of Science:

• Gastroenterology
• Rheumatology
• Pathology

Background:

• Mesenteric panniculitis, a rare form of sclerosing mesenteritis, involves inflammation and fibrosis of the small bowel mesentery.
• It is typically associated with abdominal trauma, surgery, infections, malignancies, and connective tissue diseases.
• No prior cases of sclerosing mesenteritis have been documented in patients with systemic sclerosis.

Observation:

• A 61-year-old woman presented with incidental CT findings suggestive of mesenteric panniculitis.
• Biopsy confirmed fat necrosis, diagnosing mesenteric panniculitis.
• Further evaluation revealed Raynaud's phenomenon, sclerodactyly, elevated anticentromere antibodies, and skin biopsy findings consistent with scleroderma, leading to a diagnosis of limited systemic sclerosis.

Findings:

• The patient was treated with D-penicillamine for limited systemic sclerosis.
• Both mesenteric panniculitis and systemic sclerosis remained stable over a 6-year follow-up period.
• This case represents the first reported instance of concurrent mesenteric panniculitis and systemic sclerosis.

Implications:

• The findings underscore the importance of considering rheumatic diseases, such as systemic sclerosis, in the differential diagnosis of patients presenting with mesenteric panniculitis.
• This association may warrant further investigation into potential sharedPathogenic mechanisms between these conditions.
• Clinicians should maintain a high index of suspicion for systemic sclerosis in patients diagnosed with mesenteric panniculitis, and vice versa.