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Mesenteric panniculitis presenting as fever of unknown origin
1Service of Gastroenterology, Hospital Clínic i Provincial, Barcelona, Spain.
Abstract:
A 40-yr-old man was admitted for fever of unknown origin. Mesenteric panniculitis was suspected as a result of ultrasonography, computed tomography, and nuclear magnetic resonance findings, and that diagnosis was confirmed by laparoscopy with retroperitoneal mass biopsy. Mesenteric panniculitis is a rare disease characterized by an inflammatory process of the mesenteric adipose tissue. Abdominal pain, weight loss, and abdominal mass are the most frequent symptoms. High fever and leukocytosis are uncommon. To the best of our knowledge, only two reports of mesenteric panniculitis presenting as fever of unknown origin have been described previously, with no cases published in the English literature. In the case reported, steroid therapy was started with initial improvement. Despite the temporary addition of azathioprine and the maintenance of the prednisone treatment, no further improvement has been achieved. Two years and 5 months after admission, the patient presents intermittent episodes of fever and muscle pain.
Insights
This case study highlights mesenteric panniculitis, a rare inflammatory condition, presenting unusually with prolonged fever of unknown origin. The patient showed initial response to steroids but later experienced recurring symptoms, indicating complex disease management.
Area of Science:
- Gastroenterology
- Internal Medicine
- Pathology
Background:
- Mesenteric panniculitis is a rare, benign condition characterized by inflammation of the mesenteric adipose tissue.
- Common symptoms include abdominal pain, weight loss, and palpable abdominal mass.
- High fever and leukocytosis are atypical presentations.
Observation:
- A 40-year-old male presented with prolonged fever of unknown origin.
- Diagnostic imaging (ultrasound, CT, MRI) suggested mesenteric panniculitis.
- Laparoscopy confirmed the diagnosis via retroperitoneal mass biopsy.
Findings:
- This is one of the few reported cases of mesenteric panniculitis presenting as fever of unknown origin.
- The patient initially responded to steroid therapy (prednisone).
- Subsequent addition of azathioprine did not prevent disease recurrence and persistent symptoms.
Implications:
- Mesenteric panniculitis, though rare, should be considered in the differential diagnosis of fever of unknown origin, especially with atypical presentations.
- Management of mesenteric panniculitis can be challenging, with potential for relapsing disease despite immunosuppressive therapy.
- Further research is needed to understand the pathophysiology and optimize treatment strategies for this uncommon condition.