Mesenteric panniculitis in rheumatologist practice

Abstract

Mesenteric panniculitis (MPn) is a rare form of adipose tissue inflammation, mainly of the intestinal mesentery, less often of the omentum, preand retroperitoneal tissue. There are not many descriptions of MPn in rheumatic diseases in the literature: in systemic lupus erythematosus, systemic sclerosis, Sjogren's syndrome, rheumatoid arthritis (RA), ankylosing spondylitis, mesenteric form (MF) of idiopathic lobular panniculitis (ILPn) and IgG4-related disease (IgG4-RD). Given the polymorphism of clinical manifestations, including systemic ones, it is of interest to look at the problem of MPn from the perspective of a rheumatologist.Objective: to evaluate the clinical and laboratory features of MPn in modern rheumatological practice.Material and methods. The study included 64 patients (19 men and 45 women aged 19 to 76 years, median disease duration 28.6 [0.3; 243] months). Laboratory and instrumental studies were carried out according to a single algorithm, which included standard clinical, immunological methods, as well as the determination of fecal calprotectin and tumor markers, ultrasound of the skin and subcutaneous adipose tissue (SAT), computed tomography of the chest and abdominal organs, abdominal positron emission tomography, pathomorphological examination of biopsies of the skin, pancreas and mesentery.Results and discussion. 89% of patients had abdominal pain, 48.4% had nausea, 53.1% had weakness, 44% had subfebrile fever, 32.8% had articular syndrome, and 29.6% – skin and pancreas involvement. Median ESR was 34 [11; 52] mm/h, CRP level – 14 [2; 72] mg/l. Most of the immunological parameters remained within the normal range, but in some cases there was an increase in the concentration of rheumatoid factor, antibodies to the cyclic citrullinated peptide, IgG4. The level of tumor markers CA 125, CEA, CA 19–9 and TumorM2-PK was increased 2 times or more in 5 patients. In our study, all radiological signs and all degrees of severity of MPn were observed. An additional examination confirmed the presence of MF ILPn, RA, IgG4-RD, gastrointestinal, malignant, hematological and other diseases, which made it possible to identify five diagnostic blocks.Conclusion. Early diagnosis and correct interpretation of the described changes require a lot of work-up and a multidisciplinary approach, which contributes to accurate and timely recognition of the disease.

Keywords

• mesenteric panniculitis
• abdominal pain
• rheumatic diseases
• differential diagnosis
• ct scan