An analysis of clinical characteristics of twelve cases of mesenteric panniculitis

正Objective Mesenteric panniculitis is an idiopathic,uncommon disease involving the adipose tissue of mesentery.The etiology,diagnosis and treatment are still unnoticed.We thus reported a case series to improve the understanding of this rare disorder.Methods We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation,diagno-     

CT诊断的肠系膜脂膜炎50例临床特点分析

目的探讨肠系膜脂膜炎(MP)患者的临床特点,以提高临床医生对该病的认识。方法收集山西白求恩医院2013年1月至2017年5月行腹部CT检查并诊断MP住院患者50例临床资料,对其人口学特点、临床特征、辅助检查、治疗及预后进行分析总结。结果 50例MP患者男女比例1∶0.92,发病年龄25~85岁,平均年龄(59.1±14.0)岁,多因腹痛、发热、血尿、淋巴结肿大等就诊,22例合并肿瘤,以淋巴瘤最为多见,16例有腹部手术史。实验室检查多无特殊,所有患者均未行肠系膜病理活检。6例行腹部CT复查,其中1例经激素治疗后病灶显著吸收,其余5例无明显变化。结论 MP常见于中老年人,临床表现多样,易合并肿瘤,淋巴瘤多见,腹部CT是其最重要的诊断手段,当发现MP时,应注意除外是否合并有恶性肿瘤。     

A case of suspected mesenteric panniculitis with a large amount of chylous ascites]

A 79-year-old man was admitted our hospital because of severe abdominal fullness. An abdominal ultrasonography showed a large amount of ascites, and diagnostic puncture detected chylous ascites. An abdominal computed tomography revealed a large amount of ascites and a multinodular mass with calcification in the mesentery of the small intestine. An infectious disease, such as tuberculosis, or malignant tumor was suspected to be the causative disease, but there was no diagnostic evidence in further examinations. Based on clinical features, imaging data and chylous ascites, we searched for case reports and found two similar cases of mesenteric panniculitis. Mesenteric panniculitis was highly suspected in this case, however, histopathological examination was rejected by patient. Therefore, we treated with steroid therapy, which had been reported as effective therapy, and the ascites decreased without recurrence.     

Aggressive multiple myeloma presenting as mesenteric panniculitis

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.     

Mesenteric panniculitis]

In a 76 year old patient computed tomography of the abdomen and laparoscopic biopsy revealed a mesenteric panniculitis as cause of recurrent fever and shaking chills. The fever resolved under corticosteroid therapy and the patient remains well three month after onset of treatment.     

Relationship between abdominal trauma or surgery and mesenteric panniculitis

Mesenteric panniculitis is a rare disease characterized by chronic non-specific inflammation of mesenteric fat tissue. Several etiologic and/or associated factors have been reported in the literature so far. Although trauma or surgery is one of the potential etiologic factors for mesenteric panniculitis, to the best of our knowledge, no strong correlation has been shown in the literature until now.     

Two cases of metronidazole-induced encephalopathy]

Metronidazole is a 5-nitroimidazole compound known as an antimicrobial agent widely used for the treatment of protozoal infection, anaerobic infection, Helicobacter pylori infection and hepatic encephalopathy. It may produce a number of neurologic side effects including peripheral neuropathy, seizure, encephalopathy, ataxic gait and dysarthritic speech. There have been ten or more reports of metronidazole-induced encephalopathy in the literatures including a few reports of brain imaging changes by magnetic resonance images (MRI). However, none of the case of metronidazole-induced encephalopathy in patients with hepatic encephalopathy has been reported yet. Recently, we experienced two cases of metronidazole-induced encephalopathy in patients with liver cirrhosis caused by chronic hepatitis B, which were diagnosed by brain MRI and MR spectroscopy. In this report, we present 2 cases of metronidazole-induced encephalopathy with MR imaging and MR spectroscopic changes including follow-up imaging performed after the discontinuation of the metronidazole with a review of the literatures.     

Two familial cases of psittacosis]

We report here 2 cases of psittacosis in a family. In the first case, a 51-year-old woman was admitted with fever, dry cough, and a chest radiograph showed increased opacity in the right upper lung field. On a diagnosis of atypical pneumonia, minocycline was given and her clinical symptoms and abnormal laboratory data were improved. The second case was her husband, a 58-year-old man who presented with fever 4 days after his wife's admission. His chest radiograph revealed increased opacity in the left lower lung field. The administration of azithromycin for 3 days attenuated his clinical symptoms and his abnormal laboratory data improved. The serum titer of complement fixation (CF) test and ELISA test against Chlamydophila psittaci were elevated in both cases on analysis of paired acute- and convalescent-phase serum speciments. The antigen of Chlamydophila was revealed from these parrots, which had been raised in their family. Therefore, we concluded that the psittacosis had originated from the parrots.     

Two cases of duodenal tuberculosis]

The present study described 2 cases of patients with duodenal tuberculosis. Case 1 was a 55 year-old Japanese male patient with pulmonary tuberculosis and past medical history of subtotal gastrectomy (Billroth II reconstruction). Tubercle bacilli were positive both on smear and culture from his sputum and feces. Because of complaining right hypochondralgia, upper gastrointestinal endoscopy was performed and revealed multiple ringed ulcers in the afferent limb of duodenum. Histopathological study of biopsy specimen demonstrated granulomatous inflammation as well as acid-fast bacilli confirmed by Ziehl-Neelsen staining. Tissue culture was positive for M. tuberculosis. Colonic tuberculosis was demonstrated by barium enema. Case 2 was a 45 year-old male patient with pulmonary tuberculosis in association with severe uncontrolled diabetes mellitus. Sputum polymerase chain reaction test was positive for M. tuberculosis. Granulomatous inflammation and positive acid-fast bacilli in biopsy specimen obtained from ulcers in the descending portion of the duodenum made a diagnosis of duodenal tuberculosis. No other intestinal tuberculous lesion was recognized. Since 1988, 11 cases of duodenal tuberculosis including the presented two cases have been reported in Japan. Most of the recent cases had tuberculous lesions in the descending portion of the duodenum and were diagnosed as duodenal tuberculosis by endoscopic examinations, while the majority of the cases reported before 1987 had tuberculosis in the more distant portions of the duodenum and were diagnosed mainly by surgical procedures.     

Two cases of pericardial diverticulum]

Two cases of resection of pericardial diverticulum are reported. The lesion was located in the right upper mediastinum in case 1 (66-year-old woman) and at the right anterior cardio-phrenic angle in case 2 (20-year-old woman). In case 1, the shape of the lesion varied on fluoroscopic observation when the position of the patient was changed, and in case 2, ICG instilled into the lesion operation diffused into the pericardial cavity. These procedures seemed to be useful in the diagnosis of pericardial diverticulum, differentiating it from pericardial cyst.     

Intestinal lymphoma and mesenteric panniculitis: complications of undiagnosed celiac disease

Celiac disease is the most common severe food intolerance in the Western world and is due to gluten ingestion in genetically susceptible children and adults. The key treatment in these patients is a gluten-free diet, because most complications are more common when dietary compliance is poor. The most serious complication of celiac disease is the development of neoplasms (the most common of which is enteropathy-associated T-cell lymphoma). However, a number of reports have indicated an increased prevalence of ulcerative jejunitis and extraintestinal manifestations, including chronic hepatitis, fibrosing lung disease, and epilepsy syndromes. We report the case of a 53-year-old-man with long-standing diarrhea; because celiac disease was not suspected, the patient developed celiac-associated T-cell lymphoma and mesenteric panniculitis.