Mesenteric Panniculitis: A Rare Condition in a Patient With Rheumatoid Arthritis

Abstract

Rheumatoid arthritis is a relatively common chronic inflammatory disorder affecting the synovial joints. Extra-articular manifestations of rheumatoid arthritis are not uncommon and include a wide range of cardiovascular, pulmonary, and neurological complications. Gastrointestinal involvement in rheumatoid arthritis is rare, but it can be impactful on the quality of life of patients. We present the case of a 45-year-old woman, with rheumatoid arthritis on methotrexate, who presented with a one-week history of abdominal pain. The patient visited the outpatient clinic earlier and was diagnosed with indigestion and was offered symptomatic treatment which failed to provide any improvement. Abdominal examination revealed a distended abdomen with generalized tenderness and rebound. However, the abdomen was soft with no palpable masses. Initial laboratory examination, including inflammatory parameters, was normal. The patient underwent a computed tomography scan of the abdomen with intravenous contrast which demonstrated inhomogeneous hyperdense mesenteric fat giving a mass-like lesion with a displacement of adjacent bowel loops. Such findings conferred the diagnosis of mesenteric panniculitis. The patient was started on corticosteroid therapy with oral prednisolone 40 mg daily with close follow-up. She developed gradual improvement in her condition and the pain resolved completely after six days. The patient was re-evaluated after six months from discharge and she had no recurrence. The case highlighted a rare association of mesenteric panniculitis and rheumatoid arthritis. Physicians should keep this mesenteric panniculitis in mind when they encounter patients with the autoimmune disorders who presented with abdominal symptoms.

Keywords: abdominal pain; case report; computed tomography; mesenteric panniculitis; rheumatoid arthritis.

Figure 1. Axial CT image demonstrates inhomogeneous lesion of adipose tissue (arrows) sparing the adjacent mesenteric vessels.

CT: computed tomography

Figure 2. Coronal CT image demonstrates inhomogeneous hyperdense mesenteric fat sparing the mesenteric vessels giving the appearance of fat ring sign.

CT: computed tomography