Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 56, Num. 4, 2010, pp. 303-304

Journal of Postgraduate Medicine, Vol. 56, No. 4, October-December, 2010, pp. 303-304

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Mesenteric panniculitis as a first manifestation of Schönlein-Henoch disease

N Martín-Suñé¹, JJ Ríos-Blanco¹, M Díaz-Menéndez¹, J Alvarez-Pellicer¹, A Lamarca-Lete², FJ Barbado-Hernández¹, JJS Vázquez Rodríguez¹

¹ Internal Medicine Service, La Paz Hospital, Madrid, Spain
² Medical Oncology Service, La Paz Hospital, Madrid, Spain

Correspondence Address: N Martín-Suñé, Internal Medicine Service, La Paz Hospital, Madrid, Spain, nmsune@gmail.com

Date of Submission: 04-May-2010
Date of Decision: 12-Apr-2010
Date of Acceptance: 14-Jun-2010

Code Number: jp10089

PMID: 20935406

DOI: 10.4103/0022-3859.70948

Mesenteric panniculitis has been associated to very few cases of vasculitis, but not to Schönlein-Henoch disease. We have found this association interesting as it could be a novel clinical aspect and earlier medical intervention could be done in those patients.

A 37-year-old woman was diagnosed irritable bowel syndrome five years ago due to abdominal pain episodes and diarrhea. She under went an exhaustive study that included abdominal computed tomography, colonoscopy and barium studies. On admission she had a one-week history of fever, colicky upper and middle-left abdominal pain and arthralgia. Physical examination showed a temperature of 38.9°C, a blood pressure of 87/63 and heart rate of 79 per min. The chest was clear on auscultation. She had mild left abdominal pain tenderness without rebound or guarding, with bowel sound conservation and no hepatosplenomegaly. The results of joint examination were normal without swelling or tenderness.

The laboratory tests showed a hemoglobin of 14.8 g/dL; total leucocyte count of 9500 /μL, platelet count was 287.000/μL. RCP 116 mg/L. Coagulation values-fibrinogen of 853 mg/dL, other values were normal. Biochemistry: electrolyte, creatinine, blood urea nitrogen, glucose and liver function tests were within normal limits. In the emergency room, abdominal ultrasonography showed abnormal submucous thickness in the proximal small bowel.

On Day 2 of hospitalization, some erythematous purpuric lesions appeared in the lower extremities [Figure - 1] A thoracoabdominal CT showed increased attenuation in the mesentery that enveloped the mesenteric vessels [Figure - 2]. Hepatitis B virus, Hepatitis C virus serologies were negative. Immunological study, Antinuclear antibodies, Anti-neutrophil cytoplasmic antibodies and cryoglobulins were negative. Fecal blood test was positive in one sample. Proteinuria of 333 mg/24 h. Oral endoscopy showed an erythematous and focal duodenal lesion which was catalogued as nonspecific. Considering the symptoms, Schönlein-Henoch disease was thought of and a cutaneous biopsy was performed. It was described as leukocytoclastic vasculitis with IgA deposition without panniculitis, confirming the diagnosis.

The patient received oral corticosteroid treatment, 1 mg/kg per day, with resolution of abdominal pain, fever and arthralgia in a few days. Three months later an abdominal TC was performed and mesenteric panniculitis had resolved.

Schönlein-Henoch disease is the most common form of systemic vasculitis in children and its clinical manifestations include palpable purpura, arthralgia, gastrointestinal involvement and renal disease. Gastrointestinal manifestations may vary and occur in up to 80% of the cases. ^[1] Abdominal pain has been described as the most frequent symptom, in 88-98% of the cases. ^[2] Endoscopy findings include diffuse mucosa edema, erythema, petechia, multiple irregular ulcers and nodular changes.

Mesenteric panniculitis is a rare condition characterized by chronic nonspecific inflammation involving the adipose tissue of the bowel mesentery. Up to 69% of cases have been related to malignancies or lymphoma ^[3] and to other situations such as abdominal surgery, intestinal ischemia, pancreatitis and inflammatory bowel disease. ^[4] There are a few cases reported in patients suffering from vasculitis, one case of cryglobulinemia and one small-vessel vasculitis. ^[5] This is the first time that mesenteric panniculitis has been associated with Schönlein-Henoch disease and it appears to be a novel association. In patients with clinical symptoms such as purpura and mesenteric panniculitis in TC, this finding could help clinicians to develop some more diagnostic tests that could lead to an early diagnosis and treatment minimizing disease consequences.

References

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