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Novel treatment (new drug/intervention; established drug/procedure in new situation)
Sclerosing mesenteritis successfully treated with a TNF antagonist
  1. Lisa R Rothlein1,
  2. Amy W Shaheen1,
  3. John P Vavalle2,
  4. Scott V Smith3,
  5. Jordan B Renner4,
  6. Nicholas J Shaheen1,
  7. Teresa K Tarrant1
  1. 1Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
  2. 2Department of Medicine, Duke University Medical Center, Chapel Hill, North Carolina, USA
  3. 3Department of Pathology, University of North Carolina, Chapel Hill, North Carolina, USA
  4. 4Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
  1. Correspondence to Teresa K Tarrant, tarra002{at}gmail.com

Summary

A 29-year-old female presented with intermittent nausea, vomiting, fevers, abdominal pain and fatigue. CT scans of the abdomen revealed inflammatory changes within the mesentery and small bowel. Histopathology of the mesentery and omentum showed chronic inflammation and fibrosis, supporting a diagnosis of sclerosing mesenteritis. Over the past 2 years, the patient suffered debilitating paroxysmal abdominal pain despite treatment with prednisone, azathioprine, sulfasalazine and narcotics. Additionally, she developed sacroiliitis diagnosed clinically and on radiographs. Intravenous infliximab (5 mg/kg intravenous) was initiated and continued every 6 weeks for 3 years. The patient has since had a dramatic improvement in her back and abdominal symptoms and has tapered off of prednisone, azathioprine and narcotics. Erythrocyte sedimentation rate, anaemia, leukocytosis and radiographic findings improved after initiation with infliximab. In conclusion, the authors report successfully treating sclerosing mesenteritis with sacroiliitis by the addition of infliximab. This may implicate a role for tumour necrosis factor α in disease pathogenesis.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

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