జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

Mesenteric Panniculitis as a Manifestation of Giardiasis in Tropical Regions: A Case Report

Chandra Sekhar Puli, Prabhav Kashyap Godavarthy

Background: Mesenteric panniculitis is a very rare gastroenterological condition, especially in adults. This patient had a very unorthodox manifestation of a common protozoal intestinal parasite. From this case, we can learn that in cases of non-specific abdominal pain with mesenteric panniculitis, we should also look for common intestinal protozoal parasites such as Giardia, Entamoeba, etc. This can apply to residents of tropical countries and even people who have recently travelled to a tropical region and experienced symptoms consistent with these findings.

Case presentation: A gentleman in his mid-50’s of Indian origin presented with a pinching type of non-specific mild abdominal discomfort for 10 months. The pain was episodic and was not associated with the consumption of any food. There was a prior history of acute pancreatitis and a CT scan was performed to rule out a potential recurrence of pancreatitis.

The CT imaging revealed mesenteric panniculitis in the jejunal area, with enlarged mesenteric lymph nodes. A follow-up CT scan 10 months later showed progression of the panniculitis with further enlargement of the lymph nodes in the jejunal mesentery. There were no signs of pyrexia, weight loss, altered bowel habits, nocturnal hyperhidrosis or generalized lymphadenopathy. A negative tuberculosis quantiferon test, along with the patient’s history and examination, were sufficient to rule out tuberculosis as a cause most blood tests were within normal physiological limits apart from a slightly elevated serum lactate dehydrogenase.

In view of mesenteric panniculitis involving the jejunal mesentery, a spiral enteroscopy was performed, which showed multiple non-specific segmental polypoid lesions in the jejunum, which appear to be Peyer’s patches. Subsequently, a colonoscopy was also performed to explore the large intestine, which appeared normal.

Biopsy results from the jejunum confirmed a finding of giardiasis. The patient was prescribed appropriate antiprotozoal therapy to eradicate the organism.

Conclusion: Mesenteric panniculitis can be a rare manifestation of giardiasis. In patients presenting with chronic mild abdominal pain who have a history of travelling to or visiting from a tropical region or country, mesenteric panniculitis should be in the differential during the clinical work up and investigations.