Mesenteric Panniculitis in a Patient with Ulcerative Colitis in Remission on Vedolizumab Therapy: A Case Report and Literature Review.

Background

Mesenteric panniculitis (MP) is a chronic fibroinflammatory disorder of the mesenteric adipose tissue and is frequently considered an idiopathic condition. Its association with inflammatory bowel disease (IBD), particularly ulcerative colitis (UC), remains poorly characterized, with only limited evidence available in the literature. In addition to presenting a clinical case, we performed a narrative review of the literature regarding the relationship between MP and IBD, including epidemiology, pathophysiological mechanisms, diagnostic challenges, and therapeutic approaches. Case Presentation: We report the case of a 32-year-old woman with UC in deep clinical, endoscopic, and histological remission while receiving vedolizumab therapy, who developed symptomatic MP diagnosed by contrast-enhanced computed tomography. Infectious, neoplastic, and selected fibroinflammatory causes were excluded during the diagnostic work-up. Histological confirmation was not obtained. The patient was treated with prednisone and tamoxifen, resulting in complete clinical and radiological remission while vedolizumab therapy was continued.

Conclusions

This case describes the rare co-occurrence of MP and UC in deep remission during ongoing vedolizumab treatment. Given the absence of histological confirmation and the frequently idiopathic nature of MP, a causal relationship with either UC activity or vedolizumab therapy cannot be established. The observation should therefore be regarded as hypothesis-generating. Further studies are required to clarify the potential relationship between MP, IBD, and biologic therapies.