Refractory Sclerosing Mesenteritis/Mesenteric Panniculitis Presenting With Macrophage Activation Syndrome Treated With Rituximab

Anjali Nidhaan; Gauri Pethe; Shannon Iriza

doi:10.3899/jrheum.2025-0111

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Figure 1.
Axial CT of the abdomen with intravenous contrast material demonstrates central mesenteric stranding and prominent mesenteric lymph nodes (arrow) in keeping with sclerosing mesenteritis/mesenteric panniculitis. CT: computed tomography.
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Figure 2.
Mesenteric biopsy showing fat necrosis, area of fibrosis, and infiltration of chronic inflammatory cells (H&E staining, 20×).

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Table.

Comparison of laboratory values at presentation with MAS, at recurrence with prednisone taper, and at resolution after rituximab administration through the disease course.

	At Presentation	At Recurrence	At Resolution
Ferritin (ref 22-275 ng/mL)	20,839	12000	641
sIL-2R (ref 223-710 U/mL)	4312	NA	296
WBC (ref 3.4-10.8 × 10³/μL)	2.3	2.7	8.2
Hemoglobin (ref 13.0-17.7 g/dL)	7.2	10.7	14.3
LDH (ref 105-223 IU/L)	992	720	149
CRP (ref < 5 mg/L)	31	13.3	2
ESR (ref 0-30 mm/h)	82	26	2

CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; LDH: lactate dehydrogenase; MAS: macrophage activation syndrome; NA: not applicable; sIL-2R: soluble interleukin 2 receptor; WBC: white blood cell.