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Mesenteric Lymphadenitis Clinical Presentation

  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Julian Katz, MD  more...
 
Updated: Dec 29, 2015
 

History

The disease may have a variable course, depending on the patient's age and condition and/or the pathogenic properties of the causative organisms.[3]  The onset and progression of mesenteric lymphadenitis may be insidious or, sometimes, dramatic. 

Clinical features of associated organ involvement, such as enterocolitis or ileitis in Yersinia infection, may be present. Clinical presentations include the following:

  • Abdominal pain - Often right lower quadrant (RLQ) but may be more diffuse
  • Fever
  • Diarrhea
  • Malaise
  • Anorexia
  • Concomitant or antecedent upper respiratory tract infection
  • Nausea and vomiting (which generally precedes abdominal pain, as compared to the sequence in appendicitis)
  • History of ingestion of raw pork may be obtained in areas with endemic Yersinia (eg, Belgium).
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Physical

No set of physical findings is pathognomonic of mesenteric lymphadenitis.

  • Fever (38-38.5°C)
  • Flushed appearance
  • RLQ tenderness - Mild, with or without rebound tenderness
  • Voluntary guarding rather than abdominal rigidity
  • Rectal tenderness
  • Rhinorrhea
  • Hyperemic pharynx
  • Toxic appearance
  • Associated peripheral lymphadenopathy (usually cervical) in 20% of cases
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Causes

See the list below:

  • Numerous organisms have been cultured from mesenteric lymph nodes and blood.
    • Organisms include beta-hemolytic streptococcus, Staphylococcus species, Escherichia coli, Streptococcus viridans, Yersinia species (responsible for most cases currently), Mycobacterium tuberculosis, Giardia lamblia, and non– Salmonella typhoid.
    • Viruses, such as coxsackieviruses (A and B), rubeola virus, and adenovirus serotypes 1, 2, 3, 5, and 7, have been implicated.
  • Mesenteric node involvement can also be part of infectious Epstein-Barr virus (EBV), acute human immunodeficiency virus (HIV) infection, and catscratch disease (CSD).
  • The frequent association of this condition, especially in children with upper respiratory tract infection, has popularized a theory that swallowed pathogen-laden sputum may be the primary source of infection.
  • Fecal-oral transmission occurs in Y enterocolitica infection and may present as a common source outbreak. This infection has also been associated with meat, milk, and water contamination. Rarely, person-to-person or zoonotic contacts with fecal carriers can lead to infection.
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Contributor Information and Disclosures
Author

Jennifer Lynn Bonheur, MD Attending Physician, Division of Gastroenterology, Lenox Hill Hospital

Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Society for Gastrointestinal Endoscopy, New York Academy of Sciences, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Oluyinka S Adediji, MD, MBBS Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama

Oluyinka S Adediji, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Norvin Perez, MD Medical Director, Juneau Urgent and Family Care

Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Mukul Arya, MD Associate Professor of Internal Medicine, Weill Cornell Medical College; Assistant Director of Therapeutic Endoscopy, Department of Gastroenterology and Internal Medicine, Wyckoff Heights Medical Center

Mukul Arya, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Vivek V Gumaste, MD Associate Professor of Medicine, Mount Sinai School of Medicine of New York University; Adjunct Clinical Assistant, Mount Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center at Elmhurst; Program Director of GI Fellowship (Independent Program); Regional Director of Gastroenterology, Queens Health Network

Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association

Disclosure: Nothing to disclose.

References
  1. Toorenvliet B, Vellekoop A, Bakker R, Wiersma F, Mertens B, Merkus J, et al. Clinical differentiation between acute appendicitis and acute mesenteric lymphadenitis in children. Eur J Pediatr Surg. 2011 Mar. 21(2):120-3. [Medline].

  2. Moore MM, Kulaylat AN, Brian JM, et al. Alternative diagnoses at paediatric appendicitis MRI. Clin Radiol. 2015 Aug. 70 (8):881-9. [Medline].

  3. Zinczuk J, Wojskowicz P, Kisluk J, Fil D, Kemona A, Dadan J. Mesenteric lymphadenitis caused by Yersinia enterocolitica. Prz Gastroenterol. 2015. 10 (2):118-21. [Medline].

  4. Frisch M, Pedersen BV, Andersson RE. Appendicitis, mesenteric lymphadenitis, and subsequent risk of ulcerative colitis: cohort studies in Sweden and Denmark. BMJ. 2009 Mar 9. 338:b716. [Medline]. [Full Text].

  5. Koning JL, Naheedy JH, Kruk PG. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children. Pediatr Radiol. 2014 Aug. 44 (8):948-55. [Medline].

  6. Ackerman SJ, Irshad A, Anis M. Ultrasound for pelvic pain II: nongynecologic causes. Obstet Gynecol Clin North Am. 2011 Mar. 38(1):69-83, viii. [Medline].

  7. Ja Lim K, Lee K, Yoon DY, et al. The role of US in finding intussusception and alternative diagnosis: a report of 100 pediatric cases. Acta Radiol. 2014 Feb 13. [Medline].

  8. Sheridan AD, Ehrlich L, Morotti RA, Goodman TR. Sonographic distinction between acute suppurative appendicitis and viral appendiceal lymphoid hyperplasia ("pink appendix") with pathological correlation. Ultrasound Q. 2015 Jun. 31 (2):95-8. [Medline].

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