scholarly journals Mesenteric lymphadenitis; a common diagnostic mimic to acute appendicitis. With radiology it is no more a diagnosis of exclusion, laparoscopy or surgery

2021 ◽  
Vol 11 (2) ◽  
pp. 55-57
Author(s):  
Kamel El-Reshaid ◽  
Shaikha Al-Bader ◽  
Zhaneta Markova

Mesenteric lymphadenitis (ML) is an inflammatory response to viral infections, bacterial infections, inflammatory bowel disease, or lymphoma in the ileocecal regions.  It is a common diagnostic mimic to acute appendicitis.  It is a self-limited inflammatory process that affects mesenteric lymph nodes in the right lower quadrant (RLQ).   We present a 15 year-old-girl with low grade fever and RLQ pain.  Initial physical examination and laboratory investigations suggested acute appendicitis.  However, diagnosis of ML was established by the finding abnormal lymph nodes that are usually: (a) clusters of > 3 tender ones anterior to right psoas muscle or in the small bowel mesentery, (b) > 5 mm in diameter of short axis, and (b) rounded in shape.  In addition; the ileal or ileocecal wall is thickened (> 3 mm) over at least 5 cm of the bowel and the appendicular wall is normal and its lumen is patent.  In conclusion; this case reports indicates tha with radiology; ML can be differentiated from acute appendicitis and limits the role of invasive laparoscopy or surgery in exclusion of the latter. Keywords: appendicitis, CT, mesenteric lymphadenitis, radiology, US.

2013 ◽  
Vol 52 (192) ◽  
Author(s):  
Anne Shrestha ◽  
Katie Newton ◽  
Emyr Benbow ◽  
Rajeev Kushwaha

Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenopathy of unknown aetiology, is a rare, benign and self-limiting cause of lymphadenopathy often involving the cervical nodes, and rarely presenting with mesenteric lymphadenopathy. We present a 26-year-old Caucasian male, who presented with right iliac fossa pain and low grade pyrexia, mimicking acute appendicitis. He underwent a laparatomy and an extended right hemi-colectomy for a caecal mass. Histology of the specimen showed lymph nodes with extensive areas of necrosis, with abnormal architecture suggesting Kikuchi-Fujimoto lymphadenopathy. This was further confirmed by immunohistochemistry. In this context maintenance of a high index of suspicion of this condition can avoid major surgical interventions. We describe the management of our case of Kikuchi-Fujimoto’s disease involving the mesenteric nodes and provide an up to date review of the pertinent literature on this subject.  Keywords: abdominal mass; Kikuchi- Fujimoto disease; mesenteric lymphadenopathy; necrotising lymphadenitis.  


2009 ◽  
Vol 46 (3) ◽  
pp. 439-443 ◽  
Author(s):  
R. R. Quigley ◽  
K. E. Knowles ◽  
G. C. Johnson

An adult dog with ataxia and a lingual mass, previously diagnosed as protothecosis, was euthanized. At the postmortem examination, the lingual mass, regions of the lungs and hilar lymph nodes, liver, mesenteric and sublumbar lymph nodes, and spinal meninges had pronounced green discoloration. Histologically, pyogranulomatous inflammation and algal organisms were found in the tongue, spinal meninges, hilar and mesenteric lymph nodes, liver, and lung. The algae had cell walls positive for periodic acid-Schiff and cytoplasmic granules. Ultrastructurally, the algae had a well-defined cell wall, stacks of grana and thylakoid membrane, and dense bodies, typical of starch granules. The organisms were identified as Chlorella, a green alga, based on the results of histochemistical and electron microscopic examination. To the author's knowledge this is the first report of disseminated Chlorella infection and the first report in a companion animal.


2021 ◽  
Vol 23 (1) ◽  
pp. 318
Author(s):  
Yayoi Aoki ◽  
Tomoya Ikeda ◽  
Naoto Tani ◽  
Miho Watanabe ◽  
Takaki Ishikawa

Viral infections increase the risk of developing allergies in childhood, and disruption of mucosal homeostasis is presumed to be involved. However, no study has reported a role for viral infections in such disruption. In this study, we clarified the mechanism of immunoglobulin A (IgA) overproduction in viral infections. Autopsies were performed on 33 pediatric cases, IgA and interferon (IFN)β levels were measured, and histopathological and immunohistochemical examinations were conducted. Furthermore, we cultured human cells and measured IFNβ and IgA levels to examine the effect of viral infections on IgA production. Blood IgA levels in viral infections were higher than in bacterial infections. Moreover, IFNβ levels in most viral cases were below the detection limit. Cell culture revealed increased IgA in gastrointestinal lymph nodes, especially in Peyer’s patches, due to enhanced IFNβ after viral stimulation. Conversely, respiratory regional lymph nodes showed enhanced IgA with no marked change in IFNβ. Overproduction of IgA, identified as an aberration of the immune system and resulting from excessive viral infection-induced IFNβ was observed in the intestinal regional lymph nodes, particularly in Peyer’s patches. Further, increased IgA without elevated IFNβ in the respiratory system suggested the possibility of a different mechanism from the gastrointestinal system.


2017 ◽  
Vol 45 ◽  
pp. 3
Author(s):  
Karine Ludwig Takeuti ◽  
Gabriela Fredo ◽  
Rafael Cé Viott ◽  
David Driemeier ◽  
David Emílio Santos Neves Barcellos

Background: Osseous choristomas represent the production of osseous tissue in abnormal regions, such as subcutaneous, fibrous or perivascular tissues, skeletal muscle and skin. These structures have been found in humans, dogs (lungs and dura mater), horses (large intestines) and cattle (lungs and mesenteric lymph nodes). They were also found in the mesenteric region and thoracic cavity of sows and piglets. The aim of this paper was to describe the macro and microscopic lesions found in a sow which died suddenly by a rare mesenteric osseous choristoma.Case: A lactating sow, parity four, from the Swine Department of the Federal University of Rio Grande do Sul (UFRGS), Brazil, showed appetite loss, hyperthermia (41.5ºC) and sudden death. The animal was submitted to necropsy at the Department of Veterinary Pathology, UFRGS. On external examination, the sow showed conjunctival and perioral cyanosis, proximal colon region with a firm structure with approximately 3.0 cm length in mesenteric area. Moreover, the colon was ruptured and fibrin deposition and intestinal content in abdominal cavity were observed. Fragments of organs were collected in 10% formalin, routinely processed for histology and colored with hematoxylin and eosin stain (H&E). Histologically, it was found bone trabeculae with osteoid, periosteum, spaces with osteocids and endochondral ossification with bone marrow composed by adipose tissue and intense proliferation of conjunctive stroma. The mesenteric lymph nodes showed intense lymphoid hyperplasia with multifocal centrilobular necrosis. There was fibrin in serosa of colon, acute peri-spleen and acute fibrinopurulent perihepatitis.Discussion: Macroscopic and microscopic findings were consistent with mesenteric osseous choristoma. This condition is unusual in domestic animals, however it has been already described in pigs. Osseous choristoma could be related to previous mesenteric torsions, which could occur in growing phase, causing inflammation and hemorrhage, stimulating its generation. These structures may cause lesions in adjacent organs. The abrupt movements of the sow or intestinal peristalsis could have broken the bone, raising two tips, which in contact with the colon, ruptured it. Because of this, shedding of intestinal content was observed, which resulted in an acute peritonitis and sudden death of the animal. The annual mortality rates of sows (natural deaths or euthanasia) varies from 4.0 to 6.0%, but may be variable. Sow sudden deaths represent 17.5% of all sows and boars deaths, and gilts, pregnant and lactating sows are more susceptible. The most common causes of sow sudden death are gastrointestinal problems, such as ulcer, enteritis, torsions and ruptures; pneumonia; urinary infections, such as cystitis and pyelonephritis; heart failure; dystocia, and septicemia. However, one third of sudden death causes are not identified. The necropsy is the only way to identify the cause of death, through observation of macroscopic lesions and subsequent laboratory tests. Better knowledge of causes is important to establish control measures and possibly reduce culling of swine females. The causes of sudden death in sows should be better understood. Case reports of mesenteric osseous choristomas are rare in pigs, however it is not possible to assert if its occurrence is low, since few sudden deaths in sows are investigated.


2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Rossana Helbling ◽  
Elisa Conficconi ◽  
Marina Wyttenbach ◽  
Cecilia Benetti ◽  
Giacomo D. Simonetti ◽  
...  

Acute nonspecific, or primary, mesenteric lymphadenitis is a self-limiting inflammatory condition affecting the mesenteric lymph nodes, whose presentation mimics appendicitis or intussusception. It typically occurs in children, adolescents, and young adults. White blood count and C-reactive protein are of limited usefulness in distinguishing between patients with and without mesenteric lymphadenitis. Ultrasonography, the mainstay of diagnosis, discloses 3 or more mesenteric lymph nodes with a short-axis diameter of 8 mm or more without any identifiable underlying inflammatory process. Once the diagnosis is established, supportive care including hydration and pain medication is advised. Furthermore, it is crucial to reassure patients and families by explaining the condition and stating that affected patients recover completely without residuals within 2–4 weeks.


2017 ◽  
Vol 4 (4) ◽  
pp. 1525
Author(s):  
Saransh Sabal ◽  
Lakhan Poswal ◽  
Sandip Gediya ◽  
Suresh Goyal

Background: Enlarged mesenteric lymph nodes (MLN) are frequently seen in children with abdominal pain and in the absence of other disorders, have been attributed to primary mesenteric lymphadenitis. Mesenteric lymphadenitis is commonly reported in children with acute, chronic or recurrent abdominal pain and no evidence of other pathologies. The purpose of this study was to find out the association of USG finding of enlarged mesenteric lymph nodes with causation of recurrent abdominal pain and outcome of these patients on follow up.Methods: This hospital based prospective study was done on 82 patients aged 5 to 15 years, attending Bal Chikitsalaya, RNT Medical college, Udaipur, fulfilling Apley’s criteria of RAP. Detailed history, physical examination, relevant investigations and USG abdomen was done in all patients.Results: Eighty-two children were enrolled; out of which majority (62.19%) were in age group 5-8 years with mean age 7.9±2.69 years. Mesenteric lymphadenopathy was found in 14 (17.07%) cases. All patients with mesenteric lymphadenopathy 14 (100%) had periumbilical pain and diurnal variation of pain. Follow up of 14 patients who had mesenteric lymphadenopathy showed that in 12 (85.71%) patients, the mesenteric lymphadenopathy resolved on USG despite that pain abdomen persisted in 7 (58.33%).Conclusions: The presence of mesenteric lymphadenopathy can’t be attributed to recurrent abdominal pain.


2021 ◽  
Vol 22 (7) ◽  
pp. 3456
Author(s):  
Franziska Hornung ◽  
Julia Rogal ◽  
Peter Loskill ◽  
Bettina Löffler ◽  
Stefanie Deinhardt-Emmer

Obesity is a globally increasing health problem, entailing diverse comorbidities such as infectious diseases. An obese weight status has marked effects on lung function that can be attributed to mechanical dysfunctions. Moreover, the alterations of adipocyte-derived signal mediators strongly influence the regulation of inflammation, resulting in chronic low-grade inflammation. Our review summarizes the known effects regarding pulmonary bacterial and viral infections. For this, we discuss model systems that allow mechanistic investigation of the interplay between obesity and lung infections. Overall, obesity gives rise to a higher susceptibility to infectious pathogens, but the pathogenetic process is not clearly defined. Whereas, viral infections often show a more severe course in obese patients, the same patients seem to have a survival benefit during bacterial infections. In particular, we summarize the main mechanical impairments in the pulmonary tract caused by obesity. Moreover, we outline the main secretory changes within the expanded adipose tissue mass, resulting in chronic low-grade inflammation. Finally, we connect these altered host factors to the influence of obesity on the development of lung infection by summarizing observations from clinical and experimental data.


2013 ◽  
Vol 79 (9) ◽  
pp. 873-874 ◽  
Author(s):  
Mary M. Jordan ◽  
Jennifer E. Sanders ◽  
Christina R. Stallworth ◽  
Scott Russell ◽  
Olivia Titus ◽  
...  

Enterobius vermicularis is a parasite that inhabits the human digestive tract. We present two pediatric patients with symptoms mimicking acute appendicitis who were found to have E. vermicularis infection. The first case is a 5-year-old female who presented with flank and abdominal pain associated with low-grade fever and anorexia. She had localized tenderness in the right lower quadrant and a leukocytosis with left shift. Intraoperative findings included a normal-appearing appendix, but ex vivo examination revealed Enterobius vermicularis. The second case is a 7-year-old female who presented with periumbilical abdominal pain, anorexia, and emesis. She had tenderness at McBurney's point, and ultrasound revealed a small echogenic focus within the appendix. Intraoperatively, the distal tip of the appendix appeared inflamed. Again, ex vivo examination revealed E. vermicularis. Enterobius vermicularis infection of the appendix can present with a clinical picture similar to acute appendicitis. In at-risk populations, it should be included in the differential diagnosis for children with right lower quadrant abdominal pain. Complete therapy requires treatment with mebendazole.


2015 ◽  
Vol 2 (1) ◽  
pp. 39-46
Author(s):  
Alison Haynes

Background: Hyper IgE syndrome (HIES) is a primary immunodeficiency with sporadic, autosomal dominant (STAT3 mutation) and autosomal recessive (DOCK8 and TYK2 mutations) inheritance patterns. HIES secondary to DOCK8 mutation is characterized by extensive cutaneous viral and staphylococcal infections, recurrent sinopulmonary infections, severe allergic diseases, increased susceptibility to malignancy with lymphopenia, eosinophilia, and elevated immunoglobulin E (IgE). Methods: This case report highlights the clinical presentation and immune investigations of a male patient with a novel DOCK8 mutation. Results: Our patient presented with cutaneous viral infections including severe molluscum contagiosum and herpes simplex virus plus skin abscesses and acute otitis media. In addition to infections, he developed intermittent diarrhea, eczematous lesions, abnormal fingernails, oral ulcers, and Bell's palsy. Immune evaluation revealed lymphopenia, in particular low CD8 cells, low mitogen stimulation response, and poor specific antibody production requiring immunoglobulin replacement. Genetic sequencing confirmed a novel mutation in DOCK8. Conclusion: Patients with significant cutaneous viral and bacterial infections, recurrent sinopulmonary infections, severe allergic diseases, and lymphopenia with associated elevated IgE should be investigated for DOCK8 mutation. This case report highlights a novel mutation in the DOCK8 exon 45 aa1970, c.5908 G>C change alanine to proline homozygous change A1970 to P1970 Statement of novelty: This case reports on a novel mutation in DOCK8


Toxins ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 300 ◽  
Author(s):  
Maxime Espi ◽  
Laetitia Koppe ◽  
Denis Fouque ◽  
Olivier Thaunat

Regardless of the primary disease responsible for kidney failure, patients suffering from chronic kidney disease (CKD) have in common multiple impairments of both the innate and adaptive immune systems, the pathophysiology of which has long remained enigmatic. CKD-associated immune dysfunction includes chronic low-grade activation of monocytes and neutrophils, which induces endothelial damage and increases cardiovascular risk. Although innate immune effectors are activated during CKD, their anti-bacterial capacity is impaired, leading to increased susceptibility to extracellular bacterial infections. Finally, CKD patients are also characterized by profound alterations of cellular and humoral adaptive immune responses, which account for an increased risk for malignancies and viral infections. This review summarizes the recent emerging data that link the pathophysiology of CKD-associated immune dysfunctions with the accumulation of microbiota-derived metabolites, including indoxyl sulfate and p-cresyl sulfate, the two best characterized protein-bound uremic retention solutes.


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