Hemorragia digestiva alta por linfadenitis mesentérica tuberculosa que fistuliza a la pared gástrica / Upper gastrointestinal bleeding due to tuberculous mesenteric lymphadenitis that fistulizes the gastric wall

RESUMEN La linfadenitis tuberculosa es la entidad más frecuente de la tuberculosis abdominal, que ocurre por reactivación de un foco latente. Su diagnóstico requiere un alto grado de sospecha, para lo cual requiere estudios endoscópicos, radiológicos e histopatológicos. En la evaluación de las linfadenopatías, la punción y aspiración guiada por ultrasonido endoscópico cumple un rol importante. Presentamos el caso de un paciente varón de 22 años, quien ingresa a Emergencia del Hospital Nacional Arzobispo Loayza por hemorragia digestiva alta secundaría a linfadenitis mesentérica tuberculosa que comprometió la pared gástrica. (AU)

ABSTRACT Tuberculous lymphadenitis is the most common entity of abdominal tuberculosis, which occurs due to reactivation of a latent focus. Its diagnosis requires a high degree of suspicion, for which it requires endoscopic, radiological, and histopathological studies. In the evaluation of lymphadenopathies, endoscopic ultrasound-guided aspiration puncture plays an important role. We present the case of a 22-year-old male patient who was admitted to the Emergency Department of the Arzobispo Loayza National Hospital due to upper gastrointestinal bleeding secondary to tuberculous mesenteric lymphadenitis that compromised the gastric wall. (AU)

Clinical Observation of Modified Hezhong Powder for Treatment of Children Mesenteric Lymphadenitis / 广州中医药大学学报

Objective To observe the clinical effect of modified Hezhong Powder for the treatment of children mesentetic lymphadenitis.Methods Sixty children with mesentetic lymphadenitis were randomly divided into treatment group and control group,30 cases in each group.The control group was treated routine anti-inflammatory drug Cefaclor for Oral Suspension,and was given symptomatic treatment when necessary.The treatment group was given modified Hezhong Powder on the basis of treatment for the control group.The treatment course lasted for two weeks.After treatment,clinical efficacy and safety,and effects on relieving primary and secondary symptoms and on shortening the swollen lymph nodes were observed.Results (1) The total effective rate of the treatment group was 96.7％,and that of the control group was 83.3％,the difference being significant (P ＜ 0.05).(2) The treatment group had better effect on relieving the primary symptom of abdominal pain,and secondary symptoms of poor appetite,vomiting,abdominal distention and abnormal stool than the control group.The differences of time for the symptoms disappearing were significant (P ＜ 0.05).(3) After treatment,the swollen.lymph nodes of the two groups were shrunk(P ＜ 0.05),and the shrinkage in the treatment group was superior to that of the control group (P ＜0.05).(4) During the treatment,no obvious adverse reaction occurred in the two groups.Conclusion Modified Hezhong Powder combined with western medicine is effective and safe for the treatment of children mesentetic lymphadenitis,and its efficacy is superior to that of the western medicine alone.

Clinical Effect of Modified Qiwei Baizhu Powder for Mesenteric Lymphadenitis in Children with Spleen Deficiency and Dampness Retention / 广州中医药大学学报

Objective To observe the clinical curative effect of modified Qiwei Baizhu Powder for mesenteric lymphadenitis in children with spleen deficiency and dampness retention. Methods A multi-center randomized and controlled trial was carried out in 150 cases of mesenteric lymphadenitis in children with spleen deficiency and dampness retention. The patients were randomized into Chinese medicine group, western medicine group and combination group, 50 cases in each group. Chinese medicine group was treated with modified Qiwei Baizhu Powder, western medicine group was treated with Cefaclor for Oral Suspension, and the combination group was treated with modified Qiwei Baizhu Powder plus Cefaclor for Oral Suspension. Before treatment and after treatment for 7 days, one month and 3 months, changes in syndrome manifestations and the size of abdominal mesenteric lymph nodes were monitored. The total effective rate and cure rate of the three groups were compared, and the safety of the regimen was also evaluated. Results (1) In Chinese medicine group, 5 patients dropped out, and a total of 45 cases completed the trial; in western medicine group, 3 patients dropped out, and a total of 47 cases completed the trial; in the combination group, 7 patients dropped out, and a total of 43 casescompleted the trial.(2) The total effective rate of Chinese medicine group and combination group after treatment for 7 days, one month and 3 months was significantly higher than that of western medicine group (P 0.05) at various time points.(3) After treatment for 7 days, one month and 3 months, the transverse and longitudinal diameters of mesenteric lymph nodes in Chinese medicine group and combination group were shorter than those of western medicine group (P 0.05). (4) Except for the drop-out cases, all of the children finished the trial. During the treatment, no obvious adverse reaction was found. Conclusion Modified Qiwei Baizhu Powder exerts certain efficacy for the treatment of mesenteric lymphadenitis in children with spleen deficiency and dampness retention.

Meta-analysis of effectiveness of Chinese materia medica as adjuvant therapy of antibacterial for pediatric mesenteric lymphadenitis / 药物评价研究

Objective To assess the effectiveness of Chinese materia medica (CMM) as adjuvant therapy of antibacterial for pediatric mesenteric lymphadenitis.Methods Retrieved RCT research of CMM as adjuvant therapy of antibacterial for pediatric mesenteric lymphadenitis from CNKI,Wanfang,VIP,PubMed,and Medline database from 1980 to 2016.Literatures were selected according to the inclusion and exclusion crteria,Jadad scores method was used to evaluate the literatures and meta-analysis was performed by RevMan 5.3.Results A total of 34 randomized controlled trials were included.Meta-analysis showed that the trial group was superior to the control group in terms of efficiency,cure rate,remission time of main symptoms,mesenteric lymph node recovery,and recurrence rate,there was statistical difference.Conclusions CMM as adjuvant therapy of antibacterial for pediatric mesenteric lymphadenitis is more effective than the use of antibacterial alone.

Effect of Acupuncture plus Chinese Herbal Medication on ET-1 and CGRP in Child Patients with Mesenteric Lymphadenitis / 上海针灸杂志

Objective To investigate the effect of acupuncture plus Chinese herbal medication on plasma endothelin (ET-1) and calcitonin gene-related peptide (CGRP) in child patients with mesenteric lymphadenitis.Methods One hundred and eighty child patients with mesenteric lymphadenitis were randomly allocated to groups A, B and C, 60 cases each. Group A received acupuncture at Zusanli and pricking Sifeng points plus oral administration of Wudang Babao Zijinding; group B, oral administration of amoxicillin and clavulanate potassium granules; group C, oral administration of Wudang Babao Zijinding alone. ET-1 and CGRP contents were measured in the three groups before and after treatment.Results There were statistically significant pre-/post-treatment differences in ET-1 and CGRP contents in group A (P<0.01). There were statistically significant post-treatment differences in ET-1 and CGRP contents between group A and group B or C (P<0.01).Conclusions Acupuncture plus Chinese herbal medication is an effective way to treat mesenteric lymphadenitis in children. It can regulate ET-1 and CGRP in the patients.

High-frequency Ultrasound in the Diagnosis of Pediatric Mesenteric Lymphadenitis / 中国医学影像学杂志

Purpose To analyze the high-frequency sonographic images of lymph nodes in mesenteric lymphadenitis of different ages. Materials and Methods 139 children with mesenteric lymphadenitis (study group) and 60 normal children (control group) were divided into 1 to 5 years, 6 to 10 years and 11 to 15 years group, the characteristics of high-frequency ultrasound sonographic images were analyzed, accuracy of longitudinal diameter (L), transverse diameter (S), aspect ratio (L/S) and color Doppler blood flow signal classification for the prediction of mesenteric lymph nodes swelling were evaluated using receiver operating characteristic (ROC) curve. Results Mesenteric lymph nodes in the control group appeared as spindle shape with sparse blood flow signals, L, and L/S increased with age increasing (F=4.047, 9.586;P0.05). Compared with the control group, blood flow signals were more abundant in all age groups of the study group, L and S were also significantly higher (L:t=-13.798,-12.813,-8.089;S:t= -8.212,-13.172,-9.606, P<0.01), only in the 1 to 5 years group statistically significant difference (t=-3.208, P<0.05) was showed between the two groups. From 1 to 5 years, the sensitivity and specificity for the judgment of lymph node swelling were 95.56%and 100.00%, respectively when using L=9.85 mm as a standard;from 6 to 10 years, the sensitivity and specificity for the judgment of lymph node swelling were 95.59%and 100.00%, respectively when using L=10.25 mm as a standard;from 11 to 15 years, the sensitivity and specificity for the judgment of lymph node swelling were 92.31%and 100.00%, respectively when using S=4.40 mm as a standard. Conclusion High-frequency ultrasound is able to display the location distribution and morphological characteristics of the mesenteric lymph nodes in children, and also to accurately measure the diameters and flow signal distribution of the lymph nodes, thus will provide valuable evidence for the diagnosis of pediatric mesenteric lymphadenitis.

Observation on Long-term and Short-term Therapeutic Effect of Acupuncture Therapy to Chronic Mesenteric Lymphadenitis / 浙江中医药大学学报

[Objective] To assess the curative effect of acupuncture therapy to chronic mesenteric lymphadenitis. [Methods] Al 120 children patients are ran-domly divided into two groups, 60 cases each. Control group is treated with cefuroxime sodium for infections, and treatment group with acupuncture at Sifeng(EX-UE 10), Neiguan (PC06), Zhongwan(RN 12),Zusanli(ST 36) and etc. [Results] Markedly effective rate of treatment group was 91.7%,and total effective rate was 98.3%; markedly effective rate of control group was 86.7%, and total effective rate was 95%, which showed significant difference in curative effects.The two groups symptoms were decreased compared with before treatment, the difference was significant( P<0.01);after treatment, symptom scores were lower than the control group, with significant difference. The recurrence rate of treatment group after three months was 3.6%. The recurrence rate of treatment group after six months was 1.9%, evidently lower than control group ’s 57.7%,54% respectively. [Conclusion] Acupuncture therapy to chronic mesenteric lymphadenitis has unequivocal short-term effect, a stable long-term effect, and low recurrence rate,deservers clinical applications.

Primary tuberculosis appendicitis with mesenteric mass / 대한외과학회지

Tuberculosis primarily affecting the appendix is extremely rare and the diagnosis is difficult. Here, we report the case of a 14-year-old healthy boy presenting with right lower quadrant abdominal pain. On computed tomography, the distended appendix with 3.3 x 2.7 cm mass located at the right side of the right iliac artery was detected. There was neither bowel wall thickening nor active lung lesion. After laparoscopic appendectomy with mass excision, histopathological examination revealed chronic granulomatous inflammation, with caseous necrosis of the appendix. We made a diagnosis of primary tuberculosis of appendix and administrated anti-tuberculosis medication.

Linfoadenitis criptococócica mesentérica: Una rara causa de abdomen agudo. Caso clínico / Mesenteric cryptococcal lymphadenitis: Report of one case

Cryptococcosis is an invasive mycotic infection caused by Cryptococcus neoformans, an encapsulated, yeast-like fungus. It is considered an opportunist infection, since it mainly affects immunocompromised subjects. However there are isolated reports of the infection in immunocompetent subjects. Cryptococcal infection of intra-abdominal organs or tissues is extremely rare. We report a 21-year-old HIV positive male that, during the treatment of a meningeal cryptococcosis, presented a clinical picture of an acute abdomen suggesting acute appendicitis. The patient was operated, finding enlarged mesenteric lymph nodes forming conglomerates and a macroscopically normal appendix. The conglomerated lymph nodes and the appendix were excised. The pathological study of the surgical piece revealed an intra abdominal cryptococcal lymphadenitis and a normal appendix.

A Case of Kikuchi-Fujimoto Disease Presenting as Mesenteric Lymphadenitis / 감염과화학요법

Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a benign, rare, self limitimg disease presenting with mainly cervical lymphadenopathy and fever unresponsive to antibiotics or medical treatment. A 28-year old man presented with fever and right lower quadrant abdominal pain. Physical examination showed abdominal tenderness and rebound tenderness mimicking acute appendicitis. Imaging studies showed normal appendix and other abdominal organs except enlarged multiple mesenteric lymph nodes. Symptoms persisted despite antimicrobial therapy. Multiple tender lymph nodes were palpable on bilateral cervical area at the 7th hospital day. The biopsy of the neck node showed large areas of patchy, irregular necrosis with prominent nuclear debris surrounded by T lymphocytes, histiocytes without neutrophils and granuloma, so he was diagnosed as Kikuchi-Fujimoto disease. With conservative management, clinical improvement was observed. We suggest that Kikuchi-Fujimoto disease with mesenteric lymphadenitis should be added to the differential diagnosis of acute abdomen mimicking acute appendicitis in young adults.

A Case of Kikuchi-Fujimoto Disease Presenting as Mesenteric Lymphadenitis / 감염과화학요법

Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a benign, rare, self limitimg disease presenting with mainly cervical lymphadenopathy and fever unresponsive to antibiotics or medical treatment. A 28-year old man presented with fever and right lower quadrant abdominal pain. Physical examination showed abdominal tenderness and rebound tenderness mimicking acute appendicitis. Imaging studies showed normal appendix and other abdominal organs except enlarged multiple mesenteric lymph nodes. Symptoms persisted despite antimicrobial therapy. Multiple tender lymph nodes were palpable on bilateral cervical area at the 7th hospital day. The biopsy of the neck node showed large areas of patchy, irregular necrosis with prominent nuclear debris surrounded by T lymphocytes, histiocytes without neutrophils and granuloma, so he was diagnosed as Kikuchi-Fujimoto disease. With conservative management, clinical improvement was observed. We suggest that Kikuchi-Fujimoto disease with mesenteric lymphadenitis should be added to the differential diagnosis of acute abdomen mimicking acute appendicitis in young adults.

Intraabdominal Cryptococcal Lymphadenitis in a Patient with Systemic Lupus Erythematosus

Cryptococcal infection is a rare, yet well recognized complication of systemic lupus erythematosus (SLE). We present a case of mesenteric and retroperitoneal cryptococcal lymphadenitis resulting in the obstruction of the stomach and proximal duodenum in a patient suffering from SLE, while recently she did not receive any immunosuppressive treatment. A 42-yr-old woman was admitted due to high fever and diffuse abdominal pain for three weeks. Abdominal computed tomography (CT) scan showed multiple conglomerated lymphadenopathies in the retroperitoneum and the mesentery resulting in luminal narrowing of the third portion of the duodenum. Cryptococcal lymphadenitis was proven by needle biopsy and she was treated with intravenous liposomal amphotericin B, followed by oral fluconazole. After fourteen-month antifungal therapies, the clinical symptoms and follow-up images improved. This case emphasize that the intrinsic immunological defects of SLE may be directly responsible for the predisposition to fungal infections.

Clinical Features of Acute Nonspecific Mesenteric Lymphadenitis and Factors for Differential Diagnosis with Acute Appendicitis / 대한소아소화기영양학회지

PURPOSE: Although acute nonspecific mesenteric lymphadenitis (ANML) is probably common cause of abdominal pain in children, which can be severe enough to be an abdominal emergency, the clinical features of mesenteric lymphadenitis are not clear. Also, a differential diagnosis with acute appendicitis (APPE) is indispensable to avoid serious complications. The clinical features of ANML were determined, and the risk factors for differential diagnosis with APPE were analyzed. METHODS: Between November 2000 and May 2001, data from 26 patients (aged 1 to 11 years) with ANML and 21 patients (aged 2 to 13 years) with APPE were reviewed. ANML was defined as a cluster of five or more lymph nodes measuring 10 mm or greater in their longitudinal diameter in the right lower quadrant (RLQ) without an identifiable specific inflammatory process on the ultrasonographic examination. There were risk factors on patient's history, physical examination, and laboratory examination; the location of abdominal pain, abdominal rigidity, rebound tenderness, fever, nocturnal pain, the vomiting intensity, the diarrhea intensity, the symptom duration, and the peripheral blood leukocytes count. RESULTS: Of the 26 ANML patients and 21 APPE patients, abdominal pain was noted on periumbilical (76.9% vs 14.2%), on RLQ (11.5% vs 71.4%), with abdomen rigidity (7.6% vs 80.9%), with rebound tenderness (0.0% vs 76.1%)(p0.05). The clinical symptoms were vomiting (38.4% vs 90.4%), the vomiting intensity (1.5+/-0.7 [1~3] /day vs 4.5+/-2.9 [1~10] /day), diarrhea (65.3% vs 28.5%) (p0.05). The period to the subsidence of abdominal pain in the ANMA patients was 2.5+/-0.5 (2~3) days. The laboratory data showed a significant difference in the peripheral blood leukocytes count (8,403+/-1,737 [5,900~12,300] /mm3 vs 15,471+/-3,749 [5,400~20,800] /mm3)(p<0.05). Discriminant analysis between ANML and APPE showed that the independent discriminant factors were a vomiting intensity and the peripheral blood leukocytes count and the discriminant power was 95.7%. CONCLUSION: The clinical characteristics of ANML were abrupt onset of periumbilical pain without rigidity or rebound tenderness, a mild vomiting intensity, normal peripheral leukocytes count, and relatively short clinical course. If the abdominal pain persist for more than 3 days, and/or the vomiting intensity is more than 3 times/day, and/or the peripheral leukocytes count is over 13,500/mm3, abdominal ultrasonography is recommended to rule out APPE.

Clinical Observation of Mesenteric Lymphadenitis in Children / 소아과

PURPOSE: Mesenteric lymphadenitis is classified into acute and chronic, specific and nonspecific types according to clinical aspect and causative disease. We under took this study to find out clinical aspects, associated diseases and hospital course of mesenteric lymphadenitis in children. METHODS: We examined 98 children aged from 18 months to 14 years who visited Dongsan Medical Center for abdominal pain between March 1998 and May 2002. Ultrasonography was performed and medical records were analysed. The specific group had a causative disease, and the chronic group had persistent clinical symptom over three months. RESULTS: Symptoms were chronic in 4% of the patients and acute in 96%. Most of the patients were in oen to five years of age. In the acute group, abdominal pain, vomiting, fever and diarrhea were shown commonly in order, and average WBC count was normal. Gastroduodenitis, tonsillitis, pneumonia and enterocolitis were accompanied in the acute specific group. Ultrasonograms of abdomens showed lymph node enlargement. In the acute group, symptoms were improved within one week. Lymph node enlargement was noted on follow up ultrasonograms in the chronic group. Gastrocolonoscopy of chronic group showed one case of H. pylori positive duodenitis, one case of ulcerative colitis, and two cases of Crohn's disease. CONCLUSION: There was no statistical significance in clinical aspect, laboratory findings and hospital course between the patients with specific etiology and nonspecific etiology. Symptoms improved within one week in patients in the acute group. If abdominal pain persists, additional examinations such as endoscopic biopsy, stool cultures, or small bowel studies should be performed to determine the underlying cause.

Is Acute Nonspecific Mesenteric Lymphadenitis Associated with Acute Abdominal Pain in Epidemic Aseptic Meningitis? / 소아과

PURPOSE: Acute abdominal pain in an epidemic aseptic meningitis which is mostly an enterovirus as causative agent, is noted in 23-55% of patients. An enterovirus is also known as one of the causes of acute nonspecific mesenteric lymphadenitis(ANML). The purpose of this study was to see if ANML was associated with acute abdominal pain in epidemic aseptic meningitis. METHODS: Between June 2001 and July 2001, data from 30 patients, aged 3 years to 14 years, with aseptic meningitis was reviewed. Abdominal ultrasonography was performed on all the patients and ANML was defined as a cluster of five or more lymph nodes measuring 5 mm or greater in their longitudinal diameter in the right lower quadrant with no identifiable specific inflammatory process. RESULTS: The clinical symptoms of the 30 patients were:fever(76.7%), vomiting(90.0%), diarrhea(20.0%) and abdominal pain(40.0%). The average peripheral blood leukocytes count on admission was 7,996+/-2,701(4,500-14,500)/mm(3). ANML, according to the ultrasonography, was shown in 93.3% of aseptic meningitis patients; the number of mesenteric nodes was 9.2+/-5.3(5-20), with 7.4% of the 27 control cases being mesenteric nodes positive(P<0.05). The patients with ANML were divided into two groups; those with and without abdominal pain, 42.9% and 57.1% respectively. Two patients without ANML showed no abdominal pain. The count of mesenteric nodes was not significantly correlated with the duration to diagnosis, with or without fever, peripheral blood leukocytes count, and with or without abdominal pain. CONCLUSION: ANML is presumed to be a cause of the acute abdominal pain in epidemic aseptic meningitis. Further clinical observations are recommended on the reason why ANML can be associated with and without abdominal pain.

A Case of Mesenteric Lymphadenitis Due to Mycobacterium avium Complex Infection in the Acquired Immunodeficiency Syndrome Patient / 감염

Mycobacterium avium complex (MAC) refers to infections caused by one of two nontuberculous mycobacterial species, either M. avium or M. intracellulare and the risk of MAC in patients with human immunodeficiency virus (HIV) infection increases as the CD4+ T cell number declines below 50 cells/mm3. In these patients, fever, night sweats, abdominal pain, weight loss and multiple large retroperitoneal and mesenteric lymph nodes should suggest the diagnosis of MAC infection as well as other known causes of lymphadenitis, including lymphoma, Kaposi's sarcoma, dis-seminated histoplasmosis, cryptococcosis and intraabdominal M. tuberculosis. We report an autopsy case of 55 years-old man with HIV-infection who was diagnosed mesenteric lymphadenitis due to MAC infection as a cause of fever of unknown origin during treatment of the primary central nervous system malignant B-cell lymphoma.

Mesenteric Lymphadenitis Due to Yersinia enterocolitica: A case report

Mesenteric lymphadenitis due to Yersinia enterocolitica infection is not common in Korea. Although most cases of Yersinia enterocolitica-induced mesenteric adenitis are self limited, cardinal features of Yersinia enterocolitica-induced mesenteric adenitis are so similar to those of acute appendicitis that some of the patients undergo laparotomy with suspected appendicitis. The findings on laparotomy in such patients are usually enlarged mesenteric nodes with a normal or slightly inflamed appendix. Because histologic examination of the removed mesenteric lymph nodes reveals reactive hyperplasia in most cases, it is usually difficult to suspect Yersinia enterocolitica infection on morphology of the resected nodes. But suppurative granulomata of mesenteric lymph nodes, uncommonly encountered in Yersinia enterocolitica infection, strongly suggest yersinial infection. We report a case of mesenteric lymphadenitis in a 10-year-old boy, who underwent laparotomy with suspected acute appendicitis. The removed lymph node showed several suppurative granulomata in the cortex, suggesting yersinial infection. Serologic study confirmed Yersinia enterocolitica serotype O:3 infection.

A Case of Intestinal Tuberculosis with Tuberculous Mesenteric Lymphadenitis Simulating Neoplasm

The incidence of abdominal tuberculosis is decreasing due to more effective chemotherapy and pasteurization of milk and tuberculosis may nt be given serious consideration, especially when the primary pulmonary site is healed or not roentgenographically apparent. The clinical features of these infection are relatively nonspecific and the combination of abdominal mass, weight loss, anorexia and fever frequently lead to an erroneous primary diagnosis of neoplasm, especially lymphoma or carcinoma, metastatic to mesenteric lymph node. We have recently experienced a case of abdominal tuberculosis with huge tuberculous mesenteric lymphadenitis simulating neoplasm in 24 month old male. The case was reported with the brief review of literatures.