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)

Acute kidney injury associated with Yersinia pseudotuberculosis infection: Forgotten but not gone

BACKGROUND: Yersinia pseudotuberculosis is known to cause fever, gastroenteritis, or acute kidney injury (AKI). There have been several Y. pseudotuberculosis infection outbreaks to date associated with ingestion of contaminated food or unsterile water. While this disease was considered to have practically been eradicated with the improvement in public health, we encountered several cases of AKI associated with Yersinia infection. METHODS: We retrospectively collected data from medical records of patients with suspected Y. pseudotuberculosis infection who visited Seoul National University Children’s Hospital in 2017. RESULTS: There were nine suspected cases of Yersinia infection (six males and three females; age range 2.99–12.18 years). Among them, five cases occurred in May, and seven patients were residing in the metropolitan Seoul area. Three patients had history of drinking mountain water. Every patient first presented with fever for a median of 13 days, followed by gastrointestinal symptoms and oliguria. Imaging studies revealed mesenteric lymphadenitis, terminal ileum wall thickening, and increased renal parenchymal echogenicity. Creatinine levels increased to 5.72 ± 2.18 mg/dL. Urinalysis revealed sterile pyuria, proteinuria, and glycosuria. Oliguria continued for 4 to 17 days, and two patients required dialysis; however, all of them recovered from AKI. Mucocutaneous manifestations developed later. In the diagnostic work-up, Yersinia was isolated from the stool culture in one patient. Anti-Yersinia immunoglobulin (Ig) A and IgG were positive in 6 patients. CONCLUSION: Y. pseudotuberculosis infection is an infrequent cause of interstitial nephritis presenting with AKI. When a patient presents with fever, gastroenteritis, and AKI not resolving despite hydration, the clinician should suspect Y. pseudotuberculosis infection.

A Case of Paradoxical Reaction Development during Antituberculosis Therapy / 대한소화기학회지

Paradoxical reaction during antituberculosis therapy is defined as aggravation of preexisting tuberculous lesions or the development of new lesions. A 24-year-old female college student diagnosed with abdominal and pulmonary tuberculosis presented with fever and abdominal pain after having been treated with antituberculosis agents for 4 months. Tuberculous mesenteric lymphadenitis was suspected on abdominal CT scan and enlarged necrotic abscess was also present. These findings were considered to be due to paradoxical reaction rather than treatment failure during antituberculosis treatment. Although laparoscopic bowel adhesiolysis and abscess drainage were performed, high fever and severe abdominal pain did not improve. However, the patient eventually made a completely recovery after corticosteroid therapy combined with antituberculosis agents. Herein, we report a case of paradoxical reaction which developed in a patient with abdominal and pulmonary tuberculosis during antituberculosis therapy.

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.

Typhoid Fever Complicated by Intussusception, Splenic Infarction, and Hepatitis

Salmonella typhi infections usually manifest with high fever and gastrointestinal symptoms, however, occurrence of severe complications in other organs, such as pneumonitis, bronchitis, hepatitis, nephritis, encephalitis, and osteomyelitis, is possible. Although common surgical complications include ileal perforation and gastrointestinal haemorrhage, few cases of intussusception have been reported. Splenic infarction is another uncommon complication. In this report, we present a case of typhoid fever complicated with simultaneous small bowel intussusception and splenic infarction. A 27-year-old male patient with no previous history of interest underwent examination for fever, acute abdominal pain, and watery diarrhea of seven days duration. Findings on the initial examination indicated fever of 39.1degrees C, a distended abdomen with direct and rebound tenderness of diffuse localization, and rigidity. Abdominal computed tomography showed hepatomegaly, multiple lymphadenopathies, multiple segmental splenic infarctions, and small bowel ileus with intussusception, however, findings from the small bowel enema study showed spontaneous resolution of the intussusception. Despite antibiotic therapy, abdominal symptoms continued, therefore, the patient underwent exploratory laparotomy with suspicion of intestinal perforation. Surgical findings included multiple enlarged lymphadenopathies and coarse appearance of the liver, but no perforation was found. Results of the Widal test showed positivity for flagellar (H), somatic (O) and A antigens (1:640 dilutions each). Blood cultures showed Salmonella typhi. lymph nodes and biopsy showed mesenteric lymphadenitis, with enlarged lymph nodes due to distension of the sinusoids by macrophages, which showed erythrophagocytosis and tingible bodies. In addition, liver biopsy showed a granulomatous aggregate comprised of macrophages with an epithelioid configuration. After intravenous administration of antibiotics, the patient showed progressive improvement and was discharged for outpatient department follow up.

Usefulness and Pitfall of Abdominal Ultrasonographic Examination by a Pediatrician in Children / 대한소아소화기영양학회지

Ultrasonographic examination plays an important role in non-invasive and prompt screening examinations in detecting abdominal diseases. In this review, the author's experience of the usefulness and pitfalls of ultrasonographic examinations in children with gastrointestinal symptoms is presented. A total of 1,000 cases of children who underwent ultrasonographic evaluation in the Department of Pediatrics, Pusan National University Hospital were reviewed. The main causes leading to ultrasonographic evaluation were abdominal pain (43.9%), vomiting (17.3%), elevated liver enzymes (11.8%), and jaundice (9.8%). Abnormal ultrasonographic findings accounted for 57.9% of cases. The major abnormal findings were mesenteric lymphadenitis (29.2%), fatty liver (12.1%), hepatitis (6.4%), hepatosplenomegaly (6.2%), and acute appendicitis (4.8%). The major findings in children with abdominal pain were mesenteric lymphadenitis (32.6%), intussusception (2.7%), and acute appendicitis (2.7%). The major findings in children with vomiting were mesenteric lymphadenitis (12.7%), hypertrophic pyloric stenosis (10.4%), acute appendicitis (3.5%). The major ultrasonographic findings in children with urinary tract diseases were hydronephrosis (45.4%), urolithiasis (21.5%) and cystic renal disease (18.1%). Ultrasonography performed by pediatricians is advantageous because pediatricians are able to perform the procedure with clinical information at the right time.

Clinical Features of Intestinal Tuberculosis in Recent Ten Years (2001-2010)

BACKGROUND/AIMS: Intestinal tuberculosis (ITB) evades early diagnosis due to non-specific clinical manifestations and difficulties in confirming the disease process. In the current study, we determined the diagnostic appearance and clinical manifestations of ITB in recent 10 years according to diagnostic guidelines, as proposed by the IBD Study Group of Korean Association for the Study of the Intestinal Diseases (KASID). METHODS: Fifty-six patients with ITB who were diagnosed at Seoul Paik Hospital between January 2001 and August 2010 were retrospectively reviewed. The diagnosis of ITB was defined as definite or probable in accordance with the diagnostic guidelines and the clinical features were analyzed in comparison with previous studies involving ITB in Korea. RESULTS: The mean age at the time of diagnosis was 45+/-15 years (range, 17-71 years). Definite and probable diagnoses were obtained in 29% and 71% of the patients, respectively. Twenty-three percent of the patients had synchronous active pulmonary TB and 14% of the patients had other forms of abdominal TB, such as TB mesenteric lymphadenitis or peritonitis. The most common symptoms were abdominal pain (43%), followed by diarrhea (30%), weight loss (14%). Twenty-seven percent of the patients (15 cases) were asymptomatic and diagnosed on comprehensive health care or post-operative surveillance. Only 2 patients (3.6%) underwent surgery for complications, such as intestinal obstruction and perforation. CONCLUSIONS: ITB is still prevalent in Korea; however, in the recent 10 years the symptoms of ITB have been milder than previously reported. In addition, the complication rates of ITB were remarkably decreased, suggesting that early diagnosis of ITB was increased.

Usefulness of Ultrasonographic Examination by a Pediatrician in Children with Abdominal Pain / 대한소아소화기영양학회지

PURPOSE: Ultrasonography (US) is widely used as a screening test in patients with abdominal pain (AP). We investigated the usefulness of US by a pediatrician in children with AP. METHODS: We retrospectively analysed the medical records of children with AP who undertook US from December, 2008 to July, 2010. RESULTS: A total of 628 patients (325 male, 303 female) were enrolled in this study. The mean age of patients was 8.08+/-4.61 years. Duration of AP was acute in 427 and chronic in 201 patients. Localization of AP was diffuse (36.9%), periumbilical (24.4%), epigastric (21.0%), and right lower quadrant (8.1%). On the examination, there were no abnormal findings in 327 patients (52.1%). Abnormal ultrasonographic findings were mesenteric lymphadenitis (27.1%), intestinal mural thickening (10.0%), intussusception (3.0%), appendicitis (2.6%), choledochal cyst (1.6%), and pancreatitis (0.3%). We performed additional imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) in 39 patients who showed obscure findings on the US. In 33 patients (84.6%), the same results were obtained from CT or MRI. Two cases of appendicitis, one case of pancreatitis and one case of Henoch-Shonlein purpura were diagnosed by the CT examination. However, there were two cases of appendicitis diagnosed by US thathad no evidence of appendicitis on the CT. Diagnostic accuracy of initial US in children with abdominal pain was 99.4%. CONCLUSION: US by a pediatrician as a screening test in children with AP provides a rapid and accurate diagnostic indication and has non-invasive and radiation-free advantages.

Enlarged mesenteric lymph nodes in children: a clinical analysis with ultrasonography and the implications / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the enlarged mesenteric lymph nodes in healthy children with those children with mesenteric lymphadenitis.</p><p><b>METHODS</b>According to the diagnostic criteria defining lymph node enlargement as a 5-mm enlargement or greater in the short diameter, 137 healthy children and 148 children with mesenteric lymphadenitis were retrospectively analyzed for mesenteric lymph node enlargement based on the ultrasonographic data.</p><p><b>RESULTS</b>The distribution of enlarged mesenteric lymph nodes was detected in the right lower quadrant (RLQ) in 46.3%, in the para-aortic areas in 19.2%, and in the left lower quadrant (LLQ) in 13.6% of the children. The clusters of lymph nodes between the two groups showed no significant difference in the distribution, age, L/W, longitudinal diameter or clusters, only the short diameter differed significantly between them.</p><p><b>CONCLUSION</b>Enlarged mesenteric lymph nodes are present in many healthy children, which does not necessarily suggests any abnormalities. The mesenteric lymph nodes increase with the age until 6 years and then decrease. The lymph nodes with a short diameter larger than 8 mm may indicate the condition of mesenteric lymphadenitis.</p>

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.

Clinical Features of Infectious Ileocecitis in Children / 대한소아소화기영양학회지

PURPOSE: Infectious ileocecitis is an infection confined to the ileocecal area and one of the most common causes of pediatric abdominal pain. This study was performed to demonstrate the clinical features of infectious ileocecitis in children. METHODS: The medical records and radiologic findings of 37 patients with ileocecitis diagnosed by ultrasonography and/or computed tomography, who were admitted to Pusan National University Hospital from January 2004 and July 2008, were reviewed retrospectively. Viral gastroenteritis and secondary ileocecitis were excluded. RESULTS: The mean age of the patients was 4.8+/-3.4 years. One-half of the patients were preschool children. The chief complaint was abdominal pain (75.7%), diarrhea (10.8%), and vomiting (8.1%). Accompanying symptoms were fever (56.8%), vomiting (21.6%), and diarrhea (16.2%). The mean duration of abdominal pain, fever, diarrhea, and vomiting was 3.8+/-2.1, 3.0+/-1.9, 3.4+/-1.9, and 2.4+/-2.3 days, respectively. The frequency of diarrhea and vomiting was 5.8+/-2.2 and 4.0+/-2.8 per day, respectively. Diagnosis was made by abdominal ultrasonography in 22 patients (59.5%), abdominal CT in 2 patients (5.4%), and both modalities in 13 patients (35.1%). Besides the radiologic finding of thickening of the bowel wall, mesenteric lymphadenitis (59.5%), ascites (5.4%), and both mesenteric lymphadenitis and ascites (16.2%) were revealed. The mean duration of illness was 7.5+/-5.0 days. There were no specific laboratory findings, and culture studies with stool or blood were negative. All of the patients recovered completely without specific treatment. CONCLUSION: Infectious ileocecitis has acute appendicitis-mimicking symptoms, but is self-limited within a few days, thus unnecessary treatment and work-up is avoided. However, distinguishing infectious ileocecitis from appendicitis, inflammatory bowel disease, and mesenteric lymphadenitis is important.

Agenesia del apéndice cecal: informe de un caso / Congenital absence of the cecal appendix: case report

Introducción: La agenesia del apéndice cecal es muy rara y fue descrita por primera vez por Morgagni en 1718. La incidencia estimada es de uno por cada 100 mil laparotomías realizadas por sospecha de apendicitis. Se informa este caso con la finalidad de atraer la atención de los cirujanos que se encuentren en situación similar durante la laparotomía. Caso clínico: Hombre de 48 años de edad admitido en la sala de urgencias por dolor abdominal de tipo vago, más notable en epigastrio y mesogastrio, el cual cuatro horas después de iniciado se localizó en la fosa iliaca derecha, acompañado de hiporexia, náusea, vómito y fiebre. A la exploración física se encontró paciente febril, taquicárdico, taquipneico, con peristaltismo disminuido, abdomen doloroso a la palpación y a la percusión en la fosa iliaca derecha. Signos apendiculares positivos. La biometría hemática indicó leucocitosis de 14 mil, neutrofilia (89.60 %) y linfopenia (5.33 %). Las radiografías simples de abdomen no mostraron anormalidades. Se formuló diagnóstico de probable apendicitis aguda, por lo que se efectuó celioscopia, identificándose agenesia apendicular tipo IV de Collins y adenitis mesentérica concomitante. Conclusiones: Se tienen que conocer varios criterios antes de concluir que el apéndice cecal está ausente de manera congénita. El diagnóstico no debe realizarse hasta que la regiones ileocecal y retrocecal hayan sido exploradas.

BACKGROUND: Agenesis of the vermiform appendix is very rare and was first described by Morgagni in 1718. The estimated incidence is 1/100,000 laparotomies performed for suspected appendicitis. This case is reported with the aim of attracting the attention of surgeons who may be in a similar situation during laparotomy. CLINICAL CASE: A 48-year-old male was admitted through the emergency room with the complaint of vague abdominal pain most marked in the epigastrium and mesogastrium which, 4 h after it began, was located in the right iliac fossa and was accompanied by hyporexia, nausea, vomiting and fever. During physical examination, the patient was febrile, tachycardic, and tachypneic, with decreased peristalsis, abdomen painful to palpation and percussion in the right iliac fossa. There were positive appendicular signs. Blood panel showed leukocytosis (14,000), neutrophilia (89.60%) and lymphopenia (5.33%). X-rays of the abdomen showed no abnormalities. We made a presumptive diagnosis of acute appendicitis and the patient underwent celioscopy where surgical findings were reported as type IV Collins appendiceal agenesis and concomitant mesenteric adenitis. CONCLUSIONS: Several criteria must be determined before the surgeon can conclude that the appendix is congenitally absent. Diagnosis should not be confirmed until the ileo- and retrocecal regions have been explored.

Uso de contraceptivos orais induzindo trombose mesentérica / Use of oral contraceptives causing mesenteric thrombosis

A trombose mesentérica é causa rara de dor abdominal em jovens, sendo responsável por cerca de 5 por cento a 10 por cento de todos os eventos de isquemia mesentérica. Contraceptivos hormonais orais têm sido associados a dezenas de casos de trombose mesentérica. Os autores relatam o caso de paciente com diagnóstico de trombose mesentérica após uso de contraceptivos e descrevem a relação entre ambos. M.R.F.S., sexo feminino, 19 anos, branca, deu entrada no Pronto Socorro do Hospital das Clínicas de Marília com quadro de dor abdominal há três dias associada ao uso de cinco comprimidos de anticoncepcional hormonal oral um dia antes de iniciar o quadro. Apresentava-se em regular estado geral, com abdome tenso, enrijecido, com ruídos hidroaéreos hipoativos, doloroso difusamente à palpação, sinal de Jobert e Blumberg positivos. A maioria das causas de trombose mesentérica são devidas a estados pró-trombóticos derivados de desordens da coagulação herdadas ou adquiridas. Portanto, uma vez confirmado este diagnóstico, os pacientes devem ser investigados para trombofilias hereditárias ou adquiridas com testes para deficiência de proteínas C e S, fator V de Leiden, hiperhomocisteinemia e hemoglobinúria paroxística noturna.

Mesenteric thrombosis is a rare cause of abdominal pain in the young and is responsible for about 5-10 percent of all mesenteric ischemic events. Oral contraceptives are associated to many cases of mesenteric thrombosis. The case of a woman with mesenteric thrombosis after taking a high dose of contraceptives is reported. M.R.F.S., a 19-year-old caucasian woman, arrived in the Emergency Service of the Hospital das Clínicas in Marília reporting abdominal pain over 3 days associated with the use of 5 tablets of oral contraceptives one day earlier. An examination identified the abdominal wall was hardened and tense, with hypoactive bowel sounds, generalized pain on palpation , and Jobert and Blumberg signs. Most causes of mesenteric thrombosis are due to pro-thrombotic conditions caused by acquired or inherited blood coagulation disorders. Thus, when there is suspicion of mesenteric thrombosis, patients should be investigated for acquired and inherited thrombophilia using tests of protein C and S, V. Leiden factor, hyperhomocysteinemia and nocturnal paroxysmal hemoglobinuria.

Adenitis mesentérica por Yersinia enterocolítica / Mesenteric adenitis due to Yersinia enterocolitic

Se presenta por primera vez en nuestro país un caso de adenitis mesentérica en una niña de 3 años asociado a infección por Yersinia enterocolítica. La cepa recuperada del coprocultivo correspondió al bioserotipo patogénico 4/O:3 y presentó además el plásmido de virulencia.

Analysis of 1,000 Cases of Abdominal UltrasonographyPerformed by a Pediatrician / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to evaluate the clinical usefulness of ultrasound examination of children performed by a pediatrician. METHODS: One thousand children who presented with symptoms of a gastrointestinal disorder and underwent abdominal ultrasound evaluation in the Department of Pediatrics, between January 2003 and June 2006, were included in this study. We analyzed the patient's medical records and ultrasound results retrospectively. RESULTS: Among the 1,000 patients, 58.4% were male and 41.6% were female. The mean age of the patients was 4.7+/-4.0 years. The main reasons for ultrasound were abdominal pain (43.9%), vomiting (17.3%), elevated liver enzymes (11.8%), and jaundice (9.8%). Abnormal ultrasound findings were present in 57.9% of cases. The major abnormal findings were mesenteric lymphadenitis (29.2%), fatty liver (12.1%), hepatitis (6.4%), hepatosplenomegaly (6.2%), and acute appendicitis (4.8%). The time interval between the initial medical evaluation and the ultrasound evaluation was within 24 hours in most cases (78.5%). The main findings in children with abdominal pain were mesenteric lymphadenitis (32.6%), fatty liver (5.9%), intussusception (2.7%), and acute appendicitis (2.7%). The main findings in children with vomiting were mesenteric lymphadenitis (12.7%), hypertrophic pyloric stenosis (10.4%), and acute appendicitis (3.5%). The major ultrasound findings in children with urinary tract diseases were hydronephrosis (45.4%), urolithiasis (21.5%) and cystic renal disease (18.1%). CONCLUSION: Ultrasound examination played an important role as a non-invasive and prompt screening examination for detection of abdominal diseases. Ultrasound was an important tool for pediatricians to determine timely information for patient management.

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.

Effect of cyclosporin [A] administration and withdrawal on the mesenteric lymph nodes in albino rats

The present study investigated the histological changes induced in the mesenteric lymph nodes of albino rats by short-term cyclosporin A [CsA] administration and to determine the reversibility of these changes after CsA withdrawal. Eighteen adult male albino rats were randomly allocated into 3 groups; each of 6 rats. Control rats received a daily subcutaneous [s.c.] injection of olive oil at a dose of 1 ml/kg body weight [b.wt.] for 5 days. Control rats were sacrificed either 24 hours or one week after the last injection. Rats from CsA-treated group received a daily s.c. injection of CsA at a dose of 15 mg/kg b.wt. for 5 days. Rats were sacrificed 24 hours after the last injection. Rats from CsA-withdrawal group received a daily s.c. injection of CsA at a dose of 15 mg/kg b.wt. for 5 days. Rats of this group were sacrificed one week later. The results showed that CsA administration induced decreased cellularity of the mesenteric lymph nodes with decrease of CD3 positive T cells, CD57 positive cells and CD20 positive B cells. In contrast, CD68 positive macrophages increased. The germinal centers of lymphoid follicles were enlarged with a thin mantle. Numerous tingible-body macrophages were found in the germinal centers with multiple apoptotic bodies giving the starry-sky appearance of the germinal centers of the follicles. These histological changes showed regression or complete resolution with withdrawal of CsA administration

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.