mesenteric adenitis

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basementbeast

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hey all: saw a teenager with mesentaric adenitis...had a prolonged course of abdomen pain, fever, weight loss, decreaseed appetite. several scans already obtained, no appy, stable nodes. had seen his pmd, no specific treatment had been recommend....pt brought to ed by parents for pain, fever, emesis, and *Frustration*. benign exam, soft mildly tender abdomen, mildly dehydrated, normal labs except elevated calcium and AST. received several liters IVFs and a dose of morphine.......prior eval reviewed, case discussed with pmd, pt had GI f/u and was dc to home.

question: when, if ever, do you considered antibiotics....what clinical features would trigger that in your mind?
 
basementbeast said:
question: when, if ever, do you considered antibiotics....what clinical features would trigger that in your mind?
Click to expand...

I would say that nothing should ever trigger the diagnosis of mesenteric adenitis in your mind. It's a diagnosis of exclusion. Sometimes you see some diffuse nodes on the CT but you have to rule out the long differential for abd pain first.
 
sure...he came to me already carrying the label "i have been diagnosed with mesentaric adenitis"...he a very well visualized appendix (w/o appendicitis) on multiple ct scans in the last few days....i would say that many (but of course not all) items in the abdomen pain differential were ruled out...kid still needs endoscopy and likely biopsy (perhaps laproscopic biopsy)..... i was trying to think outside the box ("what am i - and everyone else - missing") as well and decide if antibiotics would be useful or not....
 
basementbeast said:
sure...he came to me already carrying the label "i have been diagnosed with mesentaric adenitis"...he a very well visualized appendix (w/o appendicitis) on multiple ct scans in the last few days....i would say that many (but of course not all) items in the abdomen pain differential were ruled out...kid still needs endoscopy and likely biopsy (perhaps laproscopic biopsy)..... i was trying to think outside the box ("what am i - and everyone else - missing") as well and decide if antibiotics would be useful or not....
Click to expand...
Fair enough. I suppose that you could try to figure out how he was diagnosed. To really diagnose someone with this, especially if it has been going on for a while you've got to rule out stuff like IBD, lymphoma and endometriosis and zebras like sprue, parasites and whatever else you can think of. That could be what you're missing albeit unlikely. As for antibiotics I don't think that they're going to help and if you give the guy CDiff on top of everything else it can make the work up of the underlying problem even more difficult.
 
yeah...i did not rescan him .... i did not start any abx ... i did speak with the doc covering his doc (who, of course, was not familiar with him!) ... i also phone consulted our general surgeon (not that i thought he needed an emergeny laparotomy!) ...

anyways, thanks for letting me bounce this off of your guys....👍
 
We had a case of this today. He did get rescanned. Had surgery all ready to come talk to him.
We looked into it, and without the kid being septic, or deathly ill, you aren't going to do much with ABx. BTW, Rocephin and the quinolones are good treatments for Yersinia.
 
Is the patient immunocompromised (HIV)?

If he's immunocompetent, then as others have suggested, Yersenia, Campylobacter, Shigella, and Salmonella are the most likely bacterial causes. IIRC, I think viral causes are the number one causes of mesenteric adenitis.

In the immunocompromised hosts, you must also consider MAI.
 
basementbeast said:
hey all: saw a teenager with mesentaric adenitis...had a prolonged course of abdomen pain, fever, weight loss, decreaseed appetite. several scans already obtained, no appy, stable nodes. had seen his pmd, no specific treatment had been recommend....pt brought to ed by parents for pain, fever, emesis, and *Frustration*. benign exam, soft mildly tender abdomen, mildly dehydrated, normal labs except elevated calcium and AST. received several liters IVFs and a dose of morphine.......prior eval reviewed, case discussed with pmd, pt had GI f/u and was dc to home.

question: when, if ever, do you considered antibiotics....what clinical features would trigger that in your mind?
Click to expand...

sounds like IBD to my newly minted peds attending brain. wt loss, as far as i know, isn't a characteristic of mesenteric adenitis but definitely is for other badder stuff. hope the kid's pmd re-evaluates him.

--your friendly neighborhood second guessing caveman
 
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