What is the treatment for mesenteric lymphadenitis and which age group is typically affected?

Mesenteric Lymphadenitis: Age Group and Treatment

Mesenteric lymphadenitis primarily affects children, adolescents, and young adults, and treatment consists of supportive care including hydration and pain medication, as it is typically a self-limiting condition. 1

Age Group Affected

• Mesenteric lymphadenitis most commonly occurs in children, adolescents, and young adults 1
• The condition is particularly prevalent in children under the age of 3 years, with a modest female predominance, and nearly all reported cases are in whites (when specifically referring to cervical lymphadenitis caused by MAC) 2
• In a study of 127 children with mesenteric lymphadenopathy, the age ranged from 8 months to 18 years, with a mean age of 9 years and 3 months 3

Clinical Presentation

• Abdominal pain is the most common symptom, occurring in approximately 50% of affected children 3
• In about 26% of cases, abdominal pain is the sole complaint, while others may experience additional symptoms such as vomiting and fever 3
• The presentation often mimics appendicitis or intussusception, making differential diagnosis crucial 1
• White blood count and C-reactive protein have limited usefulness in distinguishing mesenteric lymphadenitis from other conditions 1

Diagnostic Criteria

• Ultrasonography is the mainstay of diagnosis 1
• Diagnostic criteria include the presence of 3 or more mesenteric lymph nodes with a short-axis diameter of 8 mm or more without any identifiable underlying inflammatory process 1
• In some studies, mesenteric lymphadenopathy is defined as at least three lymph nodes with a peroneal diameter of 5 mm or more 3
• Multidetector computed tomography can also reliably identify mesenteric nodes 4

Treatment Approach

1. Supportive Care:

   • Hydration and pain medication are the primary treatments 1
   • Nonsteroidal anti-inflammatory therapy is recommended for mild cases of inflammatory conditions affecting lymph nodes 2

2. Reassurance:

   • 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 1

3. Medication Therapy:

   • If mesenteric lymphadenitis is a complication of infectious diseases, medication therapy is indicated 5
   • In severe cases with compression of contiguous structures, prednisone (0.5–1.0 mg/kg daily with a maximum of 80 mg daily in tapering doses over 1–2 weeks) may be considered 2

4. Surgical Intervention:

   • Surgery is generally not necessary for primary mesenteric lymphadenitis 1
   • Biopsy of lymph nodes may be required for diagnostic purposes in cases of suspected tuberculosis, oncological, or autoimmune diseases 5

Etiology and Associated Conditions

• Primary mesenteric lymphadenitis is the most frequent diagnosis, recognized in approximately 21.3% of children with mesenteric lymphadenopathy 3
• Common causes include:
  • Acute diarrhea (15.7% of cases) 3
  • Respiratory tract infections (14.9% of cases) 3
  • Viral infections such as cytomegalovirus (3.1%) 3
  • Parasitic infections including toxoplasmosis (2.3%) and giardiasis (7.0%) 3
  • Inflammatory conditions like gastritis and colitis (9.4%) 3

Special Considerations

• Conglomerates of lymph nodes may be observed in various conditions including acute diarrhea, ulcerative colitis, celiac disease, cytomegalovirus infection, and giardiasis 3
• Tendency to intussusception was observed in 3.9% of children, most commonly in those with acute infections and high inflammatory markers 3
• Mesenteric lymphadenopathy may be the only indicator of an underlying inflammatory or infectious process causing abdominal pain 4
• The distribution of lymph nodes may indicate the exact nature of the underlying disease process 4

Prognosis

• Acute nonspecific mesenteric lymphadenitis is a self-limiting inflammatory condition 1
• Complete recovery without residual effects typically occurs within 2-4 weeks 1
• Long-term follow-up is generally not necessary unless there are concerns about underlying conditions 1