What are the causes of mesenteric lymphadenitis?

Causes of Mesenteric Lymphadenitis

Mesenteric lymphadenitis is primarily caused by viral infections, followed by bacterial infections, with Yersinia pseudotuberculosis and Yersinia enterocolitica being the most significant bacterial pathogens. 1

Infectious Causes

Viral Causes

• Upper respiratory tract infections are the most common antecedent events associated with mesenteric lymphadenitis, reported in 22-53% of cases 2
• Common viral pathogens include:
  • Adenovirus 1
  • Epstein-Barr virus 2
  • Cytomegalovirus 2
  • Coxsackievirus 2
  • Rubella 2

Bacterial Causes

• Yersinia pseudotuberculosis is a significant cause of mesenteric lymphadenitis, presenting with symptoms that mimic appendicitis 3, 4
• Yersinia enterocolitica can cause similar presentations 1
• Campylobacter jejuni, which is more prevalent in Asia, can trigger mesenteric lymphadenitis 2
• Pasteurella pseudotuberculosis has been isolated from mesenteric lymph nodes in acute cases 3
• Mycobacterial infections:
  • Mycobacterium tuberculosis can cause tuberculous mesenteric lymphadenitis, which may mimic pancreatic carcinoma in some cases 5
  • Nontuberculous mycobacteria (NTM) can cause mesenteric lymphadenitis, though they more commonly affect cervical lymph nodes 2, 6

Non-Infectious Causes

Inflammatory Conditions

• Inflammatory bowel disease, particularly ulcerative colitis, can present with mesenteric lymphadenitis 2
• Adult-onset Still's disease can present with abdominal pain and mesenteric lymphadenopathy 2

Autoimmune Disorders

• Various autoimmune disorders can cause mesenteric lymphadenitis as part of systemic inflammation 7

Malignancies

• Lymphoma and leukemia should be considered in the differential diagnosis, particularly in adults 2, 7
• Solid tumors can occasionally present with mesenteric lymphadenopathy 7

Diagnostic Approach

Clinical Presentation

• Typically presents with abdominal pain that mimics appendicitis or intussusception 1
• May be accompanied by fever, nausea, vomiting, and diarrhea 1
• In children and adolescents, it's often self-limiting 1

Diagnostic Tests

• Ultrasonography is the mainstay of diagnosis, showing 3 or more mesenteric lymph nodes with a short-axis diameter of ≥8 mm without any identifiable underlying inflammatory process 1
• CT scan may be helpful in cases where ultrasonography is inconclusive 2
• Laboratory tests including white blood cell count and C-reactive protein are of limited usefulness in distinguishing mesenteric lymphadenitis from other causes of abdominal pain 1
• Laparoscopy may be necessary in cases where the diagnosis remains unclear 7

Management Considerations

• Most cases of viral mesenteric lymphadenitis are self-limiting and require only supportive care 1
• Bacterial causes may require specific antibiotic therapy based on the identified pathogen 4
• For tuberculous mesenteric lymphadenitis, anti-tuberculosis therapy is indicated 5
• Biopsy of lymph nodes may be necessary to confirm diagnoses such as tuberculosis, malignancy, or autoimmune disease 7

Special Considerations

• In immunocompromised patients, cytomegalovirus colitis can present with mesenteric lymphadenitis and carries a high mortality rate if misdiagnosed 2
• In adults with persistent mesenteric lymphadenopathy, malignancy should be more strongly considered 2
• Patients with HIV may develop mesenteric lymphadenitis as part of immune reconstitution inflammatory syndrome 6