Common Causes of Mesenteric Lymphadenitis
Upper respiratory tract infections are the most common cause of mesenteric lymphadenitis, reported in 22-53% of cases. 1
Viral Causes
- Upper respiratory tract viral infections are the predominant trigger for mesenteric lymphadenitis, especially in children and young adults 1, 2
- Common viral pathogens include Epstein-Barr virus, Cytomegalovirus, Coxsackievirus, and Rubella 1
- The frequency of respiratory tract infections as antecedent events is even higher in pediatric patients (50-70%) 1
Bacterial Causes
- Campylobacter jejuni is a significant bacterial cause, particularly common in certain geographic regions like Asia 1
- Acute gastroenteritis can trigger mesenteric lymphadenitis in approximately 15.7% of cases 3
- Nontuberculous mycobacteria (NTM) can occasionally cause mesenteric lymphadenitis, though they more commonly affect cervical lymph nodes 1
- Pasteurella pseudotuberculosis has been documented as a causative agent in some cases 4
Age-Related Patterns
- Mesenteric lymphadenitis typically occurs in children, adolescents, and young adults 2
- In children, primary (nonspecific) mesenteric lymphadenitis is diagnosed in approximately 21.3% of cases when no specific cause can be identified 3
- In adults with persistent mesenteric lymphadenopathy, malignancy should be more strongly considered 1
Clinical Presentation
- Abdominal pain is the most dominant complaint, observed in approximately 49.6% of children with mesenteric lymphadenitis 3
- In about 26% of cases, abdominal pain is the sole complaint, while others may experience accompanying symptoms like vomiting and fever 3
- The condition is generally self-limiting and resolves within 2-4 weeks without residual effects 2
Diagnostic Approach
- Ultrasonography is the mainstay of diagnosis, revealing 3 or more mesenteric lymph nodes with a short-axis diameter of 8 mm or more without any identifiable underlying inflammatory process 2
- CT scan may be helpful in cases where ultrasonography is inconclusive 1
- White blood count and C-reactive protein have limited usefulness in distinguishing between patients with and without mesenteric lymphadenitis 2
Special Considerations
- In immunocompromised patients, cytomegalovirus colitis can present with mesenteric lymphadenitis and carries a high mortality rate if misdiagnosed 1
- Patients with HIV may develop mesenteric lymphadenitis as part of immune reconstitution inflammatory syndrome 1
- Inflammatory bowel disease, particularly ulcerative colitis, can present with mesenteric lymphadenitis 1
- Tuberculosis of mesenteric lymph nodes can mimic other conditions and requires a high index of suspicion for diagnosis 5