What are the causes of mesenteric adenitis?

Causes of Mesenteric Adenitis

Upper respiratory tract infections are the most common cause of mesenteric adenitis, reported in 22-53% of cases. 1

Infectious Causes

• Viral pathogens are predominant causes of mesenteric adenitis:

  • Epstein-Barr virus, Cytomegalovirus, Coxsackievirus, and Rubella are common viral triggers 1
  • Adenovirus type 7 has been specifically linked to mesenteric adenitis in pediatric populations 2
  • Influenza B virus has also been associated with this condition 2

• Bacterial causes include:

  • Yersinia species (particularly Y. pseudotuberculosis and Y. enterocolitica) are common causes, especially in Western countries 3, 4
  • Salmonella species, including S. enterica serovar Enteritidis, can cause mesenteric adenitis and carry risk for systemic complications 5, 4
  • Campylobacter jejuni is a notable cause, particularly in Asian populations 1
  • Nontuberculous mycobacteria (NTM) can affect mesenteric lymph nodes 1
  • Pasteurella pseudotuberculosis has been documented as a causative agent 6
  • Mycobacterium tuberculosis can cause mesenteric lymphadenitis 4

Non-Infectious Causes

• Inflammatory bowel disease:

  • Both Crohn's disease and ulcerative colitis can present with mesenteric lymphadenitis 1
  • IBD can cause thrombosis around the superior mesenteric vein, potentially contributing to mesenteric inflammation 7

• Autoimmune conditions:

  • Adult-onset Still's disease can present with abdominal pain and mesenteric lymphadenopathy 1

• Malignancies:

  • Lymphoma and leukemia should be considered in the differential diagnosis, particularly in adults 1

Clinical Considerations

• Mesenteric adenitis commonly presents with right lower quadrant abdominal pain, fever, and leukocytosis, making it difficult to differentiate from appendicitis 5
• In adults, the etiology may differ from pediatric cases, with infectious causes like tuberculosis and typhoid fever requiring specific consideration in certain geographic regions 4
• CT scan or ultrasound imaging is helpful for diagnosis, showing enlarged mesenteric lymph nodes with a normal appendix 5, 1
• Most cases of viral and some bacterial mesenteric adenitis are self-limiting and resolve with symptomatic treatment 5, 4
• In immunocompromised patients, cytomegalovirus colitis can present with mesenteric lymphadenitis and carries a high mortality rate if misdiagnosed 1

Special Considerations

• In adults with persistent mesenteric lymphadenopathy, malignancy should be more strongly considered 1
• Patients with HIV may develop mesenteric lymphadenitis as part of immune reconstitution inflammatory syndrome 1
• The clinical presentation can mimic appendicitis, and proper imaging studies are essential for accurate diagnosis and avoiding unnecessary surgery 3