Overview
Tuberculous mesenteric adenitis refers to inflammation of mesenteric lymph nodes caused by Mycobacterium tuberculosis, often presenting with abdominal pain, fever, and lymphadenopathy 1.Diagnosis
Clinical presentation includes abdominal pain, fever, and palpable lymphadenopathy 1.
Imaging studies (CT, MRI) may show enlarged mesenteric lymph nodes 1.
Lymph node biopsy with histopathological examination and acid-fast bacilli staining is crucial for diagnosis 1.
Tuberculin skin test (TST) or interferon-gamma release assays (IGRAs) can support the diagnosis but are not definitive 1.Management
First-line treatment involves a standard antitubercular regimen, typically consisting of isoniazid, rifampin, ethambutol, and pyrazinamide for the initial phase 1.
Duration of treatment is usually 6-9 months, with a 2-month continuation phase of isoniazid and rifampin after the intensive phase 1.
Adjunctive management may include corticosteroids in cases with severe symptoms or complications to reduce inflammation 1.Special Populations
Elderly: Portal vein thrombosis has been reported in elderly patients with mesenteric adenitis, possibly due to underlying infections like Fusobacterium nucleatum 1.
Comorbidities: Patients with pharyngo-tonsillar infections may be at risk for septic thrombosis following mesenteric adenitis 1.Key Recommendations
Perform lymph node biopsy for histopathological examination and acid-fast bacilli staining to confirm tuberculous mesenteric adenitis (Evidence: Moderate 1).
Initiate treatment with a standard 4-drug antitubercular regimen including isoniazid, rifampin, ethambutol, and pyrazinamide for the initial phase (Evidence: Moderate 1).
Consider prolonged treatment duration of 6-9 months, adjusting based on clinical response and drug sensitivity testing (Evidence: Moderate 1).References
1 El Braks R, Harnois F, Boutros N, Fallik D, Roudie J, Smadja C et al.. Mesenteric adenitis and portal vein thrombosis due to Fusobacterium nucleatum. European journal of gastroenterology & hepatology 2004. link