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Inflammation of the mesenteric lymph nodes; a common cause of self-limited RLQ abdominal pain
- Characterized by benign inflammation of the mesenteric lymph nodes; can be acute or chronic, primary or secondary
- May clinically mimic acute appendicitis
- Commonly misdiagnosed, making definitive incidence difficult to determine
- Most common cause of appendicitis-like pain in children (1)
- More common in children <15 years old than in adults
- Primary adenitis is more common in children.
- Secondary adenitis is more common in adults.
- Rule out diverticulitis, appendicitis, Crohn disease, or systemic infectious/inflammatory disease (e.g., HIV, SLE, sarcoidosis).
Affects males and females equally
- Adenitis secondary to Yersinia infection is more prevalent in boys than girls.
- Yersinia enterocolitica is most common in North America, Eastern Europe, and Australia.
Etiology and Pathophysiology
- Primary: underlying inflammatory process not present; presumed due to acute infectious gastroenteritis (specifically, terminal ileitis)
- Secondary: underlying inflammatory process present
- In infectious cases, pathogens are ingested, translocate through the intestinal epithelium via Peyer patches, and gain access to mesenteric lymph nodes where an inflammatory reaction causes symptoms and clinical disease:
- Y. enterocolitica
- Campylobacter jejuni
- Salmonella typhi
- β-Hemolytic Streptococcus spp.
- Staphylococcus spp.
- Streptococcus viridans
- Escherichia coli
- Mycobacterium tuberculosis
- Giardia lamblia
- Epstein-Barr virus (EBV) (mononucleosis)
- Acute HIV infection
- Rubeola virus
- Bartonella henselae (cat-scratch disease)
- Adenovirus species
- Toxoplasma gondii
No known genetic susceptibility
- Typically preceded by URI or pharyngitis
- History of ingesting undercooked pork particularly in areas where Yersinia is endemic (parts of Europe)
Minimize risk by fully cooking foods, especially meat.
Commonly Associated Conditions
- Crohn disease
- Celiac disease
- Other systemic inflammatory/autoimmune disease