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Forum Name: Other infections

Question: multiple enlarged rounded lymph node seen in the mesentery


 sanjoy - Mon Jun 07, 2010 1:26 am

dear doctors, iam suffering from fever and pain in abdomen,after visiting local doctors i have done some tests,here is the reports-BLOOD reports-E.S.R-25mm.T.L.C-10.500/cmm.MANTOUX TEST-22mm after 48 hrs,XRAY-nothing found,USG reprt-multiple enlarged rounded lymph node seen in the mesentery,measures ranging from-12-13.4mm, i have problem in eye-ubieyeties with complicated cataract,recently i have done cataract operation,in right eye,now i can see,but the lance is not puted in my eye due to reaction.now iam using spectacle,N.B.-IN THE YEAR OF 1995 I WAS TREATED WITH TUBERCULINE DRUG DUE TO PREASENCE OF TUBERCULOSIS IN MY EYE.AFTER THAT TREATMENT I WAS COMPLITLY FINE,recently i am suffering from one month with feaver and pain in abdomen,so,doctors please treat me to over come from the disease.thanking u,and waiting for your reply.
 Dr. Tamer Fouad - Mon Jun 07, 2010 10:17 am

User avatar Hello,

There are many causes for mesenteric lymphadepathy which include T.B., malignancy, other infectious diseases, and inflammatory diseases.

Certainly T.B. would be high on the list with a positive Mantoux test and a history of previous T.B. Fever of unknown origin can be very challenging to diagnose. Did your doctor discuss the need for a CT? obtaining biopsy specimen?

The size of the lymph nodes is not alarming, however there may be other features in the CT / US image that the radiologist could definitely comment on. Although not definitive it would certainly help make the case for TB. TB nodes present with lower attenuation values by CT near the fluid or fat areas in the node. Additionally, they may demonstrate peripheral enhancement on contrast.[1,2]

REFERENCES:
============
1. Yang ZG, Min PQ, Sone S, et al. Tuberculosis versus lymphomas in the abdominal lymph nodes: evaluation with contrast-enhanced CT. AJR Am J Roentgenol 1999; 172: 619–623.
2. Lucey BC, Stuhlfaut JW, Soto JA. Mesenteric Lymph Nodes Seen at Imaging: Causes and Significance. March 2005 RadioGraphics, 25, 351-365.
 Dr.M.jagesh kamath - Mon Jun 07, 2010 10:36 am

User avatar Hello,Apart from what Dr.Fouad has clearly alluded to,viral mesentric adenitis is quite common,and if you have had a prior throat infection could well be this.However if this does not settle down in a couple of weeks more investigations may establish other diagnosis.
Best wishes.
 Dr. Tamer Fouad - Mon Jun 07, 2010 11:45 am

User avatar Thank you Dr. Kamath. Your input is appreciated as always. One question I want to ask you Dr. Kamath - what are the odds of a false positive Mantoux test given the high positivity (>15mm)? Due to previous exposure to TB, I imagine the Mantoux test could remain positive but in such a case would the degree of positivity bare any significance?

Thanks in advance.
 Dr.M.jagesh kamath - Tue Jun 08, 2010 5:48 am

User avatar A mantoux test would not measure the immunity to tuberculosis but only the hypersensitivity to tuberculin.
However a reaction of over 15mm would be more in favour of active infection rather than previous vaccinations or atypical mycobacteria.
Thanks Dr.Fouad for this very interesting and relevant question.
 Dr. Tamer Fouad - Tue Jun 08, 2010 8:48 am

User avatar Thank you Dr. Kamath for your very informative reply. As you accurately conveyed the high positivity would be 'more in favor' of active infection - I must stress to our visitors that even a highly positive test is not enough to make the diagnosis of T.B.

Can previous exposure to T.B. in a cured patient confer hypersensitivity to tuberculin?
 Dr.M.jagesh kamath - Thu Jun 10, 2010 2:45 am

User avatar Tuberculin testing would not differentiate an active infection and a latent disease.But the degree of positivity would tend to wane in years after treatment, or after previous immunization.

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