Acute mesenteric lymphadenitis revealing systemic lupus erythematosus

Abstract

Acute mesenteric lymphadenitis (AML) remains unusual during systemic lupus erythematosus (SLE), and only a few sporadic observations have been found in the medical literature. It may exceptionally be the first manifestation revealing SLE representing a real diagnostic and therapeutic challenge for clinicians (specific lupus manifestation or infectious complication?). We report an original observation of isolated AML revealing SLE in a 29-year-old Tunisian woman without pathological medical history. She was explored for acute and febrile abdominal pain evolving for a week and not improved by symptomatic treatment. The somatic examination noted a fever at 38.5°C and a discrete diffuse abdominal tenderness. Biology showed a marked biological inflammatory syndrome, leukopenia at 3400/mm3, neutropenia at 1900/mm3, and lymphopenia at 1140/mm3 with no other abnormalities. The abdominal ultrasound and computed tomography objectified multiple large, hypoechoic, and richly vascularized on Doppler mesenteric lymph node compatible with the diagnosis of AML. Subsequent investigations concluded to SLE. The patient was treated with systemic glucocorticoids and hydroxychloroquine with favorable outcome. No recurrence has been noted for two years.

Keywords

• acute mesenteric lymphadenitis
• systemic lupus erythematosus
• lymphadenitis
• mesenteric adenitis