Is Acute Nonspecific Mesenteric Lymphadenitis Associated with Acute Abdominal Pain in Epidemic Aseptic Meningitis?

Kim, Hae Rim; Ku, Kiyoung; Lee, Young Hwan; Kam, Sin; Hwang, Jin Bok

Abstract

PURPOSE
Acute abdominal pain in an epidemic aseptic meningitis which is mostly an enterovirus as causative agent, is noted in 23-55% of patients. An enterovirus is also known as one of the causes of acute nonspecific mesenteric lymphadenitis(ANML). The purpose of this study was to see if ANML was associated with acute abdominal pain in epidemic aseptic meningitis.
METHODS
Between June 2001 and July 2001, data from 30 patients, aged 3 years to 14 years, with aseptic meningitis was reviewed. Abdominal ultrasonography was performed on all the patients and ANML was defined as a cluster of five or more lymph nodes measuring 5 mm or greater in their longitudinal diameter in the right lower quadrant with no identifiable specific inflammatory process.
RESULTS
The clinical symptoms of the 30 patients were:fever(76.7%), vomiting(90.0%), diarrhea(20.0%) and abdominal pain(40.0%). The average peripheral blood leukocytes count on admission was 7,996+/-2,701(4,500-14,500)/mm(3). ANML, according to the ultrasonography, was shown in 93.3% of aseptic meningitis patients; the number of mesenteric nodes was 9.2+/-5.3(5-20), with 7.4% of the 27 control cases being mesenteric nodes positive(P<0.05). The patients with ANML were divided into two groups; those with and without abdominal pain, 42.9% and 57.1% respectively. Two patients without ANML showed no abdominal pain. The count of mesenteric nodes was not significantly correlated with the duration to diagnosis, with or without fever, peripheral blood leukocytes count, and with or without abdominal pain.
CONCLUSION
ANML is presumed to be a cause of the acute abdominal pain in epidemic aseptic meningitis. Further clinical observations are recommended on the reason why ANML can be associated with and without abdominal pain.