Mycobacterial mesenteric adenitis

Case contributed by Dra. Mónica Mariana Azor

Presentation

Patient with a history of HIV, resuming his antiretroviral treatment, presents with abdominal pain and persistent fever.

Patient Data

Age: 40 years
Gender: Male

Numerous mesenteric nodules with a tendency to form conglomerates. Some of them have frankly hypodense areas, possibly infarcted. Adenomegalic retroperitoneal and hepatic hilum nodes are also visualized. Hepatomegaly as additional data.

Case Discussion

The patient had abandoned his antiviral treatment at least five years ago, he was resuming his treatment, after pneumonia, when he presented acute abdominal pain and persistent fever, in the context of immune reconstitution syndrome (SRI).

After the tomographic findings, the patient undergoes exploratory laparoscopy with taking a biopsy in order to know the etiology of the mesenteric adenitis.
In the exploration, adenopathic conglomerates are evidenced in the omentum, which can retrospectively be evidenced in the tomography, immediately below the stomach. Biopsies are subsequently taken from two retroperitoneal nodes. They drained a cheesy-looking discharge. They were sent to pathological anatomy and bacteriology.

The sample sent to pathology shows a negative test for Ziehl Neelsen staining and the sample sent to bacteriology is positive for atypical mycobacteria, so it is sent to a more complex laboratory for typing.

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