Two Cases of Abdominal Pain in Children with Mesenteric
Lymphadenitis due to Yersinia pseudotuberculosis Infection
Case 1
A
12-year-old boy presented with acute abdominal pain.
His abdomen was distended with localized guarding
and tenderness in right lower quadrant (RLQ). The
findings of an abdominal ultrasound revealed markedly
enlarged lymph nodes in the RLQ. Findings from laparos-
copy revealed a mass attributable to multiple enlarged lymph
nodes in RLQ (Figure 1; available at www.jpeds.com).
Lymph node culture on selective media1 was positive for
Yersinia pseudotuberculosis (YP).
Case 2
A 13-year-old boy with recurrent abdominal pain presented
with an acute exacerbation of symptoms. He had undergone
various examinations previously. The findings of an abdom-
inal ultrasound revealed slightly enlarged lymph nodes in
RLQ. Nine months after the onset of symptoms, the patient
had acute abdominal pain. His abdomen was distended
with diffuse tenderness. The findings of an abdominal ultra-
sound showed a mass resembling multiple lymph nodes in
RLQ. An abdominal computed tomography scan confirmed
the presence of an abdominal mass (Figure 2). Laparoscopy
was performed, followed by the removal of the enlarged
lymph nodes (Figure 3; available at www.jpeds.com).
Lymph node culture on selective media was positive for YP.
Figure 2. Computed tomography image demonstrates
mesenteric lymphadenopathy.
J Pediatr 2014;165:411.
0022-3476/$ - see front matter. Copyright ª 2014 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.jpeds.2014.03.057
YP is frequently isolated in cooler climates,2 and the
infection is considered rare in Italy.3 The incubation
period is not well known, but symptoms usually develop
4 to 18 days after exposure.4,5 Mesenteric lymphadenitis
is one of the most common presentations and includes
abdominal pain or appendicitis-like symptoms.6 The
illness usually lasts from 1 to 3 weeks, but symptoms
may extend several months.4 Clinicians should consider
YP infection in the differential diagnosis of patients
referred for recurrent abdominal pain, suspected appendi-
citis, or abdominal masses. To avoid unnecessary investi-
gations or surgery, specific microbiological testing for YP
should be requested, even if the duration of pain is longer
than usual and in countries with exceedingly low fre-
quencies of detection. n
Luca Bertelli, MD
Riccardo Masetti, MD
Giulia Bardasi, MD
Clinica Pediatrica Universit
a degli studi di Bologna
Michela Maretti, MD
Pediatria d’Urgenza Universit
a degli studi di Bologna
Tommaso Gargano, MD
Clinica Chirurgica Universit
a degli studi di Bologna
Ilaria Corsini, MD
Pediatria d’Urgenza Universit
a degli studi di Bologna
Fraia Melchionda, MD, PhD
Clinica Pediatrica Universit
a degli studi di Bologna
Davide Tassinari, MD
Pediatria d’Urgenza Universit
a degli studi di Bologna
Salvatore Cazzato, MD, PhD
Clinica Pediatrica Universit a degli studi di Bologna
Mario Lima, MD, PhD
Clinica Chirurgica Universit a degli studi di Bologna
Andrea Pession, MD, PhD
Clinica Pediatrica Universit
a degli studi di Bologna
Policlinico S. Orsola-Malpighi,
Bologna, Italy
References available at www.jpeds.com
411
THE JOURNAL OF PEDIATRICS  www.jpeds.com
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Figure 1. A 7  2.5  1.8-cm mass consisting of confluent
multiple inflamed lymph nodes.
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Vol. 165, No. 2
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Figure 3. Mass found in the RLQ in close proximity to the
colon.
Bertelli et al