Mesenteric Masking of Mycobacterium Tuberculosis

26 year-old Indonesian woman presented with a two week history of low back pain and abdominal pain.She denied any traumatic injury, nausea, vomiting, fevers, chills, or weight loss at the time. She had last traveled to Indonesia six months prior to presentation. Abdominal CT revealed diffuse ne-crotic mesenteric lymphadenopathy. Chest CT revealed nodules with no other abnormalities.Patient underwent bronchoscopy for AFB and after several days the AFB cultures from bronchoscopy and the lymph node biopsy returned positive for Mycobacterium Tuberculosis.

Patient was started on rifampin,isoniazid,pyrazinamide,and ethambutol.Classically TB  present with hemoptysis, fe-vers,night sweats, and weight loss.This case shows atypical presentation of TB with necrotic mesen-teric lymphadenopathy causing abdominal pain and referred low back pain.The differential diagno-sis for mesenteric lymphadenopathy includes lymphoma, sarcoidosis, tuberculosis, Epstein-Barr vi-rus, and cytomegalovirus so one should always take a thorough travel history if even a slight suspi-cion exists for TB on a differential.

Author(s): Assist Prof Dr. RohitJain

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