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Multiple mesenteric lymphadenopathies in pediatric with ulcerative colitis: A case report
Saumy Dewi Ratih1, Firdian Makrufardi1, Annisa Fairuz Nur Azizah1
1Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Insights
Pediatric ulcerative colitis (UC) diagnosis is challenging. Early investigations like colonoscopy are crucial for identifying UC, even with non-classic symptoms such as mesenteric lymphadenopathy in children.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Ulcerative colitis (UC) is a major pediatric inflammatory bowel disease (IBD).
- Early differentiation of IBD in children is often difficult.
- Accurate diagnosis relies on timely abdominal imaging and investigations.
Observation:
- A 2-year-old girl presented with prolonged abdominal pain, bloody stools, anorexia, nausea, and weight loss.
- Abdominal CT revealed mesenteric lymphadenopathies, liver enlargement, and minimal ascites.
- Colonoscopy identified rectal and sigmoid ulcers; histology showed lymphocyte infiltration.
Findings:
- The case highlights that mesenteric lymphadenopathies can be an associated finding in pediatric UC.
- Histological findings confirmed inflammatory changes consistent with UC.
- Early diagnostic procedures are vital for managing UC in children.
Implications:
- This case underscores the importance of considering UC in pediatric patients with atypical presentations.
- Prompt endoscopic evaluation and biopsy are essential for accurate UC diagnosis.
- Recognizing lymphadenopathy in UC aids in early and precise patient management.
Abstract:
Ulcerative colitis (UC) is one of the 2 major disorders in pediatric inflammatory bowel disease (IBD). Differentiating IBD at an early stage remains difficult, and abdominal imaging and early precise investigations are crucial. A 2-year-old girl was referred to the emergency department after experiencing colicky abdominal pain for 1 month. She had bloody stool 4 days before admission with the frequency of about 1-2 times per day. She also experienced anorexia, nausea, and weight loss. From Abdominal CT-Scan with contrast, multiple mesenteric lymphadenopathies accompanied by liver enlargement and minimal ascites were found. A colonoscopy showed multiple ulcers in the rectum and sigmoid colon. The histology of the gastric and colon showed lymphocyte infiltration in lamina propria. Children with UC usually present with the classic symptoms of weight loss, abdominal pain, and bloody diarrhea. The UC patients could present also with nonclassic symptoms of poor growth, anemia, or extraintestinal manifestations. The presence of inflamed mesenteric lymph nodes in the inflammatory process in UC can be associated with peri-intestinal inflammatory reactions. Mesenteric lymphadenopathies can happen in UC and early investigations using colonoscopy and biopsy are important investigative procedures to evaluate patients with UC.
