Monday, 25 November 2013

A Case of Mesenteric Adenitis

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A Case of Mesenteric Adenitis



Presenting complaints:

A eleven years old male child presented with recurrent tendency to catch cold, sneezing < morning, slightest climatic change, weakness 2+,  want of appetite, recurrent attacks of fever, emaciation, pain in abdomen with nocturnal enuresis, and offensive diarrhea. He also has dry cough < morning. The patient is physically weak, mentally active and keen.

Past history: 

Tonsillectomy one year back and anti- tuberculosis treatment for primary complex. History of recurrent boils treated by allopathic medications.

Family history : 

Mother with a history of Dysfunctional Uterine Bleeding

Physical generals: 

Appetite – Want of appetite

Thirst – drinks less than 2 liters per day; Stool – offensive diarrhea; 

Urine – nocturnal enuresis;

Sleep – disturbed by cough; Sweat – normal; desire for eggs, craving for non-veg3+

Physical examination : Examination of the neck shows enlargement of cervical glands. Inguinal lymph nodes enlarged, 

temperature was 103 F.

Systemic examination 

CVS – NAD,

 RS – monophonic wheezing heard throughout the lung fields. 

Weight – 18 kgs.

Mental generals :

 Active, restless, but physically weak.

Investigations : 

Mantoux positive. The Ultra Sonogram of the abdomen illustrated that multiple enlarged mesenteric lymph nodes and large iliac nodes are seen in the right iliac fossa – Mesenteric adenitis (Refer Plate I)

First prescription

26/08/2009  Tuberculinum 1M / one dose orally. He was also advised to take a protein-rich diet and to avoid coffee and tea intake.

Follow-up 1

31/08/2009 Cough and cold had decreased significantly. He complained of mild left-sided headache and left-sided nasal obstruction. Temperature was 100 F. Placebo was administered. They were given some general management tips and asked to wait for further progress. No complaints of diarrhea. No complaints of abdominal pain. Nocturnal enuresis reduced.

Follow-up 2

18/09/2009 Acute coryza1+ , appetite had improved, generals were normal. Placebo was administered.

Follow-up 3

02/10/2009 No complaints, generally improved. Placebo was administered. No complaints of nocturnal enuresis.

Follow-up 4

04/11/2009 On examination, the cervical gland enlargement had reduced to a significant extent. Inguinal node enlargement had also reduced as well. No attacks of fever, cold, or cough. Weight – 23 kgs. The patient was further encouraged to consume a protein-rich diet. Placebo was given.

Follow-up 5

23/11/2009 The patient had improvement. Placebo was given for 15 days.

Follow-up 6

10/12/2009 The patient was advised to undergo another USG .It shows no evidence of enlarged mesenteric glands. (Refer plate – II) Mantoux negative

DISCUSSION

Tuberculimnum is the simillimum for this case and was prescribed based on the tubercular miasmatic expression. This factor was well-indicated by the history of suppression of primary complex. Tuberculinum is the most suitable prescription for children with respiratory complaints. In my practice, the majority of children have shown improvement with this remedy.










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