COVID-19-associated mesenteric adenitis mimicking acute appendicitis: a case report

Abstract

Mesenteric adenitis is a self-limiting inflammatory condition of the mesenteric lymph nodes that can closely mimic acute appendicitis. During the COVID-19 pandemic, increasing reports have highlighted atypical gastrointestinal manifestations of SARS-CoV-2, including mesenteric lymphadenopathy. This case report illustrates a case of mesenteric adenitis in the setting of recent COVID-19 infection, initially suspected to be acute appendicitis. A 20-year-old female presented with a 24-hour history of right iliac fossa pain, concerning for acute appendicitis. Clinical examination revealed localized tenderness without peritonitis. Laboratory findings were unremarkable, and imaging failed to visualize the appendix or identify an alternative pathology. Due to persistent symptoms, the patient underwent diagnostic laparoscopy and appendicectomy, which revealed a normal appendix but prominent mesenteric lymphadenopathy. Postoperatively, she recovered uneventfully, and mesenteric adenitis was considered the most likely diagnosis. Given her recent COVID-19 infection, a viral aetiology was suspected. This case highlights the diagnostic challenges of mesenteric adenitis in the setting of COVID-19 and underscores the importance of considering viral-induced lymphadenopathy in young adult patients presenting with right iliac fossa pain. Given the overlap in clinical presentation with appendicitis, imaging and conservative management may help avoid unnecessary surgery in select cases.