Inflammatory myofibroblastic tumor of the mesentery associated with high fever and positive Widal test.
Inflammatory myofibroblastic tumor (IMT) is associated in 15-30% of cases with systemic symptomatology, such as prolonged fever, weight loss, elevated erythrocyte sedimentation rate (ESR), anemia, thrombocytosis, and leukocytosis. We report the case of a 4-year-old Lebanese boy who presented with high-grade fever of long duration, and a single (unpaired) positive Widal agglutination test. Blood culture was negative. A diagnosis of typhoid fever was made. An abdominal (mesenteric) IMT was incidentally discovered, 30 days after the fever had appeared. After surgery, the fever disappeared immediately, and the ESR returned to normal. We strongly favor the possibility of a false positive Widal test, due to polyclonal increase in serum immunoglobulins, which often occurs in IMT. We also think that IMT might be a mimicker of typhoid fever, both clinically and serologically. Physicians, especially pediatricians practicing in endemic areas, should probably be aware of this mimicry.
Chouairy
Camil J
CJ
Department of Pathology, Saint George Hospital, Beirut, Lebanon. camil.chouairy@balamand.edu.lb
Bechara
Elie A
EA
Gebran
Sleiman J
SJ
Ghabril
Ramy H
RH
D002675:Child, Preschool; D005189:False Positive Reactions; D005334:Fever / Q000209:etiology; D006386:Hemagglutination Tests; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D008643:Mesentery; D047708:Myofibroma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology