Misdiagnosis analysis of Graves disease complicated with mesenteric lymphadenitis as the initial manifestation and literature review
Li Shouxia, Gao Qingge, Jiang Fusong, Xiao Yuanyuan, Wei Li
Department of Endocrinology and Metabolism, East Hospital of the Sixth People′s Hospital Affiliated to Shanghai Medical College, Shanghai 201306, China
Abstract：ObjectiveTo explore the clinical features and misdiagnosis reasons of Graves disease in a patient with mesenteric lymphadenitis as the initial manifestation. MethodsThe clinical data of a patient with Graves disease admitted to the Department of Endocrinology and Metabolism, East Hospital of Shanghai Sixth People′s Hospital on January 19, 2019 were retrospectively analyzed, and the literatures were reviewed. ResultsThe patient who went to General Surgery Department was a 39-year-old male with clinical manifestations of abdominal pain and diarrhea. Laboratory examinations showed low levels of white blood cells （1.88×109/L）, normal infection indicators ［C reactive protein （3.37mg/L）, procalcitonin （0.08μg/L） and IL-6 （3.33ng/L）］, and no obvious abnormalities in stool routine and culture. CT of the upper abdomen showed that there were multiple enlarged lymph nodes and nodes focal at the root of the mesentery. Mesenteric panniculitis was possible and mesenteric lymphadenitis was considered. After symptomatic treatment, the symptoms of abdominal pain and diarrhea did not improved significantly, and symptoms such as palpitations and fever occurred after admission. At the same time, the thyroid function showed that thyroid stimulating hormone (TSH)＜0.005mU/L, free triiodothyronine (FT3) 32.13pmol/L, free thyroxine (FT4)＞100pmol/L, antithyroglobulin antibody (TGAb) 12.74mU/L, thyroid peroxidase antibody (TPOAb) 320.70mU/L, thyrotropin receptor antibody (TRAb) 32.84U/L. Ultrasound revealed diffuse thyroid lesion, and Graves disease was considered in the end. Conclusions Graves disease can involve multiple systems, the pre-onset of diseases should be taken seriously in patients with acute diseases. Careful and intensive collection of medical history will help reduce misdiagnosis of Graves disease with atypical symptoms as the main manifestation.
