Lopez-Navidad A, Domingo P, Cadafalch J, Farrerons J, Allende L, Bordes R
Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat, Autonoma de Barcelona, Spain.
Rev Infect Dis. 1990 Mar-Apr;12(2):297-302. doi: 10.1093/clinids/12.2.297.
Acute appendicitis is an uncommon complication of infectious mononucleosis (IM) and can readily be misdiagnosed because of the acute abdominal pain with which patients with IM occasionally present. A case report is presented of a patient with IM who developed acute appendicitis during the acute phase of the illness. The appendicitis progressed to the formation of an abscess, which was evacuated at surgery. Histologic examination of the appendix showed absence of lymphoid follicles in the mucosal layer and intense lymphoid infiltration of the mucosa and submucosa by a mixed diffuse proliferation of lymphoid cells with groups of immunoblasts scattered among them. The lymphoid infiltrate was mainly composed of T lymphocytes; the anticomplementary immunofluorescent staining of the appendix for EBNA (Epstein-Barr nuclear antigen) was negative. Three cases of appendicitis complicating IM published in the literature are reviewed. All had clinical and histopathologic features similar to those of our patient and were cured after surgery. Our case report together with the literature review confirms that appendicitis in the acute phase of IM has distinct clinical and histopathologic features and thus has to be considered a true complication of IM rather than merely a simultaneous disease.
急性阑尾炎是传染性单核细胞增多症（IM）的一种罕见并发症，由于IM患者偶尔会出现急性腹痛，因此很容易被误诊。本文报告一例IM患者在疾病急性期并发急性阑尾炎的病例。阑尾炎进展为脓肿形成，手术时进行了引流。阑尾组织学检查显示黏膜层无淋巴滤泡，黏膜和黏膜下层有密集的淋巴细胞浸润，淋巴细胞呈混合性弥漫性增生，其间散在免疫母细胞团。淋巴细胞浸润主要由T淋巴细胞组成；阑尾针对EBNA（爱泼斯坦-巴尔核抗原）的抗补体免疫荧光染色为阴性。回顾了文献中发表的3例IM并发阑尾炎的病例。所有病例的临床和组织病理学特征均与我们的患者相似，术后均治愈。我们的病例报告以及文献回顾证实，IM急性期的阑尾炎具有独特的临床和组织病理学特征，因此必须被视为IM的一种真正并发症，而不仅仅是一种同时存在的疾病。
