Unusual Presentation of Acute Typhlitis with Necrotizing Granulomatous Lymphadenitis in a Healthy Teenager

Nikhil Crain*, Victoria Martucci, Braden Olsen, Kelly Maloney, Lindsey Gumer, Andrew Boies

University of Colorado School of Medicine, Aurora, Aurora, CO 80045, United Sates

^*Correspondance to: Nikhil Crain 

 PDF  Full Text Case Report | Open Access

Abstract:

Typhlitis is a rare necrotizing inflammation of the cecum generally associated with immunosuppression. We report the unusual case of an otherwise healthy teenager diagnosed with acute typhlitis and found to have necrotizing granulomatous lymphadenitis on multidisciplinary workup. A 17-year-old female was admitted for 1 month of worsening lower abdominal pain, nausea, vomiting, diarrhea, and weight loss. She was recently admitted at an outside hospital for acute typhlitis diagnosed on computerized tomography (CT) which improved with empiric antibiotics. Repeat CT on admission demonstrated marked wall inflammation at the ileocecal valve with bilateral renal abnormalities and right lower quadrant (RLQ) adenopathy, raising concern for lymphoma. Pediatric gastroenterology, hematology-oncology, and surgery were consulted. Colonoscopy demonstrated a hard mass arising circumferentially from the appendiceal orifice into the cecum; snare or resection was deferred due to concern for perforation. Non-specific changes were shown on mass surface and surrounding intestinal mucosa biopsies. Laparoscopic surgical biopsy of the peri-appendiceal lymph node demonstrated necrotizing granulomas without signs of an oncologic process. Testing for bacterial and fungal etiologies were sent. After extensive discussion with the family and multidisciplinary team, the decision was made to repeat outpatient imaging after discharge to determine a management plan, including possible surgical resection of the ileocecal valve. Follow-up CT demonstrated an improved inflammatory process consistent with typhlitis and no evidence of mass. No further intervention or follow-up was planned. Multidisciplinary collaboration led to shared decision-making with the family to delay intervention which ultimately led to avoidance of ileocecal valve resection with potentially long-term complications.

Keywords:

Typhlitis, Cecal inflammation, Necrotizing granulomatous lymphadenitis, Pediatric gastroenterology, Adolescent case

Cite the Article:

Crain N, Martucci V, Olsen B, Maloney K, Gumer L, Boies A. Unusual Presentation of Acute Typhlitis with Necrotizing Granulomatous Lymphadenitis in a Healthy Teenager. Ann Clin Case Rep. 2025; 10: 2768..