A 26-year-old woman with no relevant past medical history presented to the emergency department complaining of pain in the lower hemi-abdomen for approximately 24 h, not associated with vomiting or diarrhea.
On physical examination, an abdominal tender abdomen was found for the right iliac fossa, with no signs of peritoneal irritation.
Axillary and rectal temperatures were 36.9oC and 37.4oC respectively, with no changes in blood count (white blood cells 8,200) and C-reactive protein of 5.
The gynecological evaluation was normal and the pregnancy test was negative.
Given the clinical and laboratory findings, symptomatic treatment with analgesics and antispasmodics was indicated.
The patient consulted after 14 days for new abdominal pain associated with fever.
Physical examination revealed axillary temperature of 37.7oC and rectal temperature of 38.2oC with pain on palpation of the right iliac fossa.
The blood count showed a leukocyte count of 10,600, erythrocyte sedimentation rate of 9 and C-reactive protein of 18.
With the suspicion of acute colitis, an abscess was performed, without surgical complications.
Macroscopic examination of the surgical specimen showed a cecal appendix of 6.7 cm in length and 1.1 cm in diameter.
The serous and mucosal surface showed no lesions.
Microscopic examination revealed the presence of non-caseating epitheloid granulomas with well-defined borders, with some Langhans-type giant cells and absence of lymphocytic corona.
Few asteroid bodies were found, with no evidence of Schaumann (conchoides) or Hamazaki-Wesenberg bodies.
No associated acute infamation or foreign material was identified in the thickness of the septal defect.
Histochemical stains for microorganisms (Ziehl Neelsen, Gram, PAS, Gro and Warthin starry) and PCR for Mycobacterium tuberculosis were negative.
Histopathological findings were compatible with granulomatous meningitis.
1.
The patient was asymptomatic.
At the 8th month of follow-up, the chest X-ray, colon and computed tomography (CT) of thorax-abdomen and pelvis were normal, being asymptomatic after 13 months.
