Clinical analysis with subacute necrotizing lymphadenitis

Abstract

Objective To investigate etiological factors, clinical characteristic and related laboratory findings of subacute necrotizing lymphadenitis and improve the acknowledgement of subacute necrotizing lymphadenitis. Methods We analyzed 14 cases of subacute necrotizing lymphadenitis who had been diagnosed by lymph node biopsy retrospectively. Results The most of patients were school children with mean age of 10.4 ± 2.9) years. The ratio of male to female was 1.8∶1 .The main clinical symptoms were that lymph nodes were swelling and pressing-pain in 14 cases (100%) and fever in 13 cases (92.9%), rash in 2 cases (14.3%),hepatosplenomegaly in 2 cases (14.3%).The white blood cell count was (2.3 ～ 7.4) × 109/L in 14 cases and average count was (3.90 ± 0.35) × 109/L. The white blood cell count showed leukopenia in 10 cases (71.4%) and none showed heighten. Twelve cases were tested by CRP and the result of 8 cases elevated slightly (10 ～ 30 mg/dl). Thirteen cases underwent ESR examination and the result of 11 cases showed higher than that of normal level (20mm/h)(82.6%). The average ESR risen value was 40mm/h and topmost value was 70 mm/h. Eight cases underwent anti-nuclear antibody test and 2 cases of them were positive. Twelve cases underwent EB virus antibody test and 4 cases of them were positive. Eleven cases underwent blood Mycoplasma-IgM examination and one of them was positive. Six cases underwent coxsackie virus antibody and one of them was positive.Coxsackie and EB virus infected in one case. Lymph node biopsy was found necrotic fragments in different sizes. The cellular hyperplasia was found around the necrotic area and plasma cells, neutrophils, and eosinophils were found rarely in these areas. The DNA of EB virus was negative in lymph nodes. Eight cases of all were treated by prednisone and effect showed well 1.5 ～ 2.0 mg/(kg·d)). One of all was recurrence and the rest recovered well. Blood routine examination was used when they were under a stable condition, five cases of them showed normal white blood cells. Conclusion Those with fever of unknown origin combined with lymphadenectasis are suggested to have an early lymph node biopsy. The process is self-limited and glucocorticoid therapy is effective to those impatients. The long-term follow up is required as recurrence and development of SLE have reported. EB virus was not an etiological factor of SNL. Leucocyte can be used as one of the indicators of improvement. Key words: Subacute necrotizing lymphadenitis; lymphadenectasis; Fever; Glucocorticoid