Clinical Study on the Histiocytic Necrotizing Lymphadenitis

ABSTRACT

Histiocytic necrotizing lymphadenitis that causes unusual lymphadenopathy is a newly recognized disease of unknown etiology and may be mistaken for other conditions such as malignant lymphoma and tuberculosis, in which specific treatment will be required. Local lymph node enlargement especially in neck is the only characteristic feature, sometimes accompanied by pain, tenderness, fever and chill like a cold, nausea, vomiting. Laboratory investigations are usually noncontributory with an occasional case showing leukopenia or an elevated erythrocyte sedimentation rate. For further understanding of this disease and helping make diagnosis, clinical features were reviewed in 15 patients (29 lymph node enlargement), who were diagnosed as histiocytic necrotizing lymphadenitis on clinical evaluation (9 patients) or excisional biopsy (6 patients). The results are as follows; Disease was more common in female(12) and young patient. It involved left sided neck nodes frequently (67%) and the most common site was suboccipit-al triangle (62%). 47% of patient showed multiple enlargement of lymph nodes and the size of nodes were varied from 8 to 23 mm (mean 12.4 mm). Most nodes were movable and showed oval in shape. Fever (47%), pain (33%), tenderness (53%), recent history of upper respiratory infection (33%), leukopenia (47%) and increased erythrocyte sedimentation rate (67%) were showed in many cases. Ultrasonogrphic and CT scan showed well defined oval to round lymph nodes enlargement with inhomogenous enhancement. All affected nodes are resolved spontaneously within 3-10 weeks (mean 5.1 weeks) without specific treatment. After reviewing all of above results, it is concluded that histiocytic necrotizing lymphadenitis is self-limiting disease without characteristic clinical features, but some factors like fever, pain, tendrness, leukopenia and increased erythrocyte sedimentation rate with cervical lymphadenopathy in young female patient are thought to be very helpful in diagnosis and in these circumstances, lymph node biopsy must be delayed for 2-3 months.