Histiocytic Necrotizing Lymphadenitis With Pneumonia And Sepsis: A Case Report And Literature Review

Objective In order to investigate the clinical characteristics,diagnosis and treatment of Histiocytic Necrotizing Lymphadenitis complicated with pneumonia and sepsis and improve the timely diagnosis and treatment of Histiocytic Necrotizing Lymphadenitis,This article discusses the feature of Histiocytic Necrotizing Lymphadenitis.It is especially important that the early diagnosis and treatment of Histiocytic Necrotizing Lymphadenitis complicated with severe infection.Methods It wes analyzed and summarized by analyzing the characteristics of clinical manifestations,imaging features,laboratory examination,diagnosis and treatment of a case of Histiocytic Necrotizing Lymphadenitis complicated with pulmonary infection and sepsis confirmed by the 10 th affiliated hospital of Guangxi Medical University in 2016 and reviewing relevant literature.Databases of CNKI,Wanfang,Weipu Chinese science and technology periodical database and Pubmed were searched to systematically analyze relevant literature,and the clinical manifestations,imaging characteristics,laboratory examination,diagnosis and treatment of Histiocytic Necrotizing Lymphadenitis were analyzed and summarized.Results In this case,pulmonary infection was complicated in the early stage.After treatment with antibiotics and right pleural effusion drainage,the pulmonary infection lesion was less than the previous stage,but recurrent fever still occurred.The treatment with antibiotics was interrupted by the patient’s request to be discharged from the hospital,however,the pulmonary infection was worsened and was re-hospitalized.Blood culture showed positive escherichia coli.After intensive antibiotics therapy,and it was re-hospitalized.Blood culture showed positive escherichia coli,after intensive antibiotics therapy.The patient was diagnosis of Histiocytic Necrotizing Lymphadenitis by lymph node biopsy.After the therapy with glucocorticoid treatment and antibiotics,the patient was improved greatly and to be discharged.In review of the literature,there were 47 cases of patients,which had complete data and confirmed diagnosis of Histiocytic Necrotizing Lymphadenitis by lymph node biopsy were reported at home and abroad from January 1,2009 to January 1,2020.There were 23 male patients and 24 female patients,and the ratio of male to female patients was 1:1.04,the mean age of onset was 27.5 years(8 to 68years).The most common clinical manifestation were lymph node enlargement(100%)and fever(95.7%).The swollen lymph nodes might feel pain or tenderness when be touched(72.3%).The swollen lymph nodes usually located in the neck(83.0%)and other superficial lymph nodes.The temperature was fluctuated from 38 ℃ to 41.1 ℃.The median of temperature was 39.6℃.The patient’s fever was mainly medium and high fever(91.5%).The large spleen(38.2%)and liver(23.5%)also could be found.The combination with chills,weight loss,skin rash,headache,joint pain and other symptoms might emerge as well.White blood cell was usually decreased(71.1%),white blood cell level was averages 3.6 * 109 / L,and the median of white blood cell was 2.9 * 109 / L.The percentage of neutrophil was increased(29.2%).The ESR was elevated(88.9%).The CRP was elevated(72.4%)as well.The elevation of ALT,AST and LDH,ferritin was found some patients.The autoantibodies and virus antibody was usually positive.The smear heterotypic lymphocytes was found in peripheral blood.The active hyperplasia or hemophagocytosis was found in bone marrow examination.Diagnostic criteria of Histiocytic Necrotizing Lymphadenitis was that the pathological features were coagulative necrosis in the paracortical area,with a large number of tissue cells,plasmacytoid dendritic cells around the necrosis,and neutrophil deficiency and the CD68,MPO,CD123 was positive by immunohistochemistry.There was little improvement by treating with antibiotics.The therapy with corticosteroid(70.2%)was prednisolone 30mg/d-50mg/d,or even 1g/d,alone or combined with gamma globumin,the other therapy were Chinese medicine,hydroxychloroquine etc.There were some patients that were improved by self-healing or symptomatic treatment(14.9%).However,there was 1 case that had been died(2.1%).Conclusion The main clinical symptoms of Histiocytic Necrotizing Lymphadenitis are lymph node enlargement and fever,and lymph node biopsy is the key for the diagnosis of Histiocytic Necrotizing Lymphadenitis.The combination of severe infection and multi-organ dysfunction requires antibiotics adequately,The onset of patients with severe infection may be associated with immune disorders caused by Histiocytic Necrotizing Lymphadenitis.The corticosteroid treatment in patients with severe infection may achieve better results.