Histiocytic necrotizing lymphadenitis combined with central nervous system damage in 4 children / 中华实用儿科临床杂志

ABSTRACT

Objective To summarize the clinical features of histiocytic necrotizing lymphadenitis (HNL) and the lesion of central neural system in children.Methods Data of the 4 cases in Beijing Children's Hospital from January 2009 to December 2014 were reviewed and analyzed,as well as other files of 12 patients from PubMed,CNKI,etc.Results All 4 patients mentioned above started from fever and lymphadenopathy,3 cases had headache,2 cases of them experienced altered mental status,and 1 case had cclampsia.The findings of cerebrospinal fluid (CSF) test was similar to viral encephalitis;2 cases had normal magnetic resonance imaging (MRI) result;1 case with MRI test indicated brain white matter diseases with extensive intracerebral hemorrhage,and 1 case had small range of encephalomalacia in left cerebral hemisphere and cerebral dura mater.Through CSF examination,2 cases were positive to Epstein-Barr viral capsid antigen (EBV-VCA)-IgM,while the 2 other cases had no positive trace of EBV-VCA-IgM.Lymph node biopsy was in accordance with HNL typical changes,1 case was positive for Epstein-Barr virus encoded RNA (EBER).Twelve cases in previous literatures were diagnosed as HNL by lymph node biopsy,and their clinical features of central nervous system were headache and altered mental status.There was no change in pathogen.It is also found that the cases in which CSF was performed had shown being negative.CT/MRI image descriptions involved in temporosphenoid lobe,hippocampus,caudate lobe,leptomeninges,etc.Conclusions HNL can be complicated with lesions of the central nervous system,characterized by aseptic meningitis,encephalitis,etc.The prognosis of most cases is good,a few can have neurological sequelae.HNL may relapse,so long-term follow-up is ne-cessary.Epstein-Barr virus in HNL and lesion of central nervous system mechanism still needs further research.