Clinical Analysis Of Histiocytic Necrotizing Lymphadenitis In 11children

Objective:The clinical manifestations,laboratory examination and histopathological features of 11 children diagnosed with histiocytic necrotizing lymphadenitis(histiocytic necrotizing lymphadenitis,HNL)by lymphoid biopsy in Hebei Provincial people’s Hospital from 2019 to 2020 were summarized.To provide some reference for the early diagnosis of HNL.Methods:From January 2019 to January 2020,11 cases of HNL children were diagnosed in Hebei Provincial people’s Hospital.Use SPSS21.0 and Excell software for statistical analysis.Results:Eleven children with HNL were aged 6-1 8,on average(1 4.6± 3.5).There were 7 boys and 4 girls.There were 2 cases in spring,2 in summer,4 in autumn and 3 in winter.All 11 children had fever,The heat peak is between 37.8℃ and 40℃,and the heat type is different.All the children had enlarged lymph nodes,ranging from 1.0cm×0.5cm to 3.0cm×2.0cm,in 3cases of simple cervical lymph node enlargement,and in 8 cases of cervical lymph node and inguinal lymph node enlargement(1 case with axillary lymph node enlargement,2 with submaxillary lymph node enlargement,1 with supraclavicular lymph node enlargement,2 with systemic lymph node enlargement);Lymph node tenderness was found in 9(81.81%)of 11 cases,3cases(27.27%)with abdominal pain,2 cases(18.18%)had rash,Dizziness,nausea,nasal congestion,runny nose,muscle pain,joint pain,pain in the anterior region of the heart,They accounted for 9.09% of the total children.One case of hepatosplenomegaly was examined.Laboratory examination:7(63.6%)of 11 children showed peripheral leukopenia,3(27.27%)granulocytopenia,1(9.09%)granulocytosis,4(36.3%)mild to moderate anemia,and no thrombocytopenia.One case(9.09%)C-reactive protein(CRP)increased,Elevated alanine aminotransferase(ALT)in 2 cases(18.1%),1 case(9.09%)with elevated alanine aminotransferase(AST),Six(54%)patients with lactate dehydrogenase(LDH)and seven(63.6%)patients with adenosine deaminase(ADA)increased;In 2 cases,1 case HLA-B27 positive.There were10 cases with detailed immunohistochemical data,10 cases with CD68(+),7cases with myeloperoxidase MPO(+),6 cases with CD163(+),and 10 cases with Ki67 scattered positive(distribution rate about 30%～50%).Of the 11 cases,2 were untreated and their body temperature gradually decreased to normal;8 were treated with hormone therapy after ineffective anti-infective therapy;6 were treated with hormone,the body temperature was normal within48 hours;the remaining 2 were not treated with hormone therapy,and the body temperature gradually returned to normal.The recurrence occurred in 3cases,accounting for 27.27% of the total children.Conclusions:1.HNL occurs throughout the year without significant seasonal differences;Children are more common in men and older children.2.Clinical manifestations are mainly fever,multi-site lymph node swelling and pain,especially in the neck lymph node swelling and pain,the diameter is mostly between 1cm～3cm.3.Most children have peripheral blood leukopenia,especially granuloc ytopenia;some have anemia;ALT、AST、LDH、ADA can be increased.C RP、platelets are mostly not abnormal.4.Immunohistochemical CD68、MPO、CD163positive is helpful for the diagnosis of HNL.5.The disease is self-limited,children may have a high recurrence rate.Anti-infection treatment is ineffective,hormone can shorten the course of disease.6.Some cases are related to autoimmune diseases,we should be vigilant and follow up in clinical work.