关键词: 组织细胞坏死性淋巴结炎, 临床特征, 预后, 儿童

Abstract:

Objective To investigate the clinical features and prognostic factors, and analyze the treatment outcomes and follow-up results of histiocytic necrotizing lymphadenitis (HNL) in children, aiming to provide a basis for improving its early diagnosis and management. Methods The method of retrospective case analysis was adopted. The clinical data of 21 children with HNL who were diagnosed by lymphocytic biopsy and received treatment in the Department of Pediatrics, Shanxi Bethune Hospital from January 2018 to April 2025 were collected. Their clinical symptoms, laboratory test results, imaging findings, pathological results, treatment regimens, and follow-up information were analyzed to summarize the clinical characteristics and prognosis of HNL. Results Of the 21 patients, 10 were male and 11 were female (M∶F ratio 1∶1.1). The children's ages ranged from 5 to 13 years (9.86 ± 2.56 years). All patients presented with fever and lymphadenopathy. The laboratory findings included leukopenia in 11 cases (52.4%), elevated erythrocyte sedimentation rate (ESR) in 17 cases (81.0%), decreased hemoglobin in 3 cases (14.3%), elevated alanine amino-transferase in 4 cases (19.0%)，and elevated lactate dehydrogenase (LDH) in 16 cases (76.2%). All patients underwent cervical lymph node ultrasonography, which showed cervical lymph node enlargement, with an average size of (1.86 ± 0.42) cm. Lymph node biopsy was performed in all 21 cases. Pathological results indicated HNL, without pathological evidence of lymphoma or Epstein-Barr virus (EBV) infection. Regarding treatment, 6 cases (28.6%) achieved spontaneous remission without corticosteroid therapy, while 15 cases (71.4%) received corticosteroid treatment. Follow-up results revealed that 18 cases (85.7%) had no recurrence after the initial episode, while 3 cases (14.3%) experienced varying degrees of recurrence. None of the patients progressed to autoimmune diseases such as systemic lupus erythematosus (SLE). Conclusion Some of HNL cases can undergo spontaneous remission during the first episode, and the disease is sensitive to corticosteroids, generally leading to a favorable prognosis. However, it's important to watch for severe complications or the development of autoimmune diseases. Long-term follow-up is essential for preventing recurrence and disease progression.

Key words: Histiocytic necrotizing lymphadenitis, Clinical characteristics, Prognosis, Child