Clinical analysis of histiocytic necrotizing lymphadenitis in adults with fever of unknown origin: a retrospective study.

IF 2.3 3区医学 Q2 PATHOLOGY

Diagnostic Pathology Pub Date : 2025-08-09 DOI:10.1186/s13000-025-01695-2

Nana Xie, Wencong Zhang, Fangbing Tian, Jia Chen, Wenyuan Zhang, Qiurong Ruan, Jianxin Song

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引用次数: 0

Abstract

Purpose: To comprehensively analyze the clinical data of histiocytic necrotizing lymphadenitis (HNL) in adults with fever of unknown origin (FUO), with the aim of enabling precise diagnosis.

Patients and methods: A total of 15 HNL patients with FUO were enrolled. The analysis encompassed clinical manifestations, laboratory parameters ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (¹⁸F-FDG PET/CT) imaging profiles, pathological features and therapeutic responses.

Results: All patients presented with fever and lymphadenopathy (predominantly cervical). Laboratory findings included leukopenia (3.28 × 10⁹/L [2.40-4.97]), elevated LDH (306 U/L [187-524]), ESR (40 mm/h [30-51]), ferritin (457.1 ng/mL [206-1823.3]), and CRP (25 mg/L [6.1-34.8]) ¹⁸F-FDG PET/CT detected metabolic lymph node abnormalities in 13 cases, primarily cervical and axillary. The pathological features were extensive coagulative necrosis of lymph nodes with reactive hyperplasia of histiocytes as well as positive or scattered positivity IHC CD3, CD4, CD8 and CD68. Corticosteroid achieved favorable responses, with only 2 cases progressing during follow-up.

Conclusion: In clinical practice, patients with fever and lymphadenopathy should be given due attention. Pathological examination remains the gold standard for diagnosing HNL. Glucocorticoid therapy has proven effective, and the majority of patients with HNL exhibit a favorable prognosis.

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成人组织细胞坏死性淋巴结炎伴不明原因发热的临床分析：回顾性研究。

目的：综合分析成人不明原因发热（FUO）组织细胞坏死性淋巴结炎（HNL）的临床资料，以提高其准确诊断水平。患者和方法：共纳入15例伴有FUO的HNL患者。分析包括临床表现、实验室参数18f -氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）成像谱、病理特征和治疗反应。结果：所有患者均有发热和淋巴结病变（主要是颈椎）。实验室结果包括白细胞减少（3.28 × 10⁹/L[2.40-4.97]）、LDH升高（306 U/L[187-524]）、ESR升高（40 mm/h[30-51]）、铁蛋白（457.1 ng/mL[206-1823.3]）和CRP （25 mg/L[6.1-34.8]）。18F-FDG PET/CT检出13例代谢性淋巴结异常，主要是宫颈和腋窝。病理表现为淋巴结广泛凝固性坏死伴组织细胞反应性增生，IHC CD3、CD4、CD8、CD68阳性或分散阳性。皮质类固醇治疗效果良好，随访期间仅有2例进展。结论：临床对发热伴淋巴结病患者应给予重视。病理检查仍然是诊断HNL的金标准。糖皮质激素治疗已被证明是有效的，大多数HNL患者表现出良好的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnostic Pathology 医学-病理学

CiteScore

4.60

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： Diagnostic Pathology is an open access, peer-reviewed, online journal that considers research in surgical and clinical pathology, immunology, and biology, with a special focus on cutting-edge approaches in diagnostic pathology and tissue-based therapy. The journal covers all aspects of surgical pathology, including classic diagnostic pathology, prognosis-related diagnosis (tumor stages, prognosis markers, such as MIB-percentage, hormone receptors, etc.), and therapy-related findings. The journal also focuses on the technological aspects of pathology, including molecular biology techniques, morphometry aspects (stereology, DNA analysis, syntactic structure analysis), communication aspects (telecommunication, virtual microscopy, virtual pathology institutions, etc.), and electronic education and quality assurance (for example interactive publication, on-line references with automated updating, etc.).