Clinical features of histiocytic necrotizing lymphadenitis in children

Conclusions: HNL is often misdiagnosed in older children with persistent fever and lymphadenopathy, leading to unnecessary diagnostic tests and evaluations, inappropriate antibiotic administration, and mismanagement. A multidisciplinary team, including primary care providers, rheumatologists, and pathologists, can improve patient outcomes by increasing their awareness of this rare condition.What is Known:• Histiocytic necrotizing lymphadenitis (HNL) is characterized by fever, leukopenia, and neck lymphadenopathy with unknown etiology.• The lack of neutrophils or eosinophils in the histology, immunohistochemistry results help distinguish HNL from infectious causes. Although HNL is a self-limiting disease, antibiotics and steroid treatments were used inappropriately.What is New:• A fever peak ≥ 40 °C was associated with a longer fever duration in HNL patients. Leukopenia presented more frequently in solitary cervical lymph node (LNs) than in extracervical LNs inpatients with prolonged fever.• Steroids are not recommended as a routine treatment, however, in some severe or relapsing cases with  persistent symptoms, prednisolone (5 mg twice a day for 2 days) or other steroids (an equivalent dose of  prednisolone) responded favorably.
Source: European Journal of Pediatrics - Category: Pediatrics Source Type: research