儿童亚急性坏死性淋巴结炎28例分析

亚急性坏死性淋巴结炎(subacute necrotizing lymphadenitis,SNL)是近年才被认识的炎性免疫反应性非肿瘤性淋巴结肿大性疾病,成人和儿童都可以发生,至今原因不明,临床上多以发热、淋巴结肿大、白细胞下降为主要表现。本病极易误诊,为提高对本病的认识,现将本院收治的28例SNL患儿临床资料分析如下。     

亚急性坏死性淋巴结炎20例

目的　探讨儿童急性坏死性淋巴结炎(SNL)的病因及临床特征,提高对本病认识及与其他疾病的鉴别。方法　回顾分析2 0例临床病例。结果　本组2 0例均经淋巴结活检确诊SNL ;发病以学龄儿为主,男女之比2 :3;均有发热、淋巴结大,白细胞减少,进而行淋巴结活检确诊;2 0例均给予肾上腺皮质激素治疗,效果显著;随访结果1例于1年后复发,1例于2年后出现典型系统性红斑狼疮症状。结论　1 儿童SNL临床表现与成人相似;2 对不明原因发热伴淋巴结大者,除进行相关化验检查外,应尽淋巴结活检以明确诊断;3 SNL是自限性疾病,预后多良好,亦有复发,少数发展为系统性红斑狼疮,应长期随访     

亚急性坏死性淋巴结炎33例

目的 探讨儿童亚急性坏死性淋巴结炎(SNL)的病因及，临床特征，提高对儿童SNL的认识，减少误诊。方法 结合文献资料对SNL患儿33例临床及实验室相关检查进行回顾分析。结果 本组33例患儿淋巴结活检确诊SNL；发病以学龄儿为主，2／3患儿冬春季节发病，男女之比3.7：1；均有淋巴结大，发热32例，白细胞总数减少21例；其中1例发展为系统性红斑狼疮，1例复发。结论 对不明原因发热伴淋巴结大者，除做相关化验检查外，应早期行淋巴结活检以明确诊断。SNL是自限性疾病，预后多良好，但也有复发。少数发展为系统性红斑狼疮，应长期随访。     

小儿组织细胞坏死性淋巴结炎2例

组织细胞坏死性淋巴结炎,亦称坏死性淋巴结炎．或亚急性坏死性淋巴结炎,是1972年日本病理学家Kikuchi与Fujimoto首先描述的组良性自限肚疾病,发病率低．青少年及壮年多见,临床具有以下3大特征①长期顽固性发热,抗生素治疗无效;②以颈淋巴结多见的淋巴结肿大,件轻微疼痛;③一过性白细胞减少等。确诊则依据淋巴结活检．病理学特征为：淋巴结病变区可见广泛性凝固性坏死区伴组织细胞反应性增生．无中性粒细胞浸润．根据病变形态可分为增生型,坏死型和黄瘤型。     

亚急性坏死性淋巴结炎1例

患儿 ,男 ,11岁 ,因持续发热 1个月余住院。 1个月前开始发热 ,体温波动在 38～ 39℃ ,予口服抗感冒药后体温下降至 37.5℃左右。右侧颈部淋巴结出现肿痛 ,静脉滴注抗生素后肿痛减轻 ,仍间断发热。体检 :右侧颈部触及数个肿大淋巴结 ,最大者 1.5cm× 1.0cm ,触痛明显 ,质软 ,活动 ,无黏连 ,余浅表淋巴结不大。心肺听诊正常 ,腹平软 ,肝脾不大。实验室检查 :外周血血红蛋白 14 0 g/L ;白细胞 3.5 3× 10 9/L ,中性 0 .2 6 ,淋巴 0 .6 5 ;血小板 2 0 8× 10 9/L ;类风湿因子 (RF)<2 0IU/ml;CRP <1.4 3mg/L ;PPD试验 ( - )。骨髓像检查 :…     

儿童亚急性坏死性淋巴结炎3例报告并文献回顾

目的探讨儿童亚急性坏死性淋巴结炎(SNL)临床特征,分析相关实验室检查结果。 方法唐山市协和医院儿科2000年以来收治3例SNL患儿,结合文献报道的433例进行回顾分析。 结果436例儿童SNL可见于9个月以上各年龄儿童,以学龄儿童多见,临床表现均有淋巴结肿大,发热占99.8%(435/436),可伴有肝肿大(36.2%,158/436)、脾肿大(22.7%,99/436)和皮疹(37.8%,165/436)。实验室检查,81.3%(300/369)一过性白细胞下降,38.1%(166/436)贫血,81.6%(319/391)血沉增快。 结论SNL极可能为多种病原感染导致的自身免疫性疾病,可引起多脏器损害,有自限性,可复发。确诊须病理检查,抗生素治疗无效,激素及非甾体抗炎药治疗有效。     

儿童亚急性坏死性淋巴结炎23例

儿童亚急性坏死性淋巴结炎２３例南京市儿童医院（２１０００８）马业耕亚急性坏死性淋巴结炎好发于儿童及青少年，是非肿瘤性淋巴结肿大性疾病。它属于淋巴结炎性免疫反应性疾病，临床上以长期颈部淋巴结肿大、发热和白细胞减少为三大特征，病理组织学上见淋巴结内广泛的...     

儿童组织细胞坏死性淋巴结炎临床及病理分析

组织细胞坏死性淋巴结炎(histiocytic necrotizing lymphadenitis,HNL)是一种少见的炎性免疫反应性非肿瘤性淋巴结肿大性疾病,1972年由日本病理学家Kikuchi及Fujimoto首次报道,又称为 Kikuchi-Fujimoto病。儿童病例较少见,漏诊、误诊率较高。为进一步提高对本病的认识,现将我院收治的13例组织细胞坏死性淋巴结炎报告如下。     

儿童组织细胞坏死性淋巴结炎38例分析

目的 探讨儿童组织细胞坏死性淋巴结炎(HNL)的临床病理特点.方法 回顾性分析2000年6月至2015年5月期间于我院诊断HNL的38例患儿的临床及病理资料.结果 HNL以学龄期儿童为主,男女比例为1.4:1,临床表现主要为:淋巴结肿大(100%)、发热(68.24%)、白细胞降低(52.63%)及淋巴细胞比例上升(84.21%).全部患儿进行淋巴结切除活检均符合HNL.部分患儿(31.58%)自发缓解,部分患儿应用非甾体类抗炎药、糖皮质激素及丙种球蛋白治疗,治疗效果满意.暂未见复发及并发其他自身免疫性疾病.结论 HNL有一定的临床特征,但缺乏特异性,明确诊断需依靠淋巴结活检;HNL是一类良性、自限性疾病,有一定的自发缓解率,激素、非甾体类抗炎药及丙种球蛋白治疗效果满意,需长期随访.     

Tubercular lymphadenitis: Clinical manifestations

One hundred and thirteen children suffering from tubercular lymphadenitis proven histopathologically, were studied for clinical and laboratory features. Age distribution was equal in all age groups except during infancy when it was rare. Sex ratio indicates a male preponderance with male to female in the ratio of 1.5∶1 (67∶46). Family history of contact with known tuberculous patient was positive in 19 (17%) children, 44 (40%) had received BCG, and 98 (88%) were either normal nourished or had mild malnutrition. Cervical, axillary and inguinal nodes were found in 90 (80%), 14 (12%), and 8 (7%) children respectively. Epitrochlear node was found in only 1 child. 11 (10%) children had discharging sinus, all being in cervical group. The consistency of nodes was firm in 98 (87%), fluctuation was present in 15 (13%). In 87 (77%) lymph nodes were matted. Hepatomegaly of more than 2 cm was present in 13 (11%) and spieen was enlarged (>2cm) in 4 (4%) only. Mantoux test was positive in 96 (85%) children and chest X-ray was abnormal in 25 (22%) cases. Findings suggest that tubercular adenitis occurs in all age groups with equal frequency. It can occur in vaccinated children also. It may be a sole manifestation of tubercular infection. The cervical nodes are predominantly involved. There is no typical location of nodes in individual groups but multiplicity and matting of nodes are characteristic features of tubercular adenitis in children.     

卡介苗性淋巴结结核40例临床分析

目的　 婴儿初种卡介苗发生卡介苗性淋巴结结核较少见。本文研究其临床特点、诊断、鉴别诊断和预防。 方法 　前瞻性研究一所市级儿童医院收治的卡介苗性淋巴结结核。研究因素包括病史、体征、胸部X光片、实验室和病理检查。 结果 　15例曾在外院误诊 ,40例均经病变淋巴结切除治愈。病理特点为 :似结核改变 ,镜下可见结核结节内多个郎罕氏细胞、多核巨细胞、类上皮细胞 ,但是均未见结核杆菌。随诊 6～ 2 4个月 ,无复发或全身其他部位结核。 结论 　卡介苗性淋巴结结核很少见 ,容易误诊和误治 ,需要与自然感染的淋巴结结核鉴别。预防应着重于菌苗摇匀 ,剂量准确和技术规范。     

组织细胞坏死性淋巴结炎9例

目的　通过对 9例小儿组织细胞坏死性淋巴结炎 (HNL)进行总结分析 ,探讨其诊断和治疗方法。方法　回顾性分析 1 999年 8月～ 2 0 0 3年 7月住院治疗 9例HNL的临床及病理学资料。结果　所有病例均有发热和颈部淋巴结大。淋巴结活检可见典型的病理和免疫组化改变。 6例应用肾上腺皮质激素治疗 ,疗程为 3～ 6个月 ,疗效显著 ,复发病例少。结论　该病临床表现缺乏特异性 ,需早期进行淋巴结活检 ,根据病理和免疫组化进行诊断 ,并早期予肾上腺皮质激素治疗。较长疗程的激素治疗可能有助于减少复发。     

Acute cervical lymphadenitis in children

A retrospective study of 78 children with acute cervical lymphadenitis treated in Newcastle over the last 9 years revealed that abscesses formed in 50 children despite antibiotic treatment. Children under 2 years of age were more likely to form an abscess than older children. The commonest organism isolated was penicillin-resistant Staphylococcus . Beta-haemolytic Streptococcus was isolated less commonly and isolation of penicillin-sensitive staphylococci was rare. Penicillin and amoxycillin alone are unsuitable as first line antibiotics. Severe infections and those failing to respond rapidly to initial antibiotic treatment should be admitted to a paediatric unit for intravenous beta-lactamase-resistant antibiotics.     

伴岛叶三层现象的急性坏死性脑病一家系临床及遗传学分析

目的探讨伴岛叶三层现象(TA)的急性坏死性脑病(ANE)临床及遗传学特征。方法回顾分析1个确诊为ANE家系的临床资料。结果先证者为男性,4.5岁时以惊厥、意识障碍起病,1岁时有热性惊厥史;头颅磁共振示对称性多灶性损害,岛叶存在TA。家系中有6例患者,起病年龄6月龄至50岁,主要以发热后惊厥或惊厥持续状态及意识障碍起病,3例因惊厥持续状态死亡;免疫治疗及能量支持可改善预后。基因检测发现家系RANBP2基因变异(NM_006267;c.1754 CT[p.T585M])。结论首次报道TA可出现于岛叶。     

Atypical mycobacterial cervical lymphadenitis with extensive local spread: a surgical disease

Atypical (nontuberculous) mycobacterium is an uncommon cause of cervical lymphadenitis in immunocompetent children. Rarely, this disease progresses to locoregional destruction of the deep structures of the neck including salivary glands. Recent reports suggest medical monotherapy as an effective treatment of this disease. We report three cases of children who experienced progression to locoregional disease while on appropriate antibiotics. We suggest that the patient population to benefit from medical monotherapy has yet to be adequately defined. In our experience, surgical therapy is the only effective treatment for locoregional disease.