组织细胞性坏死性淋巴结炎合并无菌性脑膜炎 1例并文献回顾

目的探讨组织细胞性坏死性淋巴结炎(菊池病)合并无菌性脑膜炎病人的临床特点。方法回顾分析 2022年 6月 10日南京市第二医院收治的 1例以发热、头痛、呕吐为首发临床表现的菊池病病人的临床资料。结果该病人不明原因高热，头痛、呕吐，颈部淋巴结多发肿大，外院结核感染 T细胞斑点试验为阳性，怀疑为结核性脑膜炎转入该院，入院后血清学、脑脊液化验无结核感染依据，予经验性抗病毒、抗感染、降颅压治疗后未见好转，后经颈部淋巴结穿刺活检病理检查明确诊断为菊池病，予糖皮质激素口服后体温降至正常，头痛症状缓解，随访了解到病人颈部肿大淋巴结缩小，未有复发。结论菊池病合并无菌性脑膜炎临床上有些医生认知不足，容易误诊误治，对于有发热、颈部淋巴结肿大伴有无菌性脑膜炎表现的病人要注意考虑菊池病可能，尽早行淋巴结穿刺活检可及早明确诊断。

Histiocytic necrotizing lymphadenitis combined with aseptic meningitis: a case report and literature review

Objective To investigate the clinical characteristics of patients with histiocytic necrotizing lymphadenitis (Kikuchi dis-ease) complicated by aseptic meningitis.Methods The clinical data of a case of patient with Kikuchi disease with fever, headache andvomiting as the first clinical manifestations admitted to the Second Hospital of Nanjing on June 10, 2022 were retrospectively analyzed.Results The patient had unexplained high fever, headache, vomiting, and multiple enlargements of cervical lymph nodes. The T-cell spot test of tuberculosis infection was positive in an outside hospital, and tuberculous meningitis was suspected. The patient was trans-ferred to this hospital. After admission, there was no basis for tuberculosis infection in serology and cerebrospinal fluid tests, and empir-ical antiviral, anti-infective, and cranial pressure-lowering treatments were given without improvement. The patient was diagnosed withKikuchi''s disease by cervical lymph node biopsy and was given glucocorticosteroids orally, after which her body temperature droppedto normal and her headache was relieved. The patient was followed up and the enlarged lymph nodes in the neck shrunk without recur-rence.Conclusion Kikuchi disease combined with aseptic meningitis is not well recognized by some doctors. For patients with feverand enlarged cervical lymph nodes with aseptic meningitis, it is important to consider the possibility of Kikuchi''s disease, and earlylymph node biopsy can lead to a clear diagnosis.