组织细胞坏死性淋巴结炎并系统性红斑狼疮的诊断学特征

Diagnostic features of histiocytic necrotic lymphadenitis combined with systemic lupus erythematosus

目的探讨组织细胞坏死性淋巴结炎合并系统性红斑狼疮的诊断学特征。方法回顾性分析2019年12月29日郑州大学第一附属医院急诊科收治的1例组织细胞坏死性淋巴结炎合并系统性红斑狼疮患者的临床资料,并复习相关文献。结果患儿女性,14岁,发热伴左侧颈部疼痛2周,查体双侧颈部及腋窝浅表淋巴结肿大,实验室检查中性粒细胞计数减低、尿蛋白(++)、红细胞沉降率82.00 mm/h,淋巴结活检符合组织细胞坏死性淋巴结炎病理表现,自身免疫抗体检查抗核抗体、抗双链DNA抗体、抗Sm抗体阳性,考虑组织细胞坏死性淋巴结炎合并系统性红斑狼疮及狼疮肾炎,给予免疫抑制剂治疗后患儿病情好转。结论患者组织细胞坏死性淋巴结炎共患系统性红斑狼疮时容易复发,漏诊系统性红斑狼疮诊断会耽误疾病治疗。在处理发热伴淋巴结肿大的患者时需要注意筛查系统性红斑狼疮抗体。

Objective To explore the diagnostic features of histiocytic necrotic lymphadenitis(HNL)combined with systemic lupus erythematosus(SLE).Methods The clinical data of a patient diagnosed with HNL and SLE who was admitted to the Emergency Department of the First Affiliated Hospital of Zhengzhou University on December 29,2019 were retrospectively collected and analyzed,and relevant literatures were reviewed.Results The child was a 14-year-old female with fever and left neck pain for 2 weeks,and with lymphadenectasis of bilateral neck and axilla.The laboratory examination showed reduced neutrophil count,urine protein(++),and erythrocyte sedimentation rate at 82.00 mm/h.Lymph node biopsy suggested histiocytic necrotizing lymphadenitis.Anti-nuclear antibody,anti-double-stranded DNA antibody and anti-Sm antibody were positive.The patient was diagnosed with HNL combined with SLE and lupus nephritis.After immunosuppressive treatment,the child′s condition improved.Conclusion s HNL is susceptible to relapse combined with SLE.Missed diagnosis of SLE may delay the treatment of the disease.In the treatment of patients with fever and lymphadenectasis,attention should be paid to screening antibodies about SLE.