以头痛为首发症状的组织细胞坏死性淋巴结炎一例

One case of Kikuchi-Fujimoto disease with headache as the initial symptom

目的探讨组织细胞坏死性淋巴结炎以中枢神经系统症状起病患者的诊断。方法分析1例以头痛为首发症状的组织细胞坏死性淋巴结炎患者的临床资料。结果本例患者主要表现反复头痛、发热,伴颈部及腋窝淋巴结肿大;颅脑检查、自身抗体检验无特征性改变,腋窝淋巴结穿刺可见大量组织细胞增生,结构破坏及不规则坏死病灶,免疫组化示坏死区高表达MPO、CD163。提示组织细胞坏死性淋巴结炎。结论组织细胞坏死性淋巴结炎以头痛等神经系统症状为首发病症者,临床上可以反复头痛、发热起病,脑脊液呈复发性淋巴细胞性炎症,且患者临床预后好,淋巴结活检有助于明确诊断,可避免错误治疗。

Objective To investigate the diagnosis of Kikuchi-Fujimoto disease(KFD)in patients with central nervous system symptoms.Method Analyze the clinical data of 1 case of KFD with headache as the first symptom.Results The main symptoms of this patient were recurrent headache and fever,accompanied by cervical and axillary lymph node enlargement.Brain examination and autoantibody examination showed no characteristic changes.Axillary lymph node puncture showed a large number of histiocytosis,structural damage and irregular necrotic lesions.Immunohistochemistry showed high expression of MPO and CD163 in necrotic areas.Supports the diagnosis of KFD.Conclusion For patients with histiocytic necrotizing lymphadenitis,headache and other neurological symptoms are the first symptoms.In clinical practice,recurrent headache and fever can onset of illness,and cerebrospinal fluid presents recurrent lymphocytic inflammation.Besides,the patient has a good clinical prognosis.Lymph node biopsy is helpful to make a clear diagnosis and avoid wrong treatment.