What are the symptoms of necrotizing lymphadenitis

Necrotizing lymphadenitis is a non-neoplastic disease of lymph node enlargement, which is particularly prone to adolescents. It often presents with fever, swollen lymph nodes, or some rash and urticaria symptoms.

Necrotizing lymphadenitis is also known as histiocytic necrotizing lymphadenitis, subacute necrotizing lymphadenitis, and Kikuchi disease. It is a non-neoplastic lymph node enlargement disease and a reactive lymph node hyperplasia. This disease is frequently reported in Japan, accounting for 3% to 9% of cervical lymph node biopsies. Patients are mostly found in adolescence, with the age range being 10 to 30 years old, and occasionally in the elderly. It is more common in women.

1. It is more common in young women, with more cases occurring in spring and summer. Some patients often have a history of viral infection, pharyngitis, etc. before the onset of the disease.

2. Fever patterns vary, including remittent fever, low fever or irregular fever, with the highest temperature reaching 39-40°C. It can also be intermittent, and the body temperature of some patients may be normal. The fever lasts for 1 to 2 weeks. In some patients, the high fever may persist for 1 to 2 months or longer, and it usually subsides on its own.

3. Lymph node swelling is mostly located in the neck, and may also affect the axilla, supraclavicular region, hilum of the lung, groin and other parts. It is mobile and soft in texture. Acute onset is often accompanied by pain or tenderness, and there is no obvious local inflammation. Lymph nodes often increase or decrease in size as the fever increases. This is different from the characteristics of lymph node enlargement, tough or hard texture, progressive enlargement and no tenderness in hematological malignancies such as lymphoma and malignant tumors.

4. Rash Some patients may develop rash, manifested as urticaria, papules, and erythema multiforme, which is often transient and disappears after 3 to 10 days.

5. Hepatosplenomegaly: Mild hepatomegaly can be seen in about 30% of cases, and transient splenomegaly can be seen in 50% of patients, which will return to normal after the fever subsides.

More than 80% of patients present with cervical lymphadenopathy as the first symptom. Multiple superficial lymph nodes in front of the ears, under the arms, in the groin, and mesenteric lymph nodes may also be affected. A few may experience systemic lymphadenopathy. The number of enlarged lymph nodes may be one or several; they are not fused to each other and are movable. Enlarged lymph nodes are often tender. 40% of patients have a fever above 38°C. The patient may have a sudden high fever that persists, or a persistent low-grade fever, often accompanied by upper respiratory tract symptoms, similar to the flu. Drug eruption-like rash may be seen in 20% of patients, while some patients have no obvious symptoms.