Subacute necrotizing lymphadenitis --a clinicopathologic study

This report describes the clinical and pathologic findings of 21 patients with subacute necrotizing lymphadenitis (N.L.). Clinical features of all but 2 patients were as typically described in the literature; young age, enlargement of cervical or axillary lymph nodes, slight to moderate fever with poor response to antibiotics, and invariable spontaneous resolution. Two patients showed atypical clinical findings; remittent high fever with profound prostration in both patients, generalized lymphadenopathy in one, and being a Caucasian in the other. Systemic symptoms resolved gradually, and both patients are now doing well. One patient, however, underwent a staging laparotomy due to a misdiagnosis as unclassifiable lymphoma of the lymph node biopsy. Biopsies of the lymph nodes from all patients demonstrated the typical pathologic features of N.L.; i.e., an intensive proliferation of leukocytes were characteristically absent. Bacteriologic and serological studies were negative. We conclude that some patients with N.L. run a protracted course with remittent high fever before spontaneous resolution and that a correct pathologic diagnosis helps precluding unnecessary diagnostic or therapeutic measures on such patients.U