[Subacute necrotizing lymphadenitis with a clinical course mimicking virus-associated hemophagocytic syndrome]

A 17-year old female was admitted to our hospital with fever and systemic lymph node swelling. Laboratory data revealed pancytopenia, elevation of serum lactic acid dehydrogenase, triglyceride and ferritin levels. Bone marrow aspiration showed increased numbers of mature hemophagocytic histiocytes. We suspected virus-associated hemophagocytic syndrome (VAHS) but a biopsied lymph node revealed necrosis without the presence of hemophagocytosis by histiocytes and the diagnosis of subacute necrotizing lymphadenitis (SNL) was made. She recovered entirely after treatment with gamma-globulin, acyclovir and methylprednisolone. This patient was the second reported case of SNL with the clinical course mimicking VAHS and it is necessary to consider the relationship between these two disorders.