A case of subacute necrotizing lymphadenitis with symptoms of hemophagocytic syndrome

Abstract

A 41-year-old woman was referred to our department for a fever and neck swelling. Her soluble IL-2R level was elevated at 3,619 U/㎖, and her platelet count was decreased at 59 × 10³/μℓ. Because of the high soluble IL-2 level, we strongly suspected malignant lymphoma and performed positron emission tomography. The presence of highly increased multiple aggregations in the right cervical lymph node and splenomegaly supported our suspicions of malignant lymphoma. On the day after the initial examination, her white blood cell count decreased to 3,000/μℓ, and the next day, a right cervical lymph node biopsy was performed under general anesthesia. Given the possibility of subacute necrotizing lymphadenitis, the patient was started on a steroid-tapering regimen. Postoperatively, liver enzymes were elevated, and we suspected hemophagocytic syndrome, but the patient's symptoms improved steadily, and a histological examination revealed subacute necrotizing lymphadenitis.