Abstract
A 22-year-old man complaining of high fever of 39°C, abdominal pain and diarrhea was diagnosed with acute enteritis and was given antibiotics at another hospital. Despite more than 2-week treatment with antibiotics, no symptomatic remission was gained. Abdominal contrast-enhanced CT scan revealed clustered swollen lymph nodes with the maximum diameter of 36 mm around the superior mesenteric artery and vein and the ileum branch. A biopsy of the mesenteric lymph node at the terminal ileum performed under laparotomy in our hospital for the purpose of diagnosis and treatment gave the histopathologic diagnosis of necrotizing lymphadenitis. Antibiotic treatment was sustained for postoperative seven days for a prophylactic aim. Another abdominal contrast-enhanced CT scan on the postoperative 10th day revealed that the maximum lymph node had spontaneously decreased to 28 mm in diameter, when he had no high fever. Thus he was discharged from our hospital. Abdominal enhanced CT scan on the fifth week after the operation showed the diminished lymph nodes to the diameter of approximately 10 mm. Thereafter no relapse has occurred.
It took a long time and lymph node biopsy under laparotomy was eventually required until the definite diagnosis was made in this case, however, the operation could be avoided if we would bear the possibility of the disease in mind from the beginning. When we encounter a patient presented with persistent high fever which resists antibiotics, a possibility of diagnosis of necrotizing lymphadenitis should be kept in mind in the diagnosis and treatment.
