组织细胞性坏死性淋巴结炎合并无菌性脑膜炎1例并文献回顾  

Histiocytic necrotizing lymphadenitis combined with aseptic meningitis:a case report and literature review

作　　者：裴学玉 徐春华 池云 胡志亮 PEI Xueyu;XU Chunhua;CHI Yun;HU Zhiliang(Department of Infectious Diseases,Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine(The Second Hospital of Nanjing),Nanjing,Jiangsu 210003,China)

机构地区：[1]南京中医药大学附属南京医院(南京市第二医院)感染病科,江苏南京210003

出　　处：《安徽医药》2023年第9期1783-1786,共4页Anhui Medical and Pharmaceutical Journal

基　　金：南京医学科技发展重点项目(ZKX21037)。

摘　　要：目的探讨组织细胞性坏死性淋巴结炎(菊池病)合并无菌性脑膜炎病人的临床特点。方法回顾分析2022年6月10日南京市第二医院收治的1例以发热、头痛、呕吐为首发临床表现的菊池病病人的临床资料。结果该病人不明原因高热,头痛、呕吐,颈部淋巴结多发肿大,外院结核感染T细胞斑点试验为阳性,怀疑为结核性脑膜炎转入该院,入院后血清学、脑脊液化验无结核感染依据,予经验性抗病毒、抗感染、降颅压治疗后未见好转,后经颈部淋巴结穿刺活检病理检查明确诊断为菊池病,予糖皮质激素口服后体温降至正常,头痛症状缓解,随访了解到病人颈部肿大淋巴结缩小,未有复发。结论菊池病合并无菌性脑膜炎临床上有些医生认知不足,容易误诊误治,对于有发热、颈部淋巴结肿大伴有无菌性脑膜炎表现的病人要注意考虑菊池病可能,尽早行淋巴结穿刺活检可及早明确诊断。Objective To investigate the clinical characteristics of patients with histiocytic necrotizing lymphadenitis(Kikuchi disease)complicated by aseptic meningitis.Methods The clinical data of a case of patient with Kikuchi disease with fever,headache and vomiting as the first clinical manifestations admitted to the Second Hospital of Nanjing on June 10,2022 were retrospectively analyzed.Results The patient had unexplained high fever,headache,vomiting,and multiple enlargements of cervical lymph nodes.The T-cell spot test of tuberculosis infection was positive in an outside hospital,and tuberculous meningitis was suspected.The patient was transferred to this hospital.After admission,there was no basis for tuberculosis infection in serology and cerebrospinal fluid tests,and empirical antiviral,anti-infective,and cranial pressure-lowering treatments were given without improvement.The patient was diagnosed with Kikuchi's disease by cervical lymph node biopsy and was given glucocorticosteroids orally,after which her body temperature dropped to normal and her headache was relieved.The patient was followed up and the enlarged lymph nodes in the neck shrunk without recurrence.Conclusion Kikuchi disease combined with aseptic meningitis is not well recognized by some doctors.For patients with fever and enlarged cervical lymph nodes with aseptic meningitis,it is important to consider the possibility of Kikuchi's disease,and early lymph node biopsy can lead to a clear diagnosis.

关 键 词：组织细胞性坏死性淋巴结炎 中枢神经系统损伤 无菌性脑膜炎 

分 类 号：R551.2[医药卫生—血液循环系统疾病] R742.9[医药卫生—内科学]