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PubMed1994

Localized Leishmania lymphadenitis. Immunohistochemical studies.

Tissues from 10 patients with localized leishmania lymphadenitis were stained by immunoperoxidase technique for leishmanian antigens, immunoglobulins (Ig), complement, components, alpha 1-antitrypsin, and fibrin and by routine and chloroacetate esterase techniques. Lymph nodes with leishmania lymphadenitis showed a granulomatous process with a varying degree of necrosis, leishmanian amastigotes, abundant plasma cells, and focal fibrosis. Leishmanian antigens stained by rabbit anti-Leishmania tropica antiserum was detected in lymph nodes with granulomatous lymphadenitis (eight cases examined) and in a skin lesion but not in a lymph node showing only nonspecific hyperplasia. Positive antigen staining was seen in leishmanian amastigotes, granulomata, and (in three cases) vascular smooth muscles. Dominant plasma cell classes were IgG and IgE. Macrophages and granulomata stained positively for IgG and IgE (but not for IgM or IgA), faintly for C3, and strongly for alpha 1-antitrypsin. Mast cells were few. IgG and IgE may be involved in a specific way in this condition; formation of immune complexes with leishmanian antigens leads to immunologically mediated lysis of the host macrophages. This finding is important for the understanding of the pathogenesis of leishmania lymphadenitis and for effective elimination of the parasites.

Animals↗

PubMed1994

Fine-needle aspiration cytologic diagnosis of Kikuchi's lymphadenitis. A report of 27 cases.

Kikuchi's lymphadenitis is a self-limiting condition typically affecting young patients. Surgical biopsy is unnecessary if a firm diagnosis can be rendered by fine-needle aspiration cytology (FNAC). The authors report the FNAC findings for 27 cases, including 24 female and 3 male patients aged 12 to 43 years. Histologic sections of FNAC cell blocks and excisional biopsy specimens were available in 26 and 9 cases, respectively, for confirmation of the diagnosis. In the smears, karyorrhectic and granular debris were mixed with two distinctive cell types: (1) phagocytic histiocytes with peripherally placed "crescentic" (sometimes elongated or twisted) nuclei and abundant cytoplasm containing phagocytosed karyorrhectic or eosinophilic granular debris, easily distinguishable from tangible-body macrophages, which possessed central round nuclei, and (2) medium-sized cells possessing eccentrically placed round nuclei, fairly condensed chromatin, and a moderate amount of amphophilic cytoplasm, consistent with plasmacytoid monocytes. Also present were nonphagocytic histiocytes with twisted nuclei and delicate chromatin and immunoblasts that sometimes showed atypical features such as irregular foldings of the nuclei. Neutrophils were sparse or absent. Review of the FNAC findings of 50 lymph nodes involved by various reactive processes, tuberculosis, and lymphoma for comparison showed that although tangible-body macrophages and debris were not uncommon, very few phagocytic histiocytes with crescentic nuclei were observed, in only 2 cases; plasmacytoid monocytes were observed in 4 cases. The constellation of features described above permits diagnosis of Kikuchi's lymphadenitis by FNAC. Because of morphologic similarities between lupus lymphadenitis and Kikuchi's lymphadenitis, however, serologic studies are warranted to exclude systemic lupus erythematosus.

Adolescent↗

PubMed1981

Suppurative granulomatous lymphadenitis caused by corynebacterium ovis (pseudotuberculosis).

A 30-year-old previously healthy man developed cervical adenopathy associated with mild constitutional symptoms. Corynebacterium ovis was isolated in pure culture from lymph node tissue on two separate occasions, and small gram positive organisms were identified in both lymph nodes with tissue gram stain. Histopathologically, the nodes displayed suppurative and necrotizing granulomas. Of eight previously reported cases of C. ovis lymphadenitis in man, all but one have involved inhabitants of rural Australia, most of whom had contact with sheep, an animal reservoir of C. ovis. Necrotizing granulomas were usually observed. The patient described was an American urban dweller with a history of raw milk ingestion. We believe this to be the first reported case of C. ovis lymphadenitis from the United States. C. ovis infection should be considered n the differential diagnosis of localized lymphadenitis with necrotizing and/or suppurative granulomas. In evaluation of granulomatous lymphadenitis tissue gram stain should be performed and culture of a diphtheroid organism not readily dismissed.

Adult↗

PubMed1989

Plasmacytoid monocytes (so-called plasmacytoid T-cells) in Kikuchi's lymphadenitis. An immunohistologic study.

Three cases of Kikuchi's lymphadenitis were studied immunohistochemically on paraffin-embedded material in order to compare the plasmacytoid monocyte aggregates occurring in this disorder with plasmacytoid monocyte clusters in nonspecific reactive lymphadenitis. One of the cases was also analyzed on frozen material. In Kikuchi's lymphadenitis, plasmacytoid monocytes expressed the CD38 and LN1 antigens in addition to their monocyte/macrophage antigens found in nonspecific reactive lymph nodes. These plasmacytoid monocyte aggregates contained large numbers of Mac387+ lysozyme+ macrophages, scattered HLADR+ dendritic cells, and high numbers of CD8+ T-lymphocytes. Collections of T-immunoblasts or areas of necrosis were observed within these aggregates. The authors speculate that the histologic feature of Kikuchi's lymphadenitis is the morphologic substrate of a T-cell-mediated cytotoxic immune reaction occurring in plasmacytoid monocyte aggregates and resulting in plasmacytoid monocyte damage and necrosis.

Adult↗

PubMedDate not supplied

An unusual cause of cervical lymphadenitis: Kikuchi-Fujimoto disease.

Cervical lymphadenitis may be the result of diverse conditions in a patient. Clinical and epidemiologic information about cervical lymphadenitis can often lead to a presumptive diagnosis and, thus, limit the number of studies required as well as direct the type of initial therapy administered. We report a case of cervical lymphadenitis in a Vietnamese woman for whom a presumptive diagnosis of tuberculosis was made and antituberculous therapy was started. Pathologic examination of an excised lymph node revealed the correct diagnosis--histiocytic necrotizing lymphadenitis, or Kikuchi-Fujimoto disease. We review the clinical, epidemiologic, and pathologic features of this recently recognized disease. Careful examination of excised material from the lymph nodes should prevent patients who have Kikuchi-Fujimoto disease from receiving unnecessary treatment.

Adult↗

PubMed1995

Neuroretinitis, aseptic meningitis, and lymphadenitis associated with Bartonella (Rochalimaea) henselae infection in immunocompetent patients and patients infected with human immunodeficiency virus type 1.

Bartonella (Rochalimaea) henselae causes a variety of diseases, including bacillary angiomatosis, peliosis hepatis, lymphadenitis, aseptic meningitis with bacteremia, and cat-scratch disease (CSD). Cases of B. henselae-related disease were collected from September 1991 through November 1993. Patients with suspected CSD, unexplained fever and lymphadenitis, or suspected B. henselae infection who were seen in the Infectious Diseases Clinic at Wilford Hall Medical Center (Lackland Air Force Base, TX) underwent physical and laboratory examinations. In addition to three previously described cases, 23 patients with R. henselae-related infection were identified. The patients included 19 immunocompetent individuals presenting with lymphadenitis (11), stellate neuroretinitis (5), Parinaud's oculoglandular syndrome with retinitis (1), chronic fatigue syndrome-like disease (1), and microbiologically proven adenitis without the presence of immunofluorescent antibodies to B. henselae (1) and four patients infected with human immunodeficiency virus type 1 presenting with isolated lymphadenitis (1), diffuse upper-extremity adenitis (1), neuroretinitis (1), and aseptic meningitis (1). A couple with neuroretinitis and their pet cat, a persistently fatigued patient, and a patient with Parinaud's oculoglandular syndrome were shown to have bacteremia. Tissue cultures were positive for B. henselae in three recent cases of adenitis. Twenty-two patients were exposed to cats. This series further demonstrates the similarities between B. henselae-related diseases and CSD and identifies several new syndromes due to B. henselae.

Adolescent↗

PubMed1997

Human lymphadenitis due to Corynebacterium pseudotuberculosis: report of ten cases from Australia and review.

Corynebacterium pseudotuberculosis commonly causes caseous lymphadenitis in Australian sheep. We describe 10 cases of human lymphadenitis due to C. pseudotuberculosis; in all cases, isolates were submitted to a reference laboratory in Victoria, Australia. Most of the patients were occupationally exposed to sheep. We also review the 12 previously published cases of this infection, most of which were reported from Australia. No patient had any underlying disease or predisposing condition. Surgical excision of the affected lymph glands is the mainstay of management, and antibiotic therapy is supplementary treatment. Diagnosis was delayed for some patients, and some patients had a protracted or recurrent clinical course and/or a slow recovery. These 10 additional cases from one Australian state indicate that human lymphadenitis caused by C. pseudotuberculosis has not been as rare as the number of published reports indicates, at least in Australia. However, the increasing use of a vaccine against caseous lymphadenitis in sheep in Australia should result in the decreasing human incidence of this zoonosis.

Adolescent↗

PubMed1999

Nontuberculous mycobacterial lymphadenitis in children.

OBJECTIVES: To describe the clinical and epidemiologic features, management and outcome associated with the development of nontuberculous mycobacterial (NTM) superficial lymphadenitis in children. METHODS: The medical records of all children 0 to 14 years of age with NTM superficial lymphadenitis who were diagnosed at P. and A. Kyriakou Children's Hospital between January, 1982, and December, 1997, were reviewed. RESULTS: Forty-seven children were identified, 76.5% during the second half of the study period. Mycobacterium avium complex was the predominant isolate. Children with NTM lymphadenitis noted satisfactory aesthetic results when total excision was performed within 1 month after its onset. CONCLUSIONS: NTM superficial lymphadenitis in children has been increasingly recognized during the last decade. Prompt total excision of the involved lymph node is required in such patients.

Adolescent↗

PubMed2002

The natural course of nonsuppurative Calmette-Guérin bacillus lymphadenitis.

In a tertiary level hospital in North India, we studied the outcome of infants with nonsuppurative Calmette-Guérin bacillus (BCG) lymphadenitis managed conservatively. Twenty-three infants with nonsuppurative BCG lymphadenitis diagnosed on the basis of clinical presentation, evidence of granulomatous inflammation and demonstration of acid fast bacilli in the aspirated material were followed prospectively without being offered specific antitubercular drug therapy. Twenty patients were available for final analysis; three were lost to follow-up. Seventeen (85%) had spontaneous regression of BCG lymphadenitis without progression and drainage. The mean time to resolution was 9.1 months. Three (15%) patients developed suppuration and drainage, but even these children had uneventful healing on conservative management only. Nonsuppurative BCG lymphadenitis follows a benign course in most individuals. Most of the cases regress spontaneously with conservative management.

BCG Vaccine↗

PubMed1989

Bacterial lymphadenitis with the picture of a lymphoepithelioid cell lymphoma--Lennert's lymphoma.

Three cases with the typical light microscopic picture of lymphoepithelioid cell lymphoma (so-called Lennert's lymphoma) were investigated by electron microscopy. Surprisingly, Lennert's lymphoma could be excluded in two cases. These two cases exhibited, in addition to pleomorphic lymphocytes and epithelioid cells, macrophages with accumulations of bacteria, indicating that a bacterial infection was the cause of the disease. By comparing the typical case of Lennert's lymphoma with the other cases, we found several criteria for distinguishing between Lennert's lymphoma and bacterial lymphadenitis. In bacterial lymphadenitis: (1) small and medium-sized lymphocytes exhibited a wide cytological spectrum whereas the lymphocytes in Lennert's lymphoma were relatively uniform; the lymphocytes with prominent lysosome-like granules found in Lennert's lymphoma were not seen; (2) cytology and distribution of epithelioid cells were similar to those in Lennert's lymphoma; (3) epithelioid venules contained recirculating lymphocytes, which were rarely found in Lennert's lymphoma; (4) numerous interdigitating reticulum cells, fibroblasts and myofibroblasts were seen, but not in Lennert's lymphoma; (5) focal increase in reticulin fibres was the main difference in light microscopy; (6) rod-shaped bacteria were accumulated in the cytoplasm of a few macrophages. The presence of bacteria could not be demonstrated unequivocally by light microscopy. In both cases the large number of intracytoplasmic bacteria suggests that this unusual and until now unknown lymphadenitis is the result of an infection caused by facultative intracellular parasitic bacteria. The outcome of bacterial lymphadenitis that gives the false impression of Lennert's lymphoma is uncertain. Cure was achieved in one of our cases. The other patient died before therapy was commenced.

Adult↗

PubMed1986

Non-tuberculous mycobacterial lymphadenitis.

Most cases of mycobacterial lymphadenitis in children are caused by non-tuberculous mycobacteria, previously called the atypical mycobacteria. It is important to differentiate non-tuberculous mycobacterial lymphadenitis from tuberculous lymphadenitis as the treatment is different. We reviewed 19 children (12 girls and seven boys) with non-tuberculous mycobacterial lymphadenitis to define likely presenting features, helpful diagnostic measurements, and optimum management. Mean age at diagnosis was 5.2 years. Most had no systemic upset and clear chest x ray films. Cervical nodes were the commonest affected, and enlargement was usually unilateral. Mean duration of swelling was 6.6 weeks, and 63% of the nodes had an appearance suggestive of cold abscess. Routine haematology was unhelpful, and standard tuberculin testing performed in 47% yielded negative results in two thirds. Differential Mantoux testing with human purified protein derivative and an avium-intracellular antigen may be more useful. Antituberculous drugs were ineffective. The organism was usually highly resistant. Total excision is the treatment of choice. Antituberculous drugs are unnecessary.

Child↗

PubMed1999

Herpes lymphadenitis in association with chronic lymphocytic leukemia.

BACKGROUND: Herpes simplex virus (HSV) infections range in severity from common cutaneous outbreaks to life-threatening central nervous system and deep organ involvement. HSV lymphadenitis is extremely rare but occurs both as a component of widely disseminated disease and as a localized, mild illness. METHODS: Five patients with chronic lymphocytic leukemia (CLL) underwent lymph node biopsy and were found to have histologic and immunophenotypic evidence of HSV infection in association with CLL. RESULTS: The patients were 3 males and 2 females ranging in age from 50 to 86 years. Only 1 patient had clinical evidence of cutaneous herpes at any time; in that patient, herpes lymphadenitis preceded the cutaneous herpes by 3 years. Four patients received no therapy for herpes at any time, whereas one was treated with intravenous and oral acyclovir. One patient died of CLL approximately 20 months after herpes lymphadenitis was diagnosed. The remaining four patients are alive with CLL. No patient had a fulminant clinical course related to HSV or developed disseminated infection. CONCLUSIONS: Herpes lymphadenitis may not have a fulminant course even in immunosuppressed CLL patients, even if they receive no antiviral therapy.

Aged↗

PubMed2001

A scoring system for ultrasonographic differentiation between cervical malignant lymphoma and benign lymphadenitis.

The purpose of our study is to assess the usefulness of a scoring system for ultrasonography using a high-frequency transducer as a non-invasive examination in the differential diagnosis of cervical malignant lymphoma from benign lymphadenitis. Ultrasonography was performed with a real-time linear scanner using 7.5 and/or 11 MHz probes in 66 patients who were presented with cervical lymphadenopathy and were suspected to have malignant lymphoma. Thereafter, a surgical biopsy was performed for histopathological diagnosis, revealing 49 cases of malignant lymphoma and 17 cases of benign lymphadenitis. Ultrasonographic findings were reviewed retrospectively. The incidence of following ultrasonographic features was found to be significantly higher in malignant lymphoma than in benign lymphadenitis. These were; (1) longitudinal and transverse diameter ratio(L/T) < 2.0, (2) a delineation of multiple nodes, (3) a tendency of fusion, (4) an irregular margin, (5) hypoechoic masses with heterogeneous internal echoes, (6) a presence of line echoes and (7) an absence of hilum. These 7 ultrasonographic features were used in combination for a scoring system to discriminate malignant lymphoma from benign lymphadenitis. When ultrasonographic findings of lymph nodes fulfilled more than 3 of the 7 features, malignant lymphoma was diagnosed with a sensitivity of 98.0% and a specificity of 76.5%. Ultrasonographic evaluation of swollen cervical lymph nodes using a high-frequency transducer would be informative and should be performed prior to a surgical biopsy.

Adolescent↗

PubMed2002

Needle aspiration as a diagnostic tool and therapeutic modality in suppurative lymphadenitis following Bacillus Calmette Guerin vaccination.

OBJECTIVES: Outbreaks are known to occur after Bacillus Calmette Guerin (BCG) vaccination. An outbreak of suppurative lymphadenitis in 18 infants, following BCG vaccination is reported from Sikkim, with incidence of 8.6%. The outbreak occurred after a change of vaccine. METHODS: In a prospective study the cases of suppurative lymphadenitis were diagnosed by needle aspiration cytology and culture of the material aspirated and managed only with repeated needle aspiration and no antitubercular treatment was given. RESULTS: Cytomorphology revealed necrosis alone in 66.6% and necrotizing granulomas in 22.2%. Acid and alcohol fast bacilli were detected in 77.7% cases. Mycobacterium bovis was isolated in eight cases. One case of staphylococcal suppurative lymphadenitis was detected. Sixteen cases were managed with weekly aspiration with mean period of resolution in eight weeks. CONCLUSIONS: Needle aspiration is useful in the diagnosis and effective in the management of these cases. No antitubercular treatment is desired and required in the cases of suppurative lymphadenitis following BCG vaccination.

Adjuvants, Immunologic↗

PubMedDate not supplied

Bacillus Calmette-Guerin (BCG) lymphadenitis-changing trends and management.

BACKGROUND: Bacillus Calmette-Guérin (BCG) vaccination is performed as a part of expanded Programme of Immunization (EPI). Suppurative lymphadenitis is the common complication of BCG vaccination. The optimum treatment for this complication is debated. METHODS: All cases of BCG lymphadenitis presenting to pediatric surgical service over a 17-year study period were reviewed to determine the optimum treatment for this problem. RESULTS: Sixty children were referred for the management of BCG lymphadenitis during the study period. Most patients (n=43) presented during 1988 and 1990. Children were healthy and received BCG (Pasteur strain) vaccination at EPI during first 2 months of life. Initially all the patients received medical treatment with anti-tuberculous drugs for one to nine months. Fifty-two children who presented with large (approximately 3cm) fluctuant lymph nodes, required a surgical procedure to avoid spontaneous rapture and sinus formation (Group A), whereas medical treatment was effective in five out of eight patients presenting with small (approximately 1 cm) nodes (Group B). CONCLUSIONS: Medical treatment with antituberculous drugs is not effective to treat BCG lymphadenitis, when the involved lymph nodes are around 3.0 cm and have developed fluctuation and inflammation of over lying skin.

BCG Vaccine↗

PubMed2006

[Rash and purulent lymphadenitis in cat scratch disease].

We present a case of a cat-scratch disease (CSD) presenting with typical (primary lesion and regional lymphadenitis) and rare (purulent lymphadenitis and maculopapular rash) symptoms and positive epidemiological data. Laboratory blood test showed normal values for routine parameters, except for mild leukocytosis (L 12.4 x 10(9)), elevated erythrocyte sedimentation rate (SE 65/h) and moderately elevated asparta e-aminotransferase and alanine-aminotransferase values (AST/ALT 48/90), fibrinogen (5.3 g/L) and C-reactive protein (CRP 85 mg/L). Cytological analysis of lymph node content revealed granulomatous inflammation in the first sample, and purulent inflammation in the second sample. In paired serum samples, collected on the 15th and 29th day from the onset of disease, antibodies IgG (titre 4096/8192) and IgM (titre 80/40) to Bartonella henselae were detected by using an indirect immunofluorescence assay (IFA). Antibiotic therapy with azithromycin (1 x 500 mg per os/5 days) was administered. Purulent lymphadenitis and rash, although a rare clinical manifestation in CSD, are significant clinical findings in differentiating CSD from other febrile illnesses accompanied with rash and lymphadenitis.

Cat-Scratch Disease↗

PubMed1979

Visceral caseous lymphadenitis in thin ewe syndrome: isolation of Corynebacterium, Staphylococcus, and Moraxella spp from internal abscesses in emaciated ewes.

The relationship between the visceral form of caseous lymphadenitis and a chronic debilitating condition of mature sheep designated as the thin ewe syndrome was investigated. Internal abscesses were found during necropsy in 81% of animals with thin ewe syndrome and Corynebacterium pseudotuberculosis (C ovis) was recovered from 86% of the animals with internal abscesses. Other pyogenic bacteria, including C pyogenes, C equi, Staphylococcus epidermis, S aureus, and Pseudomonas aeruginosa were often recovered in association with C pseudotuberculosis. Moraxella sp was recovered in 41% of the animals with internal abscesses. In some abscesses, Moraxella sp was the dominant microorganism isolated and in others, they were outnumbered only by C pseudotuberculosis. Species isolated included M bovis, M osloensis, and M nonliquefaciens. The potential importance of Moraxella sp to the cause and pathogenesis of the thin ewe syndrome is not known. The results of the present study indicate that visceral caseous lymphadenitis is either an important contributing factor to the development of thin ewe syndrome or that the presence of thin ewe syndrome may predispose affected sheep to the development of visceral caseous lymphadenitis. A skin test reagent prepared by sonicating C pseudotuberculosis was of limited value in detecting animals with visceral caseous lymphadenitis. Only 56% of the animals with abscesses caused by C pseudotuberculosis gave positive delayed-type hypersensitivity skin test responses.

Abscess↗

PubMed1995

[Kikuchi lymphadenitis. A contribution to the differential diagnosis of cervical lymph node swelling of unknown origin].

According to its morphological appearance, Kikuchi's disease is also called "histiocytic necrotizing lymphadenitis". This disorder was first described in Japan in 1972 as a benign lymphadenopathy of the neck. In Germany only a few cases have been reported by pathologists, whereas most clinicians are unaware of the existence of this rare disease, which can easily be mistaken for malignant lymphoma. In 1993 three cases of Kikuchi's lymphadenitis were treated at the ENT Department of the University of Lübeck. Patients' ages ranged from 15 to 30 years old. Except for cervical adenopathy, findings in blood tests, viral serology and radiological imaging were unremarkable. While fine needle aspirations were suspicious for malignant lymphoma, a final diagnosis of self-limiting "Kikuchi's lymphadenitis" was established histologically from excised lymph nodes. In our opinion early extirpation of lymph nodes and consultation of a pathologist are necessary to make a correct diagnosis without delay. Thus, in patients with Kikuchi's lymphadenitis unnecessary staging procedures and treatment can be avoided.

Adolescent↗