Tanaka M, Yano T, Ichikawa Y, Kaji M
First Department of Internal Medicine, Kurume University, Fukuoka, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Sep;28(9):1234-8.
A 16-year-old male was admitted with a history of cervical lymph node swelling, high fever, cough and hemosputum. On admission, bilateral cervical lymph nodes swelling and fine crackles in the right lower lung field were noted. A chest X-ray film showed an infiltrative shadow in the right lower lung field and right hilar enlargement. Cervical lymph node biopsy specimens revealed wide areas of necrosis with nuclear debris. Transbronchial lung biopsy showed infiltration of lymphocytes in the interstitium and bronchoalveolar lavage fluid showed increased T-lymphocytes and a decreased T4/T8 ratio. The patient was diagnosed to have subacute necrotizing lymphadenitis with T-lymphocyte alveolitis. Additionally, antinuclear antibodies were positive, and anti HTLV-I antibody was false positive. These findings suggested an immunological abnormality in this case. His cervical lymph node swelling and infiltrative shadow on chest X-ray film improved with steroid therapy. Our case may be the first case of subacute necrotizing lymphadenitis with T-lymphocyte alveolitis.
一名16岁男性因颈部淋巴结肿大、高热、咳嗽和咯血痰入院。入院时，发现双侧颈部淋巴结肿大，右下肺野有细湿啰音。胸部X线片显示右下肺野有浸润性阴影，右肺门增大。颈部淋巴结活检标本显示大片坏死并有核碎片。经支气管肺活检显示间质淋巴细胞浸润，支气管肺泡灌洗显示T淋巴细胞增加，T4/T8比值降低。该患者被诊断为亚急性坏死性淋巴结炎伴T淋巴细胞肺泡炎。此外，抗核抗体阳性，抗HTLV-I抗体为假阳性。这些发现提示该病例存在免疫异常。经类固醇治疗后，他的颈部淋巴结肿大及胸部X线片上的浸润性阴影有所改善。我们的病例可能是首例亚急性坏死性淋巴结炎伴T淋巴细胞肺泡炎。
