Berlin C M, Boal D K, Zaino R J, Karl S R
Department of Pediatrics, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey 17033.
Clin Pediatr (Phila). 1990 Jun;29(6):339-42. doi: 10.1177/000992289002900610.
A patient is described who presented with a 1-month history of daily fever to 38.8 degrees C. There was no sign of joint pain or swelling and no skin rash. The patient had impressive hepatomegaly without splenomegaly. The only abnormal laboratory test was a sedimentation rate of 120 mm/hr. Ultrasound examination showed hypoechoic foci throughout the liver. These foci were confirmed by CT scan, which showed multiple well-marginated lesions of decreased attenuation and variable size throughout the right and left lobes of the liver. A liver biopsy specimen showed large nodules that were yellow and gritty in texture. Microscopic examination of biopsy specimens of these nodules showed extensive areas of necrotizing granulomatous inflammation with palisading histiocytes and occasional giant cells surrounded by necrotic foci. There was an associated fibroinflammatory infiltrate. The patient was treated with a nonsteroidal anti-inflammatory agent with prompt cessation of fever. A repeat CT examination of the liver after 14 months of treatment showed only mild hepatomegaly and a normal liver parenchyma. The focal lesions had disappeared. This is a case of hepatic granulomata in a child showing features of necrotizing inflammation.
描述了一名患者，其有持续1个月的每日发热至38.8摄氏度的病史。无关节疼痛或肿胀迹象，也无皮疹。患者肝脏肿大明显但无脾肿大。唯一异常的实验室检查是血沉率为120毫米/小时。超声检查显示肝脏内有低回声灶。CT扫描证实了这些病灶，显示肝脏左右叶有多个边界清晰、密度减低且大小不一的病灶。肝脏活检标本显示有大的结节，质地呈黄色且有沙粒感。对这些结节的活检标本进行显微镜检查显示，有广泛的坏死性肉芽肿性炎症区域，伴有栅栏状组织细胞，偶尔可见被坏死灶包围的巨细胞。有相关的纤维炎性浸润。患者接受了非甾体抗炎药治疗，发热迅速消退。治疗14个月后对肝脏进行的重复CT检查仅显示轻度肝脏肿大和正常肝实质。局灶性病变已消失。这是一例儿童肝肉芽肿病例，表现为坏死性炎症特征。
