Role of fine-needle biopsy in an atypical case of lupus lymphadenopathy.

Necrotizing lymphadenitis dominated by individual cell necrosis with tingible body macrophages and karyorrhectic nuclear debris is an unusual appearance in smears from fine-needle biopsies (FNB) of lymph nodes (Greenberg et al., Diagn Cytopathol 1993; 9:443-447). These features together with a polymorphous population of lymphocytes, absent epithelioid histiocytes and neutrophils, suggest a possible diagnosis of either histiocytic necrotizing lymphadenitis (HNL) (syn. Kikuchi's Disease) or systemic lupus erythematosus (SLE). These were the cytologic features found in a FNB of a cervical lymph node in a 43-year-old female, treated for a mixed connective tissue disease. A presumptive diagnosis of an acute lupus lymphadenitis was made, based on the above features, and was subsequently confirmed by the presence of raised antinuclear antibodies as well as resolution of the lymphadenopathy on high dose steroids.