[The ratio of cervical subacute necrotizing lymphadenitis occupying superficial lymphadenopathy and its clinical findings].
BACKGROUND
Diseases in which cervical lymphadenopathy is a chief complaint are commonly observed. These cases are associated with a good prognosis, high fever and pain which usually recovers without medication. This condition is referred to as subacute necrotizing lymphadenitis (SNL). We investigated cases of SNL that were correctly diagnosed by biopsy.


OBJECTIVE
We examined cases of SNL that were correctly diagnosed by biopsy in the Naha Prefectural hospital between April 1987 and March 1997. We statistically analyzed the ratio of occurrence and clinical findings (age, sex, season of occurrence, physical characteristics, clinical progress, blood findings, therapy, and prognosis).


RESULTS
In a total of 629 cases, a biopsy specimen from the body surface of the area affected by lymphadenopathy was obtained. Among these cases, SNL was diagnosed in 54 accounting for 9% of the total body surface biopsies and 13% of the cervical lymphadenopathic biopsies. Sex: Of the 54 subjects, 18 were males and 36 females. AGE: Most of the subjects (87%) ranged from 10 to 30 years of age. Season of occurrence: The number SNL cases decreased from 1993. Many cases occurred in the cold season, from October to March.


RESULTS
Forty cases were investigated as fever, swelling, pain and complications. FEVER: Six cases (15%) were not associated with fever and 34 cases (85%) exhibited fever. Swelling: All subjects demonstrated swelling for at least one week and the longest duration of swelling was six months. Swelling continued for two to three months on average. Thirty-five cases (88%) showed swelling on one side only, left or right, and five cases (12%) showed swelling on both sides. PAIN: Ten cases (25%) were without pain and 30 cases (75%) with some pain.


RESULTS
Twelve cases (30%) had complications including six of drug allergy, four of dermatitis, and some cases of diabetes mellitus and hyperthyroidism. Eleven of 54 cases (20%) were admitted to the hospital. Blood findings: The white blood cell level decreased in 30 of 37 cases (82%). As shown below, increased levels of CRP (6/34), ESR (4/31) and LDH (17/31) were observed.


METHODS
Steroids were administered in 24 of 36 cases and were effective in all cases. Antibiotics were administered in 25 of 31 cases and were effective in six cases (19%)) and ineffective in 10 cases (32%). The condition in nine cases (29%) worsened. Pain killers were employed in 26 of 32 cases. They were effective 18 cases (56%) and ineffective in eight cases (25%). No subjects died. The prognoses were good and all patients recovered without sequela.


CONCLUSIONS
SNL was detected in a large number of patients with cervical lymphadenopathy who visited our hospital, if patients who were not diagnosed correctly by biopsy were included. Many patients exhibited lymphadenopathy on one side (88%). This result was slightly higher than that previously reported. SNL is considered to be related to allergy or upper respiratory infections. This disease often occurs in cold seasons and patients often exhibit complications such as drug allergies or antoimmune diseases.
Maeda
H
H
Department of Otorhinolaryngology, University of the Ryukyus Faculty of Medicine, Okinawa.
Ura
M
M
Noda
Y
Y
Yamazato
S
S
Matuyashi
S
S
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009333:Neck; D012621:Seasons