title: Comparison of clinical features and EBV expression in histiocytic necrotizing lymphadenitis of children and adults.
abstract: OBJECTIVE
  Histiocytic necrotizing lymphadenitis (HNL) is a self-limiting disease characterized by cervical lymphadenopathy and fever. Epstein-Barr virus (EBV) has been implicated as a cause of HNL in some reports but not in others. The aim of this study was to compare the clinical features and laboratory findings in children and adults with HNL and to evaluate the relationship between EBV infection and HNL.
  
  
  METHODS
  The records of patients diagnosed with biopsy-confirmed HNL at Gyeongsang National University Hospital from May 2009 to December 2012 were retrospectively reviewed. Clinical features, laboratory data (blood count, biochemistry, and serology), and computed tomography findings were collected. Immunohistochemistry for CD4, CD8, CD68, and myeloperoxidase (MPO), and in situ hybridization for EBV RNA were performed on archived lymph node biopsies from pediatric and adult patients.
  
  
  RESULTS
  A total of 16 children and 31 adults were diagnosed with HNL. Fever was present in 87.5% of children and 25.8% of adults (P<0.0001). Fever duration was longer for children (mean, 5.06 days) than for adults (mean, 0.63 days; P=0.008). Necrosis of the involved lymph nodes was observed in eight (50%) children and six (19.4%) adults (P=0.045). HNL recurred in five (31.35%) children and one (3.2%) adult (P=0.015). All had detectable CD4, CD8, CD68, and MPO immunoreactivity. EBV reactivity was higher in children (26.7%) than in adults (6.7%) without statistical support.
  
  
  CONCLUSIONS
  There is more variability in the clinical presentation and laboratory findings in children with HNL than in adults. In particular, the degree and duration of fever was more severe in children than in adults, and necrosis of lymph nodes was more frequent in children than in adults. There was no definitive correlation between EBV reactivity and NHL. Further study of the relationship between EBV and HNL is needed with a larger number of patients.
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju,Republic of Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Seo
authors.affiliation: Department of Pathology and Urology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Republic of Korea.
authors.forename: Jong Sil
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Republic of Korea.
authors.forename: Eun-Jae
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Department of Pathology and Urology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Republic of Korea.
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Republic of Korea.
authors.forename: Jin Pyeong
authors.initials: JP
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Republic of Korea.
authors.forename: Seung Hoon
authors.initials: SH
authors.lastname: Woo
authors.affiliation: Department of Otolaryngology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Republic of Korea.
authors.forename: Seong-Ki
authors.initials: SK
authors.lastname: Ahn
authors.affiliation: Department of Otolaryngology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Republic of Korea.
authors.forename: Oh Jin
authors.initials: OJ
authors.lastname: Kwon
authors.affiliation: Department of Pathology and Urology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Republic of Korea.
authors.forename: Jeong Seok
authors.initials: JS
authors.lastname: Hwa
authors.affiliation: Department of Otolaryngology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Republic of Korea.
authors.forename: Jung Je
authors.initials: JJ
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D020042:Histiocytic Necrotizing Lymphadenitis / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D012367:RNA, Viral
keywords: Child; Epstein–Barr virus; Histiocytic necrotizing lymphadenitis; Kikuchi’s disease