Mesenterial histiocytic necrotizing lymphadenitis. Case report.

A 14-year-old girl was hospitalized with fever, jaundice, vomiting and right sided abdominal pain. A laparotomy was performed because of muscular defence and ascites. There was a mass of enlarged red and blue colored lymph nodes in the mesentery of the lower ileum loop. The histologic diagnosis of HNL without granulocytic infiltration was made. A septic-toxic shock developed after surgery. Respiratory insufficiency necessitated the use of a respirator, and acute renal failure with oliguria made hemodialysis necessary. The dramatic clinical course of the illness and the localization of the affected lymph nodes in the abdomen are unusual for an HNL; the lack of granulocytic infiltration contradicts the clinical picture of a bacterial infection. Neither a bacterial nor a viral pathogen could be found. However, the patient had been treated with antibiotics before.