A 14-year-old male, previously healthy, presented with a two-month history of occipital, jugular, submandibular and inguinal lymphadenopathy, which was sensitive, associated with fever, anorexia and weight loss.
The hemogram showed 3,400 leukocytes x mm3, 46% lymphocytic and 50% neutrophilic.
C-reactive protein (CRP) and sedimentation rate (SSR) were 6.2 mg/L and 28 mm/h, respectively.
Liver profile, coagulation tests and renal function showed no abnormalities.
Paracoccidioidomycosis was negative: hemocultive, urocultive, coprocultive, immunofluorescence for respiratory viruses, serology for Epstein virus and HIV parvoxoB, Bartonella hesenCM
There were no significant findings on computed axial tomography (CAT) of the chest, abdomen and pelvis or on transthoracic echocardiography.
Cervical ultrasound showed bilateral adenopathies, both in anterior and posterior cervical triangles, of nonspecific aspect.
During hospitalization, a maculopapular rash appeared in the malar region, trunk and extremities associated with arthralgias.
Antinuclear antibodies (ANA) and anti-DNA were negative and anti-anthelmintic nuclear antibodies (ENA) and rheumatoid factor (RF) were normal.
Complement levels C3 and C4 were 131 mg/dL and 45 mg/dL respectively.
Biopsy of cervical adenopathy revealed distortion of architecture, foci of fibrinoid necrosis and apoptotic remains surrounded by abundant histiocytes, compatible with histiocytic necrotizing lymphadenitis.
The symptoms resolved spontaneously in 1 month and after one year of follow-up there were no recurrences.
