case_images: PMC9707495_01
case_images: A neck ultrasound showing an enlarged lymph node which measures 1.9 cm in transverse diameter, 0.8 cm in anteroposterior diameter and 2.2 cm in crania-caudal diameter in the right upper posterior triangle region.
case_images: fped-10-1054025-g001.jpg
case_images: PMC9707495_01_fped-10-1054025-g001.jpg
case_images: F1
case_images: The largest one measured 1.9 cm in transverse diameter, 0.8 cm in anteroposterior diameter and 2.2 cm in craniocaudal diameter in the right upper posterior triangle region (Figure 1).
case_images: (A) A hematoxylin and eosin (H&E) slide illustrating a characteristic area of necrotising histiocytic lymphadenitis: there is necrosis accompanied by histiocytes (circled in red) and significant karyorrhectic debris. (B,C) Within the necrotic area, there are crescentic histiocytes (brown-staining cells) with dual expression of MPO (usually a marker for myeloid lineage) (B, left side of the picture) and PGM1 (A histiocyte marker) (C, right side) by immunohistochemistry.
case_images: fped-10-1054025-g002.jpg
case_images: PMC9707495_01_fped-10-1054025-g002.jpg
case_images: F2
case_images: The hematoxylin and eosin (H&E) slide showed necrosis accompanied by histiocytes and significant karyorrhectic debris (Figure 2A). There were crescentic histiocytes with dual expression of MPO (usually a marker for myeloid lineage) (Figure 2B) and PGM1 (a histiocyte marker) (Figure 2C) by immunohistochemistry.
case_images: A temperature graph illustrating a remittent and intermittent fever, which persists despite a course of IV cefotaxime from day 1 to 7 of admission and IVIG on days 13 and 14. The fever settles promptly after the commencement of IV methylprednisolone on day 15 and does not recur.
case_images: fped-10-1054025-g003.jpg
case_images: PMC9707495_01_fped-10-1054025-g003.jpg
case_images: F3
case_images: The fever settled promptly after the commencement of methylprednisolone (Figure 3), and the enlarged cervical lymphadenopathy resolved in four days.
case_images: A graph illustrating the rise of predominantly ALT and AST since day 8 of admission. They show a downtrend after the commencement of IVIG on days 13 and 14 of admission. ALT elevates transiently after the commencement of methylprednisolone on day 15 before it drops again five days later. Both AST and GGT show a downtrend. ALP remains within the reference range throughout the whole of the admission.
case_images: fped-10-1054025-g004.jpg
case_images: PMC9707495_01_fped-10-1054025-g004.jpg
case_images: F4
case_images: ALT elevated transiently before it dropped again five days after methylprednisolone treatment (Figure 4).