Q. My daughter has swollen lymph nodes and positive ANA. Please provide opinion.

Answered by
Dr. Naval Mendiratta
and medically reviewed by iCliniq medical review team.
Published on Feb 16, 2018

Hello doctor,

My daughter, 15 years, has swollen lymph nodes. Biopsy done. It is non-malignant. No TB. But ANA has come positive. I would like to share the reports and take your opinion.

Dr. Naval Mendiratta

Rheumatology
#

Hello,

Welcome to icliniq.com.

There is a possibility of autoimmune disorder with underlying ANA and large lymph nodes. It is a good thing the malignancy is ruled out. But I would like to see the detailed biopsy report as well to be sure where we are heading.

As for ANA positive, I would like to know if she has any other symptoms as well:

  1. Any history of oral ulcers?
  2. Any history of hair fall?
  3. Any rashes over the body which get worse on sun exposure?
  4. Any joint pains or muscle aches?

What about the routine blood tests like CBC, liver function, kidney function, and ESR?

We need to put it all together before starting her on treatment. Her ENA shows only one antibody which may not be very specific to her symptoms.Do let me know these queries.

Revert with more information to a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

Hello doctor,

There are absolutely no symptoms of all the above. Yes, she has a very bad dandruff for which she has small pimples on the forehead and back and neck. Also, would like to share that the ANA report did come negative with ELISA method.

Dr. Naval Mendiratta

Rheumatology
#

Hello,

Welcome back to icliniq.com.

Well, the biopsy does point towards autoimmune disease. Kikuchi in itself is a problem of lymph nodes enlargement which usually accompanies lupus. But with so much necrosis, we cannot rule out tuberculosis even though AFB stain is negative.

So my next investigation will be to look at all other sites of lymph nodes as well. That would involve screening of chest and abdomen. If we have generalized lymphadenopathy with similar findings it is worth giving a short course of steroids. But if it is only these nodes, I would prefer giving a course of antitubercular treatment considering the high prevalence in our country. As for ANA IFA method is more specific than ELISA. And also one more antibody was positive. So we just have to keep a watch for any new symptoms and repeat it again after three months Hope the information was useful.

For further queries consult a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

Thank you doctor,

I missed sending one point yesterday. Her WBC count is 3590, platelet count 1.4. Enclosed is the CBP report and FNAC done earlier and one more which may help. Just FYI that X-ray of chest and the ultrasound has all come normal.

Dr. Naval Mendiratta

Rheumatology
#

Hello,

Welcome back to icliniq.com.

This does go in favor of lupus. Low leukocyte count and platelet along with ANA positive and Kikuchi's lymph nodes. We have enough evidence to start treatment. I am advising few more tests to point us more towards connective tissue disease.

  1. Complement C3 C4.
  2. Lupus anticoagulant.
  3. Coomb's test direct and indirect.
  4. LDH (lactate dehydrogenase).
  5. Reticulocyte count.

Do let me know for more queries. Regards.

For more information consult a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

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