HomeAnswersRheumatologylymphadenopathyWhy swollen nodes in my daughter with a non-malignant biopsy?

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

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Published At February 16, 2018
Reviewed AtDecember 26, 2023

Patient's Query

Hello doctor,

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

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:

Any history of oral ulcers?

Any history of hair fall?

Any rashes over the body which get worse on sun exposure?

Any joint pains or muscle aches?

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

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

Thank you.

Patient's Query

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.

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.

Patient's Query

Hello 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 for your information that X-ray of chest and the ultrasound has all come normal.

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.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Naval Mendiratta
Dr. Naval Mendiratta

Rheumatology

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