Infection and Drug Resistance (Mar 2022)

Histiocytic Necrotizing Lymphadenitis with Cupriavidus Pauculus Infection in a Patient with Graves Hyperthyroidism: A Case Report

  • Tian S,
  • Zhu B,
  • Tian Y,
  • Li J,
  • Peng C

Journal volume & issue
Vol. Volume 15
pp. 1019 – 1025

Abstract

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Shan Tian,1,* Bin Zhu,1,* Youyou Tian,2 Junyuan Li,1 Cheng Peng1 1Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, People’s Republic of China; 2Department of Infectious Diseases, Taihe Hospital, Hubei Medical University, Shiyan, 442000, Hubei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cheng Peng, Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei, People’s Republic of China, Email [email protected]: Histiocytic necrotizing lymphadenitis (HNL) is a self-limiting inflammatory disease presenting with fever and cervical lymphadenopathy. However, no case of HNL with confirmed bacterial infection has been reported. A 38-year-old man was admitted to our hospital owing to an intermittent fever from 8 days. He was diagnosed with Graves hyperthyroidism 3 months prior and began taking methimazole tablets orally. Physical examination revealed superficial lymphadenopathy and goiter of the thyroid (grade II). Blood routine showed a decrease in peripheral blood cells, including significant reduction in leukocytes and platelets. A bone marrow culture identified a very rare pathogen, Cupriavidus pauculus, but the antibiotic effect of meropenem was unsatisfactory. Biopsy of the left cervical lymph node revealed HNL, and the patient had no fever after using glucocorticoids. This case report indicates that clinicians should be aware of the coexistence of HNL and bacterial infections, especially in patients with Graves hyperthyroidism.Keywords: histiocytic necrotizing lymphadenitis, leucopenia, Graves hyperthyroidism, Cupriavidus pauculus, glucocorticoid

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