A 13-year-old male presented to outpatient clinic with swelling right side of the neck of two months duration. There was no history of fever, malaise or weight loss. Haematological and biochemical parameters were normal. General blood picture showed hypochromic red cells, normal white cell count with occasional atypical lymphocyte and adequate platelets.
Examination revealed multiple 1x1 cm soft to firm lymph nodes in right supraclavicular, lower jugalodigestric chain and in both axilla. Left neck, other areas of right neck and inguinal areas were normal. Abdominal and per rectal examination did not reveal any abnormality. A clinical diagnosis of Hodgkin's disease was made and an excision biopsy of right supraclavicular node was performed. Microscopic examination of lymph node showed retained architecture with hyperplastic follicles having prominent germinal centres. There was marked paracortical expansion with sheets of histiocytes showing karyorrhexis, surrounding mature lymphocytes were admixed with immunoblasts. A diagnosis of necrotising histiocytic lymphadenitis was made (Figure 1 and 2). No treatment was offered to the patient in light of the diagnosis and patient was lost to follow-up.
