Aseptic meningitis and meningoencephalitis associated with pediatric histiocytic necrotizing lymphadenitis: a 26-case series
Frontiers in Immunology·
- DOI
- 10.3389/fimmu.2026.1893986
- PMID
- —
- PMCID
- —
- OpenAlex
- W7203796023
- Study type
- Journal article
- Publisher
- Frontiers Media SA
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The findings delineate a recognizable clinical and imaging pattern for HNL-associated aseptic meningitis/meningoencephalitis in children, suggesting that younger age, markedly elevated ferritin, and brain parenchymal involvement may signal higher severity, and that early glucocorticoid therapy was associated with favorable response in this series.
Structured evidence summary
Research question
The study aimed to characterize the clinical features of aseptic meningitis and meningoencephalitis associated with pediatric histiocytic necrotizing lymphadenitis (HNL), a complication described as rare and under-recognized in children.
Study design
Retrospective single-center case series of 26 children with HNL-associated aseptic meningitis or meningoencephalitis admitted between January 2018 and January 2026, drawn from a larger cohort of 797 children with HNL.
Population and setting
Children hospitalized with histiocytic necrotizing lymphadenitis complicated by aseptic meningitis (23 cases) or meningoencephalitis (3 cases). The overall median age at onset was 10.0 years, with a male-to-female ratio of 4.2:1, and all meningoencephalitis cases were aged ≤6 years.
Main findings
All 26 patients presented with fever and lymphadenopathy, and neurological symptoms were the initial manifestation in 42.3%. Leukopenia occurred in 76.9%, and 19.2% had serum ferritin above 500 μg/L. All had CSF pleocytosis, with elevated CSF pressure in 10 children and elevated CSF protein in 12. Linear sulcal FLAIR hyperintensity was seen in 30.8%, and leptomeningeal enhancement was present in 3 of the 5 patients who underwent gadolinium-enhanced MRI. Glucocorticoids were given to 92.3%, often combined with IVIG (26.9%), and recurrence occurred in 8.3% of glucocorticoid-treated patients versus both untreated patients. Among the 3 meningoencephalitis children, 2 developed epilepsy and 1 developed macrophage activation syndrome.
Public-health relevance
The findings delineate a recognizable clinical and imaging pattern for HNL-associated aseptic meningitis/meningoencephalitis in children, suggesting that younger age, markedly elevated ferritin, and brain parenchymal involvement may signal higher severity, and that early glucocorticoid therapy was associated with favorable response in this series.
Important limitations
This is a retrospective case series from a single center with a small number of meningoencephalitis cases (n=3), and only 5 patients underwent gadolinium-enhanced MRI, limiting imaging interpretation. No explicit limitations are stated in the supplied abstract; this summary is therefore limited to the supplied single-article abstract and metadata and requires the original paper for decision-grade interpretation.
GIDS interpretation
The article is discoverable through the classifier topic 'Treatment' and disease tag 'Aseptic meningitis,' which may help contextualise the report within broader pediatric neuro-inflammatory or autoimmune-lymphadenitis literature. No connection is made to any live surveillance signal.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 6 auditable classifier relationships to diseases, places, topics, and study design.