{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:27:58Z","timestamp":1787120878401,"version":"build-2736575974"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>Aseptic meningitis (AM) and meningoencephalitis (ME) is a rare and under recognized complication of histiocytic necrotizing lymphadenitis (HNL) in children, with no large-scale series reported. The present study aims to characterize the clinical features of HNL-AM\/ME and improve recognition of this condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed the clinical data of children with HNL-AM\/ME admitted from January 2018 to January 2026, summarizing their clinical manifestations, laboratory findings, brain magnetic resonance imaging (MRI) findings,and treatment protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 797 children with HNL, 26 met criteria (23 AM, 3 ME), with a male-to-female ratio of 4.2:1. Median age at onset for all cases was 10.0 years (IQR, 6.8\u201312.0 years), but all ME cases were \u22646 years. All 26 presented with fever and lymphadenopathy, with a median fever duration of 26.5 days (IQR, 18.0\u201335.3 days), and only 4 (15.4%) cases defervesced before glucocorticoids, while neurological symptoms were the initial manifestation in 11 (42.3%) cases. Leukopenia was observed in 20 (76.9%) cases. Elevated serum ferritin (&amp;gt;500 \u03bcg\/L) was found in 5 (19.2%) cases. All 26 patients had cerebrospinal fluid (CSF) pleocytosis (median 57.0\/\u03bcL; range 16\u2013529\/\u03bcL). Elevated CSF pressure (220\u2013280 mmH\n                      <jats:sub>2<\/jats:sub>\n                      O) was noted in 10 children, and CSF protein was increased in 12 children. Nine (30.8%) cases exhibited linear hyperintense signals along segments of the cerebral sulci on fluid-attenuated inversion recovery (FLAIR) sequences. Only 5 patients underwent gadolinium-enhanced brain MRI, with 3 showing leptomeningeal enhancement (LME). A total of 24 cases (92.3%) received glucocorticoid treatment, 7 cases (26.9%) were combined with IVIG, and 3 ME children received immune enhancement treatment. Recurrence occurred in 8.3% (2\/24) of glucocorticoid-treated patients, whereas both untreated patients relapsed. Of the 3 ME children, 2 developed epilepsy, and 1 concurrently developed macrophage activation syndrome (MAS).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HNL-AM\/ME predominantly affects school-aged boys. Typical features include recurrent fever, headache, leukopenia, CSF pleocytosis, linear sulcal FLAIR hyperintensity, LME, poor response to anti-infective therapy, and favorable response to glucocorticoids. Younger children (&amp;lt;6 years) with markedly elevated ferritin, and brain parenchymal involvement, may have a higher risk of severe disease. Early diagnosis and glucocorticoid therapy improve prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1893986","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:47:57Z","timestamp":1787118477000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Aseptic meningitis and meningoencephalitis associated with pediatric histiocytic necrotizing lymphadenitis: a 26-case series"],"prefix":"10.3389","volume":"17","author":[{"given":"Fang","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Infections Disease, Hebei Provincial Clinical Research Center for Child Health and Disease","place":["Shijiazhuang, Hebei, China"]},{"name":"Department of Infectious Disease, Hebei Children\u2019s Hospital","place":["Shijiazhuang, Hebei, China"]},{"name":"Hebei Provincial Key Laboratory of Pediatric Cardiovascular Disease","place":["Shijiazhuang, 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Research Center for Child Health and Disease","place":["Shijiazhuang, Hebei, China"]},{"name":"Department of Infectious Disease, Hebei Children\u2019s Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Infections Disease, Hebei Provincial Clinical Research Center for Child Health and Disease","place":["Shijiazhuang, Hebei, China"]},{"name":"Department of Infectious Disease, Hebei Children\u2019s Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"B1","article-title":"Lymphadenitis showing focal reticular cell hyperplasia with nuclear debris and phagocytes","volume":"35","author":"Kikuchi","year":"1972","journal-title":"Acta Haematologica 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