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KMID : 0378020090520010027
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New Medical Journal
2009 Volume.52 No. 1 p.27 ~ p.33
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Clinical Features and Differential Diagnosis of Cervical Lymphadenopathy Diagnosed as Kikuchi’s Disease
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Chun Yeon-Joo
Choi Ik-Jun
Chang U-Im
Wie Seong-Heon
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Abstract
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Background: Subacute necrotizing lymphadenitis known as Kikuchi disease is a benign, self-limiting condition of unknown etiology. It presents with cervical lymphadenopathy and can be accompanied by fever and other respiratory symptoms. Kikuchi’s disease frequently mimics tuberculous lymphadenitis, malignant lymphoma, SLE and other malignant conditions. Therefore, it is important to evaluate thoroughly for possibilities of other underlying disease.
Methods: We analyzed the medical record of patients, who were diagnosed as subacute necrotizing lymphadenitis on excisional biopsy with retrospective chart review at Catholic University St Vincent’s Hospital from January 2002 to December 2006.
Results: Patients demographics revealed a mean age of 26.7(range: 16~52 years) and the male to female ratio was 1:0.91. The most common symptoms were fever, cervical lymphadenopathy, headache, night sweating, sore throat, weight loss, and skin rash. Laboratory evaluation reveals leukopenia in 81%, elevated LDH in 76.2% and elevated ferritin in 70.5% of cases. Erythrocyte sedimentation rate and c-reactive protein levels were mildly elevated. Among 21 cases of Kikuchi’s disease, 4 cases were associated with systemic diseases such as systemic lupus erythematosus (2 cases), undifferentiated connective tissue disease (1 case), and HIV infection (1 case).
Conclusions: In our study, most of patients with Kikuchi’s disease revealed laboratory findings such as leukopenia, elevated LDH, elevated ferritin and did not show a female pre- ponderance, compard to the groups with uberculous lymphadenitis and reactive hyperplasia. Several underlying diseases may be associated with Kikuchi’s disease. It is very important to differentiate between Kikuchi’s disease and other diseases, such as tuberculous lymphadenitis and connective tissue diseases, based on clinical, laboratory findings.
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KEYWORD
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Subacute necrotizing lymphadenitis, Kikuchi’s disease, Cervical lymphadenopathy, Tuberculous lymphadenitis
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