Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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November 2, 2015
Kikuchi Disease (Histiocytic Necrotizing Lymphadenitis)
- Background: The disease is rare and of unknown etiology, with proposed infectious and inflammatory etiologies. It is a benign, self-limiting cause of cervical lymphadenopathy.
- Clinical Information: The disease usually occurs in patients younger than 35, with a female predominance, and more commonly in Asian populations. Symptoms include mild fever and night sweats and, less frequently, gastrointestinal symptoms. Many have extracervical lymphadenopathy, constitutional or gastrointestinal symptoms, and mild leukopenia.
- Key Diagnostic Features:
- Unilateral or asymmetrical lymph node enlargement, perinodal inflammatory changes
- Vast majority of nodes < 2.5cm in diameter
- Usually homogeneous in attenuation but can have evidence of necrosis
- Can appear similar to lymphoma; however, involved lymph nodes in Kikuchi disease will be slightly enlarged, whereas lymph nodes are moderate to markedly enlarged in lymphoma.
- Biopsy findings reveal karyorrhectic nuclear debris admixed with mononuclear cells and histiocytes, virtually absent of neutrophils.
- DDx:
- Lymphoma
- Metastasis
- Tuberculosis
- Treatment Options: Most cases resolve or improve within 1–8 months without medical treatment. Supportive therapy such as NSAIDs and, in severe cases, corticosteroids can be used to treat symptoms. It is important to consider Kikuchi disease in the differential to avoid unnecessary treatments.
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