Tuberculosis mimicking Kikuchi's disease

Kikuchi's disease is an idiopathic self-limiting necrotizing lymphadenitis. Clinically, it mimics tuberculous cervical lymphadenopathy. The disease is diagnosed by histopathologic study. The only specific treatment that has been reported is empiric steroid therapy. We report a case of tuberculosis that was originally thought to be Kikuchi's disease in a 24-year-old man. When the patient's condition worsened during a course of steroid therapy, he underwent surgical exploration, which revealed the presence of tuberculous lymphadenitis. The patient was switched to antituberculosis drug therapy, and his improvement was dramatic.     

Management of Kikuchi's disease using glucocorticoid

Histiocytic necrotizing lymphadenitis, or Kikuchi's disease, is a self-limiting cervical lymphadenitis of unknown origin. Since no specific treatment has been reported for Kikuchi's disease to date, once a diagnosis of Kikuchi's disease has been established, the role of the physician has been limited only to treating the symptoms. Sometimes, however, the clinical manifestations of the disease can be very distressing for the patients. Thus, a more aggressive form of treatment may be required for the patients who suffer from severe and persisting symptoms and recurrence. We present three cases of Kikuchi's disease that benefited significantly from systemic administration of prednisone.     

Kikuchi's disease: a case report and review of the literature

Kikuchi's disease is a necrotizing lymphadenitis that is prevalent in Asia and is being increasingly recognized in other areas of the world. It usually occurs in women in their late 20s or early 30s and manifests as a posterior cervical adenopathy. It resolves spontaneously, usually over a period of several weeks to 6 months. Its initial clinical appearance is commonly similar to that of a lymphoma, and it can be pathologically misdiagnosed as such. Kikuchi's disease might be associated with systemic lupus erythematosus. We report a case of Kikuchi's disease that occurred in a 36-year-old Asian woman. We discuss the clinical features, differential diagnosis, radiographic evaluation, and pathology of this case, and we review the literature in an effort to assist otolaryngologists in diagnosing this benign and uncommon entity.     

Kikuchi's necrotising lymphadenitis

Three cases of Kikuchi's necrotizing lymphadenitis without granulocytic infiltration presented to the ENT department as cervical lymphadenopathy with neutropaenia. Differential diagnosis from malignant lymphoma was difficult both clinically and histopathologically. Two recovered spontaneously without treatment within three months, one improved initially but was lost to follow-up after one month.     

Kikuchi-Fujimoto's disease: 3 cases report

OBJECTIVE: Kikuchi-Fujimoto's is a rare disease, characterized by the diversity of clinical symptoms, with predominance of enlarged cervical lymph nodes and fever. We report three cases with different presentations. MATERIAL AND METHOD: The first one was a classic form, frequently described in literature. The second was characterized by concomitant association with systemic lupus erythematosus. Histologic findings of Kikuchi's disease were the presence of nuclear debris, absence of haemathoxilin bodies and neutrophils polynuclears. The presentation of the third case was acute meningitis with cervical lymphadenopathy. Lumber puncture showed lymphocytic meningitis, mild hypoglycorrhachia and hyperproteinrrhachia. Favourable evolution was noted in all cases without recurrence. CONCLUSION: Wathever its presentation the prognosis of the Kikuchi-Fujimoto's disease is generally benign with a spontaneously favorable evolution between 1 to 6 months.     

Cervical lymphadenopathy due to mycobacterial infection: a diagnostic protocol

Mycobacterial cervical lymphadenopathy is relatively uncommon in the United Kingdom; when cases do occur opportunities for early diagnosis and treatment may be missed. We have reviewed twenty-three cases of mycobacterial cervical lymphadenopathy presenting to an urban general hospital over a four-year period. We discuss the techniques available to aid a diagnosis of mycobacterial disease and suggest a protocol to allow efficient use of these techniques.     

Kikuchi's disease as the etiology of chronic neck adenopathy

Kikuchi's disease, a rare cause of chronic cervical adenopathy, does not have specific clinical signs. There is a general deterioration in the condition of the patient accompanied by cervical adenopathy. The diagnosis is made histologically by the recognition of histiocytic necrotizing lymphadenitis. The prognosis is usually favorable with spontaneous resolution within a few weeks to a few months.     

Histiocytic necrotizing lymphadenitis (Kikuchi's disease)

Histiocytic necrotizing lymphandenitis (HNL), or Kikuchi's disease, is a newly recognized disease of unknown origin that causes cervical lymphadenitis, usually in young women. Initially described in Japan, cases of HNL are being reported in the United States and other western countries with increasing frequency. Symptoms of HNL include tender cervical adenopathy, fever, weight loss, and night sweats. Laboratory studies reveal leukopenia with relative granulocytopenia and lymphocytosis. Lymph node biopsy reveals areas with frank cellular necrosis, karyorrhexis, and absence of plasma cells. The histologic features of HNL are distinctive but can be confused with those of lymphoma. We describe two cases of HNL and present recommendations for diagnosis and treatment.     

A case of cervical progressive transformation of germinal center

Progressive transformation of the germinal center is an unexplained borderline disease that presents as lymphadenopathy. The histological feature is an abnormally enlarged germinal center. Reports of this disease in otolaryngology are rare. A case of progressive transformation of the germinal center occurring in the bilateral multiple submandibular lymph nodes with swelling is presented. A 41-year-old man complained of bilateral painless cervical lymphadenopathy. Because fine needle cytology of the lymph nodes did not reveal any atypical cells, medical observation was performed. However, as the patient suffered from hoarseness, he consulted our hospital again. An otolaryngeal examination revealed mild enlarged bilateral lymphadenopathy. Removal of these lymph nodes to obtain a definitive diagnosis was performed. The pathological diagnosis was progressive transformation of the germinal center (PTGC). Immunostaining of the lymph nodes showed increased IgG4+cells (IgG4/IgG ratio=50%). To date, no significant changes in the cervical lymph nodes have been noted on follow-up. Because PTGC is apt to be misdiagnosed as Hodgkin's lymphoma, otolaryngologists should have full knowledge of PTGC.     

Kikuchi-Fujimoto's syndrome masquerading as tuberculosis.

We report a case of a 27-year-old Asian man presenting with the typical features of tuberculous cervical lymphadenitis who was commenced on anti-tuberculous therapy on the strength of the clinical presentation. Histological examination of an excised cervical lymph node however, revealed the diagnosis of Kikuchi's syndrome; a histiocytic necrotizing lymphadenitis which is usually self-limiting.     

Necrotizing lymphadenitis (Kikuchi-Fujimoto disease) as a rare cause of cervical lymphadenopathies. Diagnosis and differential diagnosis

BACKGROUND: The ENT specialist is often confronted with the inquiry as to the cause of lymph node enlargements. Common causes include inflammations, neoplastic, or autoimmune diseases. We report on three cases of Kikuchi-Fujimoto disease as a benign self-limiting lymphadenopathy of unknown etiology, which is usually found in young women between 20 and 30 years of age. Main symptoms are indolent or light tender, enlarged lymph nodes in the neck area. The correct diagnosis requires the histologic examination of the lymph node. Even for the experienced pathologist the differential diagnosis of malignant systemic disorders can be difficult. PATIENTS: Three female patients suffering from Kikuchi-Fujimoto disease were treated in our department between September 1997 and March 1998. RESULTS: All patients showed indolent and enlarged lymph nodes in the neck. In one case we were able to diagnose an acute cytomegalovirus infection; in another case an acute Epstein-Barr virus infection. After 3-5 months the symptoms disappeared spontaneously in all patients. In two of the three cases, histologic lymph node examination revealed T-cell lymphoma and Hodgkin's disease and in one case led to initial chemotherapeutic treatment. As a result of a second histologic examination, both diagnoses were reviewed and Kikuchi-Fujimoto disease was diagnosed. Chemotherapy was discontinued. CONCLUSIONS: Kikuchi-Fujimoto disease is a benign, self-limiting lymphadenopathy which is usually diagnosed in young women. Distinguishing Kikuchi-Fujimoto disease from malignant systemic disorders may even be difficult for pathologists using histological examination techniques and requires close cooperation between the ENT specialist and the pathologist. In order to minimize the risk of misdiagnosis and incorrect treatment, the ENT specialist should inform the pathologist about the differential diagnosis of Kikuchi-Fujimoto disease in such cases.     

Kikuchi's Disease: Report of Three Cases and an Overview

We describe, to our knowledge, the first native Finnish patients with Kikuchi's histiocytic necrotizing lymphadenitis. The diagnosis was based in all cases on histopathological findings in openbiopsy. The disease was first detected in Japan in 1972, but in Scandinavia, until this decade, there had been no cases reported. Our patients were young, otherwise healthy women who had cervical lymphadenopathy, fever, and fatigue as their main symptoms. In two of them, the disease was mild and subsided spontaneously within 2-6 months. One patient with more fulminant lymphadenopathy was treated with antimicrobial and antiinflammatory drugs. She became symptomless in 3 months. The cause of Kikuchi's disease is unknown. A viral or postviral hyperimmune reaction has been proposed as its etiology. Malignant lymphoma and systemic lupus erythematosus are differential diagnoses. Histopathological findings are pathognomonic and pathologists must be aware of its typical characteristics.     

Mucocutaneous lymph node syndrome mimicking acute coalescent mastoiditis

Mucocutaneous lymph node syndrome (Kawasaki's disease) is an acute febrile, exanthomatous illness in which massive lymphadenopathy may occur in the cervical area. This lymphadenopathy may mimic other conditions and present a diagnostic dilemma. We present a case report of a child whose initial clinical signs, symptoms, and laboratory findings were compatible with acute coalescent mastoiditis; however, the child was found after close observation to have Kawasaki's disease. The case demonstrates the similarity between the two diseases and how close observation can prevent unnecessary surgery. When considering the rare diagnosis of mastoiditis, other entities need to be considered in the differential diagnosis before surgical intervention is undertaken. If the patient is unstable or a threatened complication of mastoiditis is apparent, however, immediate mastoidectomy is required.     

Cat scratch disease: an unusual cause of acute parotid pain (a case report with a literature review)

CSD is a well recognised cause of cervical lymphadenopathy, and parotid involvement occurs in 3 per cent of cases. Parotid lymphadenopathy is usually asymptomatic or tender but acute parotid pain treated successfully by surgery is previously undescribed. In our case excision of the primary lesion with parotid biopsy provided an immediate diagnosis and decompression of the parotid capsule resulted in dramatic relief of the patient's pain. We would therefore recommend that, in all cases of obscure cervical lymphadenopathy, CSD should be considered and a documentation of domestic pets actively sought. We would also advise that in those cases of parotid CSD in which either the diagnosis is equivocal, CS antigen is unavailable or intense parotid pain is a predominant feature, excision of the primary lesion together with surgical decompression of the parotid capsule should be performed.     

Sinus histiocytosis with massive lymphadenopathy (rosai-dorfman disease): Report of a case with respiratory tract involvement

The term “sinus histiocytosis with massive lymphadenopathy,” introduced in 1969 by Rosai and Dorfman, refers to a newly recognized disease entity characterized by painless cervical lymphadenopathy, fever, leukocytosis, increased erythrocyte sedimentation rate, and hypergammaglobulinemia. The typical course is one of insidious onset, protracted duration of the active disease state, and eventual spontaneous remission, occasionally with subsequent recurrences. Lymph nodes other than those in the cervical area may be involved, and extranodal involvement can occur (such as in the orbit, skin, or respiratory tract). Clinically, this entity may closely simulate malignant lymphoma or nonneoplastic conditions with lymphadenopathy. We present a case in which this disease process extensively involved the respiratory tract and produced obstructive symptoms. The otorhinolaryngologist should be aware of this disease entity and should include it in the differential diagnosis for patients with cervical lymph node enlargement or bronchial obstruction.     

Kikuchi's--a new cause of cervical lymphadenopathy

A case of Kikuchi's presenting in a young West Indian lady is recorded which typifies this rare condition. This histological features have been discussed and differential diagnosis outlined.     

Epstein-Barr virus infection as a cause of cervical lymphadenopathy in children

Objective

Cervical lymphadenopathy is a common pediatric problem; reactive hyperplasia, specific infective agents, and malignancy are mainly the differential diagnosis. The aim of our study was to detect the prevalence of Epstein-Barr virus infection among children who complained of cervical lymphadenopathy and also to evaluate the clinical manifestations of the disease in pediatric patients.

Methods

One hundred and sixty children presented with cervical lymphadenopathy were subjected to Epestien-Barr Virus (EBV) serology testing. Cases that showed positivity to heterophile antibody test, and/or EBV-specific antibodies; IgM against viral capsid antigen (VCA-IgM) and IgG against viral capsid antigen (VCA-IgG) were evaluated clinically for manifestations of the disease.

Results

Twenty-four cases (15%) showed positivity to EBV serology, all of them had posterior cervical lymph nodes enlargement, 70.8% had fever, 66.6% had tonsillo-pharyngitis, 58.3% had splenomegaly, 25% had hepatomegaly, 41.6% had generalized lymphadenopathy, while skin rash was detected in 12.5%, and both palatal petechiae and palpebral edema were detected in 8.3%.

Conclusions

EBV infection is not a rare cause of cervical lymphadenopathy in children. Posterior cervical lymphadenopathy in pediatric age group may represent a password for suspicion of EBV infection, while other clinical manifestations of the disease may include hepato-splenomegaly, skin rash, palpebral edema and palatal petechiae.     

Retropharyngeal abscess. A rare presentation of nasopharyngeal carcinoma.

Early symptoms of nasopharyngeal carcinoma (NPC) can often be deceptive and confusing. Most patients with nasopharyngeal carcinoma present at an advanced stage with metastatic cervical nodes present at the time of diagnosis. A deep neck abscess as the presenting feature has not been reported. We report two cases of nasopharyngeal carcinoma which presented with retropharyngeal abscesses and persistent lymphadenopathy. These two patients illustrate that refractory lymphadenopathy, despite adequate treatment of the associated infection, should prompt a search for underlying disease. The relationship between nasopharyngeal carcinoma and retropharyngeal abscess is discussed.     

Cat scratch disease: a diagnosis to be aware of!

Subacute cervical lymphadenopathy among young adults may be of an infectious or malignant aetiology. We report two cases of young males with chronic cervical lymphadenopathy. A diagnosis of Cat scratch disease (CSD) was made by serological and molecular studies. CSD is one of the most frequent infectious lymphadenopathies among young people. Diagnosis of CSD is dependent on clinical, epidemiological, molecular and histological criteria. The detection of antibodies to Bartonella Henselae and the amplification of its DNA by Polymerase Chain Reaction (PCR) are the two main methods of laboratory diagnosis. The evolution of CSD is usually benign; however therapeutic management remains problematic, particularly in atypical forms.     

Rosai-Dorfman disease presenting as an isolated extranodal mass of the carotid sheath: a case report

Rosai-Dorfman disease is a rare, benign granulomatous disease that typically presents with massive cervical lymphadenopathy. In less than 50% of cases, other soft-tissue manifestations may also be found in the head and neck. Rosai-Dorfman disease can be difficult to diagnose because of its rarity and its ability to mimic, both clinically and radiologically, more common diseases such as lymphoma. The histopathologic diagnosis can also be difficult to make, particularly when the disease exhibits extranodal manifestations. We present a case of isolated extranodal Rosai-Dorfman disease involving the carotid sheath, without the typical massive adenopathy.