![]() ![]() Patients with Kikuchi disease have been misdiagnosed as having lymphoma and treated with cytotoxic agents when physicians are unfamiliar with this entity. This vignette highlights the importance of recognizing Kikuchi disease as a possibility and the necessity of lymph node biopsy. Along with the severity of symptoms seen here, rarer still is KFD in the African-American population. This rather uncommon case of generalized lymphadenopathy, B symptoms, and the pancytopenia even led to a bone marrow biopsy which was negative for malignancy. Treatment is symptom management, and the recurrence rate is low.Ĭonclusions: Constitutional “B symptoms” of fever, night sweats, and weight loss suggest a differential of malignancies, inflammatory disorders and infections. ANA should be performed and lupus needs to be excluded by criteria. Although KFD is found in all racial and ethnic groups, most of the cases are from East Asia and predominantly affects females under the age of 30. Immune response of T-cells and histiocytes to an infectious agent or an autoimmune process is suspected. ![]() This showed necrosis and histiocytic infiltrate but no features of malignancy.ĭiscussion: Kikuchi-Fujimoto’s disease (KFD), or histiocytic necrotizing lymphadenitis, tends to be a benign, self-limiting disease of unclear etiology. Certain that the finding would be lymphoma, we obtained an excisional lymph node biopsy. ![]() PET scan revealed extensive hypermetabolic lymphadenopathy with splenomegaly and increased splenic uptake. Created for people with ongoing healthcare needs but benefits everyone. Infectious work-up (influenza, EBV, CMV, toxoplasma, and Bartonella titers, HIV, hepatitis panel, RPR, PPD, urine and blood cultures) as well as ANA and rheumatoid factor were negative. Doubt it: When lymph nodes become reactive they generally enlarge from pea/peanut sized to noticeably larger within days. On laboratory evaluation, her complete blood count was consistent with pancytopenia, and transiently reached levels that required neutropenic precautions. Nodal classification is critical for staging tumor extent 618.Lymph nodes of the neck may be divided into 10 major groups 718. Her abdomen was tender over the lower quadrants with mild splenomegaly. The location of the various lymph node groups of the neck is most succinctly understood using a simplification of the Rouviere classification. Shotty submandibular, submental, axillary, and inguinal lymph nodes were also noted. On exam, she was febrile with visibly bulky cervical lymphadenopathy that was tender to palpation. Case Presentation: A 23-year-old previously healthy African-American female presented with one month history of progressive symptoms: first fever, night sweats, sore throat, malaise and body aches then poor oral intake, severe fatigue, lower abdominal pain and cramping with 10-15 pounds of weight loss and finally intermittent pressure-like chest pain, worsening neck pain, nausea and vomiting. ![]()
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