DOCSLIB.ORG

Kikuchi's Disease of the Mesenteric Lymph Nodes Presenting As Acute

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Kikuchi's Disease of the Mesenteric Lymph Nodes Presenting As Acute The Korean Journal of Pathology 2007; 41: 44-6 Kikuchi’s Disease of the Mesenteric Lymph Nodes Presenting as Acute Appendicitis Kyueng-Whan Min∙Ki-Seok Jang Kikuchi’s disease is a benign self-limiting necrotizing lymphadenitis that occurs most commonly Si-Hyong Jang∙Young Soo Song in young women, and is usually found in the cervical lymph nodes. When there is an unusual Woong Na∙Soon-Young Song1 location of involved lymph nodes, the diagnosis can be difficult. We recently treated a patient Seung Sam Paik with Kikuchi’s disease who had ileocecal mesenteric lymph node involvement; the patient pre- sented with symptoms of acute appendicitis in an 11-year old boy. Although mesenteric lymph node involvement of Kikuchi’s disease is very rare, Kikuchi’s disease should be added to the Departments of Pathology and differential diagnosis of acute appendicitis in patients with enlarged ileocecal mesenteric lymph 1Diagnostic Radiology, Hanyang nodes on radiological evaluation. University College of Medicine, Seoul, Korea Received : May 29, 2006 Accepted : August 11, 2006 Corresponding Author Seung Sam Paik, M.D. Department of Pathology, College of Medicine, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea Tel: 02-2290-8252 Fax: 02-2296-7502 E-mail: [email protected] Key Words : Kikuchi’s disease; Mesentery; Lymph node; Appendicitis Kikuchi’s disease was first described by Kikuchi1 and Fuji- local clinic. The patient presented with nausea and had vomit- moto et al.2 in 1972. They reported the distinctive histological ed seven times in two days. Fever (39.2℃) and right lower abdo- appearance of the lymph nodes in descriptive terms such as ‘‘lym- minal pain developed one day prior to presentation. The past phadenitis showing focal reticulum cell hyperplasia with nuclear history showed bilateral tonsillectomy due to reactive follicular debris and phagocytosis’’ and ‘‘cervical subacute necrotizing lym- hyperplasia two years ago. Physical examination revealed rebound phadenitis’’. This disorder is usually found in the cervical lymph tenderness in the right lower quadrant of the abdomen. Serum nodes, less frequently in the axillary nodes and rarely presents electrolytes, liver function tests and routine urine analysis were as a generalized lymphadenopathy.3-5 Kikuchi’s disease localized within normal limits. C-reactive protein and erythrocyte sedimen- to the mesenteric lymph nodes is extremely unusual. Only a few tation rate were elevated (2.52 mg/dL, 16 mm/h). The leuko- reports have been previously described in the medical literature.3,6-10 cyte count was elevated at 13,000/ L with 85% of neutrophils. Here we report an additional case of Kikuchi’s disease with ileo- Serologic and microbiologic tests for tuberculosis, systemic lupus cecal mesenteric lymph node involvement that clinically present- erythematosus (SLE), Yersinia infection, cat scratch disease, Tox- ed as acute appendicitis. oplasma lymphadenitis and infectious mononucleosis were not performed. The abdominal plain radiograph was unremarkable. The abdominal computerized tomography showed suspicious CASE REPORT features for acute appendicitis with multiple enlarged mesenteric lymph nodes around the ileocecal area (Fig. 1). With the impres- An 11-year-old boy was transferred to our hospital with the sion of acute appendicitis, the patient underwent laparotomy via impression of acute appendicitis based on the findings of the right oblique skin incision. A normal appearing appendix was 44 Kikuchi’s Disease in Mesenteric Lymph Nodes 45 Fig. 1. An axial scan of contrast-enhanced abdominal CT reveal- Fig. 2. The lymph node showed the characteristic histologic features ed multiple homogeneously enhanced mesenteric lymph nodes of Kikuchi’s disease including marked proliferation of histiocytes, (arrows) at ileocecal area. necrosis with extensive karyorrhexis, and marked phagocytic activity (inset). located at the antececal area. Several enlarged ileocecal lymph nodes were present. The ileocecal mesentery showed mild con- exclude either the clinical diagnosis of tuberculosis or lymphoma.7 gestion. Appendectomy and excision of a mesenteric lymph node The mean age of patients with mesenteric Kikuchi’s disease in were performed. On gross examination, the appendix was unre- previously reported cases was 21.8 years (range, 12-29 years). markable. The mesenteric lymph node was enlarged and mea- Our case was an 11-year-old boy. sured 1 cm in diameter. On microscopic examination, the lymph The histological features of Kikuchi’s disease are characteris- node showed the histological features of Kikuchi’s necrotizing tic. The involved lymph nodes have patchy necrotizing features lymphadenitis including patchy necrotic lesions localized to the localized mainly to the paracortical areas. The necrotizing areas paracortical areas, marked proliferation of benign histiocytes with show eosinophilic fibrinoid material associated with a striking crescent or C-shaped form, necrosis with extensive karyorrhexis, degree of karyorrhexis. Fragments of nuclear debris are distribut- marked phagocytic activity and mild perinodular polymorphous ed irregularly throughout areas of necrosis associated with the infiltrates (Fig. 2). Evaluation with periodic acid-Schiff and sil- presence of apparently atypical mononuclear cells. There is a mix- ver stains, to rule out fungal infection, were negative. The appen- ture in variable proportions of benign histiocytes (so-called cres- dix was well preserved without evidence of acute inflammation. cent or C-shaped forms), immunoblasts, plasmacytoid monocytes, Recovery was uneventful and the patient was discharged three and small lymphocytes. Granulocytes are absent and plasma cells days after surgery. are rare or absent. The capsule is intact and the perinodal adipose tissue may contain a polymorphous infiltrate.4,5,8,11 The histolog- ical findings in our case were consistent with the characteristics DISCUSSION of Kikuchi’s disease. The main differential diagnosis includes several necrotizing Kikuchi’s disease (Necrotizing lymphadenitis) is a well doc- lesions associated with SLE, Yersinia infection, cat scratch dis- umented, benign self-limiting condition that usually presents ease, Toxoplasma lymphadenitis and infectious mononucleosis. with cervical lymphadenopathy and often with a fever of unknown The histological features of SLE include a prominent infiltration origin.1,6,8 The etiology of Kikuchi’s disease remains unknown. of plasma cells, the presence of hematoxyphilic bodies aggregated Although there is no proven etiological agent to date, virus, Tox- toward the edges of the acellular necrotizing areas and the depo- oplasma or Yersinia are currently favored possibilities.5-7 sition of DNA on the vessel walls. In our case, infiltration of The disease occurs much more commonly in young women plasma cells and hematoxyphilic bodies were not present and than men, with most patients being under the age of 40 years.3,5 the blood vessels were unremarkable. A Yersinia infection is char- The classical presentation is one of painful tender cervical lym- acterized by the presence of microabscesses with polymorphonu- phadenopathy associated with pyrexia and frequently arthralgia clear leukocytes localized to germinal centers and aggregates of and rash. The diagnosis is usually made by excision biopsy to epithelioid histiocytes producing a granulomatous reaction. In 46 Kyueng-Whan Min Ki-Seok Jang Si-Hyong Jang, et al. cat-scratch disease, the most characteristic finding is that of stel- remely rare, Kikuchi’s disease with involvement of the ileocecal late microabscesses containing numerous granulocytes surrounded mesenteric lymph nodes should be considered in the differential by pallisading histiocytes. The histological findings of Toxoplas- diagnosis of acute abdominal pain mimicking acute appendicitis. ma lymphadenitis are characterized by florid follicular hyperpla- sia and clusters of epithelioid histiocytes in close proximity or infiltrating reactive germinal centers of follicles, and prominent REFERENCES monocytoid B-cell proliferation within sinuses. Infectious mono- nucleosis shows prominent follicular hyperplasia and a florid 1. Kikuchi M. Lymphadenitis showing focal reticulum cell hyperpla- immunoblastic proliferation in the interfollicular areas.4,11 In our sia with nuclear debris and phagocytes. A clinicopathological study. case, the features of granulomatous inflammation and neutro- Nippon Ketsueki Gakkai Zasshi (Acta Haematol Jpn) 1972; 35: 379- philic infiltration to form an abscess or follicular hyperplasia were 80. not present. 2. Fujimoto Y, Kozima Y, Yamaguchi K. Cervical subacute necrotizing An unusual location of lymph node involvement can make the lymphadenitis. A new clinicopathologic entity. Naika 1972; 30: 920-7. diagnosis of Kikuchi’s disease difficult. Kikuchi’s disease usually 3. Rudniki C, Kessler E, Zarfati M, Turani H, Bar-Ziv Y, Zahavi I. Ki- presents as solitary or multiple enlarged cervical lymph nodes kuchi’s necrotizing lymphadenitis: a cause of fever of unknown ori- and only rarely with generalized lymphadenopathy.3-5,8 Rare sites gin and splenomegaly. Acta Haemat 1988; 79: 99-102. of extracervical lymphadenopathy include axillary, supraclavic- 4. Dorfman RF, Berry GJ. Kikuchi’s histiocytic necrotizing lymphadeni- ular, mediastinal, inguinal, intraparotidal, iliac, celiac, and peri- tis: an analysis of 108 cases with emphasis on differential diagnosis. pancreatic.4 However, localization of Kikuchi’s disease to the Semin
Load more

Recommended publications
  • Kikuchi Disease with Generalized Lymph Node, Spleen And
    Case Report Mol Imaging Radionucl Ther 2016;25:102-106 DOI:10.4274/mirt.25338 Kikuchi Disease with Generalized Lymph Node, Spleen and Subcutaneous Involvement Detected by Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Flor-18-Florodeoksiglukoz Pozitron Emisyon Tomografisi/Bilgisayarlı Tomografi ile Saptanan Yaygın Lenf Nodu, Dalak ve Deri Altı Tutulumu Olan Kikuchi Hastalığı Alshaima Alshammari1, Evangelia Skoura2, Nafisa Kazem1, Rasha Ashkanani1 1Mubarak Al Kabeer Hospital, Clinic of Nuclear Medicine, Jabriya, Kuwait 2University College London Hospital, Clinic of Nuclear Medicine, London, United Kingdom Abstract Kikuchi-Fujimoto disease, known as Kikuchi disease, is a rare benign and self-limiting disorder that typically affects the regional cervical lymph nodes. Generalized lymphadenopathy and extranodal involvement are rare. We report a rare case of a 19-year- old female with a history of persistent fever, nausea, and debilitating malaise. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed multiple hypermetabolic generalized lymph nodes in the cervical, mediastinum, axillary, abdomen and pelvic regions with diffuse spleen, diffuse thyroid gland, and focal parotid involvement, bilaterally. In addition, subcutaneous lesions were noted in the left upper paraspinal and occipital regions. An excisional lymph node biopsy guided by 18F-FDG PET/CT revealed the patient’s diagnosis as Kikuchi syndrome. Keywords: Kikuchi-Fujimoto disease, histiocytic necrotizing lymphadenitis, fluorine-18-fluorodeoxyglucose Öz Kikuchi hastalığı olarak bilinen Kikuchi-Fujimoto hastalığı, genellikle bölgesel servikal lenf düğümlerini etkileyen, nadir görülen benign ve kendini sınırlayıcı bir hastalıktır. Yaygın lenfadenopati ve ekstranodal tutulum nadirdir. Bu yazıda sürekli ateş, bulantı ve halsizlik şikayetleri olan 19 yaşında bir kadın hasta sunulmaktadır.
    [Show full text]
  • Focus: Blood Cancer
    JAN-MAR 17 www.singhealth.com.sg A SingHealth Newsletter for Medical Practitioners MCI (P) 027/11/2016 FOCUS: BLOOD CANCER Haematologic Emergencies An Overview of in the General Practice Myeloproliferative Neoplasms When to Suspect Approach to an Adult with Myeloma in Primary Care Lymphadenopathy in Primary Care SingHealth Duke-NUS Academic Medical Centre • Singapore General Hospital • KK Women’s and Children’s Hospital • Sengkang Health • National Cancer Centre Singapore • National Dental Centre of Singapore • National Heart Centre Singapore • National Neuroscience Institute • Singapore National Eye Centre • SingHealth Polyclinics • Bright Vision Hospital Medical Appointments: 6321 4402 (SGH) Focus: Update Blood Cancer 6436 8288 (NCCS) Haematologic Emergencies in the General Practice Adj Assoc Prof Wong Gee Chuan, Senior Consultant, Department of Haematology, Singapore General Hospital; SingHealth Duke-NUS Blood Cancer Centre Patients with malignant haematological diseases may present with dramatic and life-threaten- ing complications. General physicians must be able to recognise these conditions as prompt treatment can be life-saving. Hyperleukocytosis and leukostasis and febrile neutropaenia in patients with haematologic malignancies are two such conditions highlighted in this article. mental state and unsteadiness in gait. patient presents with a high white cell HYPERLEUKOCYTOSIS AND There is also increased risk of intracra- count and symptoms suggestive of tis- LEUKOSTASIS IN HAEMATOLOGIC nial haemorrhage. sue hypoxia. MALIGNANCIES Besides affecting the central nervous Hyperleukocytosis has been variably system, eyes and lungs, other manifes- Leukostasis constitutes a medi- defined as a total white cell count tations include myocardial ischaemia, cal emergency. Prompt treatment (WBC) of 50 x 109/L or 100 x 109/L. Leu- limb ischaemia or bowel infarction.
    [Show full text]
  • Kikuchi–Fujimoto Disease: Lymphadenopathy in Siblings
    Practice CMAJ Cases Kikuchi–Fujimoto disease: lymphadenopathy in siblings Allison Stasiuk BSc Pharm, Susan Teschke MD, Gaynor J. Williams MD MPhil, Matthew D. Seftel MD MPH Patient 1 Key points • Kikuchi–Fujimoto disease is an uncommon and sometimes A 19-year-old Aboriginal woman presented with a three-week familial disorder that should be considered in the history of swollen neck glands, nausea, vomiting, chills and differential diagnosis of cervical lymphadenopathy. weight loss. On examination, she had bilateral, nontender, dif- • Typical presentation includes fever, leukopenia and fuse cervical lymphadenopathy. Oral examination revealed cervical lymphadenopathy. extensive dental caries and periodontal disease. The results of • Although Kikuchi–Fujimoto disease is self-limiting and no her laboratory workup are shown in Table 1. Both a lymph definitive treatment exists, lymph node biopsy is required node aspiration and a bone marrow biopsy were nondiagnostic. to rule out malignancy. The patient was scheduled for a surgical lymph node biopsy, • Patients should be followed closely because of increased but when she was seen one month later, the lymphadenopathy risk for recurrence and for systemic lupus erythematosus. had resolved spontaneously. Based on these findings, she was diagnosed with Kikuchi–Fujimoto disease. At follow-up a year and a half later, she had no evidence of recurrence. of a cervical lymph node in the first sister was nondiagnostic. In the second sister, an excisional biopsy showed geographic areas Patient 2 of necrosis containing apoptotic bodies and a striking degree of karyorrhexis with nuclear debris (Figure 1). Cells within the Two years after the initial presentation of the first patient, her 19- areas of necrosis were highly proliferative; more than 60% of year-old younger sister was assessed for a three-week history of the cells tested positive for the Ki-67 proliferation marker.
    [Show full text]
  • Kikuchi's Disease with Multisystemic Involvement and Adverse Reaction to Drugs Maria L
    Kikuchi’s Disease With Multisystemic Involvement and Adverse Reaction to Drugs Maria L. Murga Sierra, MD*; Eva Vegas, MD*; Javier E. Blanco-Gonza´lez, MD*; Almudena Gonza´lez, MD‡; Pilar Martı´nez, MD‡; and Maria A. Calero, MD§ ABSTRACT. Kikuchi’s disease (KD), or histiocytic ne- 163 mg/dL. Biochemical analysis, coagulation, hepatic and renal crotizing lymphadenitis, was initially described in Japan functions, immunoglobulins, and complement count were normal in 1972. In the following years, several series of cases (Tables 1, 2). Rheumatoid factor, antinuclear antibodies, direct involving patients of different ages, races, and geo- Coombs test, and two Mantoux test results proved to be negative. graphic origins were reported, but pediatric reports have Multiple blood, urine, feces, sputum, and tissue culture results been rare. also were negative. Antibody titers against Epstein–Barr, cyto- megalovirus, hepatitis, HIV, and Parvovirus B19, and serum poly- The etiology of KD is unknown, although a viral or merase chain reaction for herpesvirus type 6 were negative as autoimmune hypothesis has been suggested. The most well, as were results of serologic tests for syphilis, Brucella, toxo- frequent clinical manifestation consists of local or gen- plasmosis, Leishmania, Rickettsia, Borrelia, and Bartonella henselae eralized adenopathy, although in some cases, it is asso- and quintana. ciated with more general symptoms, multiorganic in- Results of chest roentgenography, echocardiography, and bone volvement, and diverse analytic changes (leukopenia, scan were normal; an abdominal ultrasound examination detected elevated erythrocyte sedimentation rate, and C-reactive hepatosplenomegaly with uniform density and nephromegaly protein, as well as an increase of transaminases and se- with increased cortical echogenicity.
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2010/0210567 A1 Bevec (43) Pub
    US 2010O2.10567A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2010/0210567 A1 Bevec (43) Pub. Date: Aug. 19, 2010 (54) USE OF ATUFTSINASATHERAPEUTIC Publication Classification AGENT (51) Int. Cl. A638/07 (2006.01) (76) Inventor: Dorian Bevec, Germering (DE) C07K 5/103 (2006.01) A6IP35/00 (2006.01) Correspondence Address: A6IPL/I6 (2006.01) WINSTEAD PC A6IP3L/20 (2006.01) i. 2O1 US (52) U.S. Cl. ........................................... 514/18: 530/330 9 (US) (57) ABSTRACT (21) Appl. No.: 12/677,311 The present invention is directed to the use of the peptide compound Thr-Lys-Pro-Arg-OH as a therapeutic agent for (22) PCT Filed: Sep. 9, 2008 the prophylaxis and/or treatment of cancer, autoimmune dis eases, fibrotic diseases, inflammatory diseases, neurodegen (86). PCT No.: PCT/EP2008/007470 erative diseases, infectious diseases, lung diseases, heart and vascular diseases and metabolic diseases. Moreover the S371 (c)(1), present invention relates to pharmaceutical compositions (2), (4) Date: Mar. 10, 2010 preferably inform of a lyophilisate or liquid buffersolution or artificial mother milk formulation or mother milk substitute (30) Foreign Application Priority Data containing the peptide Thr-Lys-Pro-Arg-OH optionally together with at least one pharmaceutically acceptable car Sep. 11, 2007 (EP) .................................. O7017754.8 rier, cryoprotectant, lyoprotectant, excipient and/or diluent. US 2010/0210567 A1 Aug. 19, 2010 USE OF ATUFTSNASATHERAPEUTIC ment of Hepatitis BVirus infection, diseases caused by Hepa AGENT titis B Virus infection, acute hepatitis, chronic hepatitis, full minant liver failure, liver cirrhosis, cancer associated with Hepatitis B Virus infection. 0001. The present invention is directed to the use of the Cancer, Tumors, Proliferative Diseases, Malignancies and peptide compound Thr-Lys-Pro-Arg-OH (Tuftsin) as a thera their Metastases peutic agent for the prophylaxis and/or treatment of cancer, 0008.
    [Show full text]
  • Evaluation of Pathologic Lesions in Superficial Lymph Node Biopsies
    Sangeeta Gupta et al / International Journal of Biomedical Research 2016; 7(5): 289-294. 289 International Journal of Biomedical Research ISSN: 0976-9633 (Online); 2455-0566 (Print) Journal DOI: 10.7439/ijbr CODEN: IJBRFA Original Research Article Evaluation of pathologic lesions in superficial lymph node biopsies Vidyadhara Rani P*1, Naveen Kumar S.1 and Ravinder T2 Department of Pathology, Department of Radiology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana *Correspondence Info: Dr. Vidyadhara Rani P, Department of Pathology, Department of Radiology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India E-mail: [email protected] Abstract Introduction: Lymphadenopathy can be due to any disease process involving lymph nodes. Enlargement of lymph node is a very common clinical symptom seen in outpatient department of any hospital. Lymphadenopathy can occur at any age group and at any site of the body. Detail clinical history for signs and symptoms, size of lymph nodes, presence of generalized lymphadenopathy, and hepatosplenomegaly help to arrive at provisional diagnosis. Histopathological examination of the lymph node biopsies is a gold standard test in the distinction between reactive and malignant lymphoid proliferations as well as for detailed subtyping of lymphomas. Aim: The aim of present study is to analyze pathological spectrum of various neoplastic and non-neoplastic lesions affecting superficial lymph nodes in the neck, axilla, inguinal region and correlation with clinical findings. Materials and Methods: The present study was a retrospective study conducted in the department of Pathology, at Chalmeda Anand Rao Institute of Medical Sciences, Bommakal Karimnagar,during the period from february 2014 to march 2015.
    [Show full text]
  • INFECTIOUS DISEASES of HAITI Free
    INFECTIOUS DISEASES OF HAITI Free. Promotional use only - not for resale. Infectious Diseases of Haiti - 2010 edition Infectious Diseases of Haiti - 2010 edition Copyright © 2010 by GIDEON Informatics, Inc. All rights reserved. Published by GIDEON Informatics, Inc, Los Angeles, California, USA. www.gideononline.com Cover design by GIDEON Informatics, Inc No part of this book may be reproduced or transmitted in any form or by any means without written permission from the publisher. Contact GIDEON Informatics at [email protected]. ISBN-13: 978-1-61755-090-4 ISBN-10: 1-61755-090-6 Visit http://www.gideononline.com/ebooks/ for the up to date list of GIDEON ebooks. DISCLAIMER: Publisher assumes no liability to patients with respect to the actions of physicians, health care facilities and other users, and is not responsible for any injury, death or damage resulting from the use, misuse or interpretation of information obtained through this book. Therapeutic options listed are limited to published studies and reviews. Therapy should not be undertaken without a thorough assessment of the indications, contraindications and side effects of any prospective drug or intervention. Furthermore, the data for the book are largely derived from incidence and prevalence statistics whose accuracy will vary widely for individual diseases and countries. Changes in endemicity, incidence, and drugs of choice may occur. The list of drugs, infectious diseases and even country names will vary with time. © 2010 GIDEON Informatics, Inc. www.gideononline.com All Rights Reserved. Page 2 of 314 Free. Promotional use only - not for resale. Infectious Diseases of Haiti - 2010 edition Introduction: The GIDEON e-book series Infectious Diseases of Haiti is one in a series of GIDEON ebooks which summarize the status of individual infectious diseases, in every country of the world.
    [Show full text]
  • Pepid Pediatric Emergency Medicine Clinical Topics
    PEPID PEDIATRIC EMERGENCY MEDICINE CLINICAL TOPICS NEONATOLOGY • CEPHAL HEMATOMA • CYSTIC FIBROSIS • ABDOMINAL AND CHEST WALL • CEREBRAL PALSY • CYTOMEGALOVIRUS (CMV) DEFECTS (NEONATE AND INFANT) • CHRONIC NEONATAL LUNG • DELAYED TRANSITION • ABNORMAL HEAD SHAPE DISEASE • DRUG EXPOSED INFANT • ABO-INCOMPATIBILITY • COMNGENITAL PARVOVIRUS B 19 • ERYTHROBLASTOSIS FETALIS • ACNE - INFANTILE • CONGENITAL CANDIDIASIS • EXAMINATION OF THE NEWBORN • ALIGILLE SYNDROME • CONGENITAL CATARACTS • EXCHANGE TRANSFUSION • AMBIGUOUS GENITALIA • CONGENITAL CMV • EYE MISALIGNMENT • AMNIOTIC FLUID ASPIRATION • CONGENITAL COXSACKIEVIRUS • FETAL HYDRONEPHROSIS • ANAL ATRESIA • CONGENITAL DYSERYTHROPOIETIC • FETOMATERNAL TRANSFUSION • ANEMIA - SEVERE AT BIRTH ANEMIA • FFEDS/FLUIDS - PRETERM • ANEMIA OF PREMATURITY • CONGENITAL EMPHYSEMA • FPIES(FOOD PROTEIN INDUCED • ANHYDRAMNIOS SEQUENCE • CONGENITAL GLAUCOMA ENTEROCOLITIES SYNDROME) • APGAR SCORE • CONGENITAL GOITER • GASTRO INTESTINAL REFLUX • APNEA OF PREMATURITY • CONGENITAL HEART BLOCK • GROUP B STREPTOCOCCUS • APT TEST • CONGENITAL HEPATIC FIBROSIS • HEMORRHAGIC DISEASE OF THE • ASPHYXIATING THORACIC DYSTRO- • CONGENITAL HEPATITIS B NEWBORN PHY (JEUNE SYNDROME) INFECTION • HEPATIC RUPTURE • ATELECTASIS • CONGENITAL HEPTITIS C • HIV • ATRIAL SEPTAL DEFECTS INFECTION • HYALINE MEMBRANE DISEASE • BARLOW MANEUVER • CONGENITAL HYDROCELE • HYDROCEPHALUS • BECKWITH-WIEDEMANN SYN- • CONGENITAL HYPOMYELINATING • HYDROPS FETALIS DROME • CONGENITAL HYPOTHYROIDISM • HYPOGLYCEMIA OF INFANCY • BENIGN FAMILIAL NEONATAL
    [Show full text]
  • A Case of Kikuchi's Disease with Skin Involvement
    Korean Journal of Pediatrics Vol. 49, No. 1, 2006 □ Case Report □ 1) A case of Kikuchi's disease with skin involvement Ji Min Jang, M.D., Chul Hee Woo, M.D., Jung Woo Choi, M.D.* Dae Jin Song, M.D., Young Yoo, M.D. KwangChulLee,M.D.andChangSungSon,M.D. Department of Pediatrics and Pathology*, College of Medicine, Korea University, Seoul, Korea Histiocytic necrotizing lymphadenitis, which is also commonly referred to as Kikuchi's disease (KD), is a self-limiting disease of unknown etiology. It affects individuals of all ages, although it is usu- ally seen in young women. However, only a few descriptions of this disease are available in the pediatric literature. KD is clinically characterized by cervical lymphadenopathy, high fever, myalgia, neutropenia and, rarely, cutaneous eruptions. Cutaneous manifestations have been reported in 16-40 percent of KD cases. The specific skin changes occurring in cases of KD have yet to be completely characterized. In most of the reported cases thus far, the lesions have beenlocatedonthefaceand upper extremities. In this report, we describe a case of pediatric Kikuchi's disease, occurring in a 9- year-old boy. The boy exhibited transient erythematous maculopapular skin lesions over the entirety of his body, including his lower extremities. (Korean J Pediatr 2006;49:103-106) Key Words : Histiocytic necrotizing lymphadenitis, Kikuchi's disease, Erythematous maculopapular skin lesion tremities, and the face5-10). Here, we present a case of pedi- Introduction atric Kikuchi's disease, with erythematous maculopapular skin lesions occurring over the entirety of the patient's Kikuchi's disease (KD), also known as histiocytic nec- body, including the lower extremities.
    [Show full text]
  • Dynamic CT Findings of Bilateral Castleman Disease in the N Eck
    J Korean Radiol Soc 1997; 37 : 797 - 800 Dynamic CT Findings of Bilateral Castleman Disease in the N eck : A Case Report 1 3 2 Hyung-Jin Kim, M.D. L 2, Jae SOO Kim, M.D., Eui Gee Hwang, M.D. , Won Hong Kim, M.D. We present a case ofhyaline vascular type Castleman disease involving the bilateral cervicallymph nodes. To our knowledge, no previous case ofthis localized form ofthe disease has been reported. Dynamic CT demonstrated a hypervascular pattern of en­ hancement, with central less enhanced areas that corresponded histologically to fi­ brosis. For the diagnosis of this uncommon lymph node disease, these findings might be helpful. Index Words : Neck, CT Lymphatic system, hyperplasia Lymphatic system, neoplasms Castleman disease is an uncommon lymphoproli­ increased. Antibiotics were administered, but the ferative disorder most commonly found in the medias­ patient did not respond, and incisional biopsy tinum (1). It may, however, occur in any area where performed at that time revealed only inflammation. lymphatic tissues are found such as the lung, neck, ax­ Physical examination and laboratory tests showed no illa, mesentery, pelvis, and retroperitoneum (2 - 6). It remarkable findings except for two palpable masses on is estimated that 71 % of cases occur in the thorax and both sides of the upper cervical neck with the left one less than 10% in the neck (2, 3). Although the literature larger than the right. He denied any mass-related contains several reports of isolated cervical Castleman symptoms, and chest radiography and abdominal disease (3, 6), bilateral disease confined to the neck has ultrasonography were unremarkable.
    [Show full text]
  • Kikuchi's Disease in Asian Children Hsin-Ching Lin, Chih-Ying Su and Shun-Chen Huang Pediatrics 2005;115;E92 DOI: 10.1542/Peds.2004-0924
    Kikuchi’s Disease in Asian Children Hsin-Ching Lin, MD, FARS*; Chih-Ying Su, MD*; and Shun-Chen Huang, MD‡ ABSTRACT. Objective. Kikuchi’s disease (KD), or ABBREVIATIONS. KD, Kikuchi’s disease; SLE, systemic lupus histiocytic necrotizing lymphadenitis, is a unique form erythematous; FUO, fever of unknown origin; CT, computed to- of self-limiting lymphadenitis and typically affects the mography; ESR, erythrocyte sedimentation rate; CRP, C-reactive head and neck regions. It usually occurs in young adults protein. and has a female predilection. The aim of this study was to review the authors’ institutional experience with KD in children over a 16-year period. lthough neck masses are frequently encoun- Methods. Between January 1986 and May 2002, a total tered in the pediatric population, physicians of 23 patients who were younger than 16 years under- Awho care for a child with a cervical mass are went cervical lymph node biopsies and received a diag- often faced with a diagnostic challenge. In actual nosis of KD. Clinical features, laboratory values, patho- practice, in child cases, it may be difficult to obtain a logic parameters, specific characteristics of our pediatric clear patient history and cooperative physical exam- patients, and long-term follow-up results are discussed. ination, and there are few straightforward processes The follow-up period averaged 8 years. for evaluation of these children. Thus, a thorough Results. There were 8 girls and 15 boys with a mean age of 12.8. All 23 patients had affected cervical lymph knowledge of the clinical entities that may cause nodes located in the posterior cervical triangle, and 2 neck masses in the pediatric population and the com- cases additionally had affected nodes in the anterior prehensive elucidation of clinical characteristics that triangle.
    [Show full text]
  • Kikuchi-Fujimoto Disease: an Atypical Presentation of a Rare Disease
    Open Access Case Report DOI: 10.7759/cureus.3999 Kikuchi-Fujimoto Disease: An Atypical Presentation of a Rare Disease Amanda Moyer 1 , Muhammad Z. Hanafi 2 , Teresa Scordino 3 , Michael Bronze 4 1. Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, USA 2. Gastroenterology, University of Oklahoma Health Science Center, Oklahoma City, USA 3. Pathology, University of Oklahoma Health Sciences Center, Oklahoma City , USA 4. Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA Corresponding author: Amanda Moyer, [email protected] Abstract Kikuchi-Fujimoto disease (KFD), or necrotizing histiocytic lymphadenitis, is a rare cause of lymphadenopathy and fever. Although the clinical course is usually benign, KFD is often mistaken for malignancy or infection. Recognition of typical and atypical cases of KFD is necessary to avoid unnecessary interventions. Here we report an atypical presentation of KFD with diffuse lymphadenopathy and leukocytosis associated with high levels of circulating Epstein-Barr viral DNA. Categories: Internal Medicine, Pathology, Rheumatology Keywords: kikuchi fujimoto, lymphadenopathy, histiocytosis, lymphadenitis, epstein-barr Introduction Kikuchi-Fujimoto disease (KFD) is a benign lymphohistiocytic disorder characterized by lymphadenopathy (typically cervical), fatigue, and fever [1-2]. Additional common findings include hepatosplenomegaly, weight loss, elevated acute phase reactants, and leukopenia/lymphopenia [3]. The etiology of KFD is controversial. Some authors speculate that viral and autoimmune processes influence the development of KFD [4-5]. It generally resolves in one to four months, but has been associated with subsequent development of systemic lupus erythematous (SLE) [3, 5-6]. Excisional lymph node biopsy with hallmark findings confirms the diagnosis [7-8]. Case Presentation A 20-year-old Caucasian female was admitted with one month of cervical lymphadenopathy and two months of fever, fatigue, night sweats, and 15-pound weight loss.
    [Show full text]