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Fever and cervical lymphadenopathy in a young female; thinking beyond tuberculosis.

Khadanga S, Sen R, Thatoi PK, Mohanty R, Mishra KB, Karuna T - J Glob Infect Dis (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, LN Medical College, Bhopal, Madhya Pradesh, India.

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Sir, A 28-year-old female presented with bilateral multiple cervical lymphadenopathy and fever for 6 weeks [Figure 1]... Excision biopsy of one of the lymphnode showed histiocytic necrotizing lymphadenitis of Kikuchi's disease [Figure 2]... The patient was treated with indomethacin 75 mg bid... As the lymphadenopathy did not resolve after 2 weeks, we added oral prednisolone (0.5 mg/kg) for a period of 4 weeks, which was tapered over the next 4 weeks... There have also been reports of a possible link with autoimmune disorders like systemic lupus erythematosus (SLE) and autoimmune thyroiditis... The classical clinical features of sub-acute fever with unilateral, discrete, and tender regional lymphadenopathy have often been confused with tuberculosis, SLE and lymphoma... SLE lymphadenitis demonstrates degenerated nuclear material in walls of blood vessels, abundant plasma cells and pericapsular inflammation... The large cells observed in Kikuchi's disease are positive for CD68, MPO, and Ki-M1P1, while they are negative for CD3, CD15, CD20, CD30 or mucin, which excludes the possibility of lymphomas... The disease is self-limiting and treatment is supportive with nonsteroidal anti-inflammatory drugs... Corticosteroids, hydroxychloroquine, methotrexate, and intravenous immunoglobulin have been used for severe cases... It usually resolves in several weeks to months with a 1-year recurrence rate of 3-4%... We report this case for the clinicians to prevent misdiagnosis and inappropriate treatment of Kikuchi's disease especially in tubercular endemic areas and for some of its atypical features.

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(H and E, ×100) showing histiocytes, lymphocytes and few neutrophils
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Figure 2: (H and E, ×100) showing histiocytes, lymphocytes and few neutrophils

Mentions: A 28-year-old female presented with bilateral multiple cervical lymphadenopathy and fever for 6 weeks [Figure 1]. There was cervical lymphadenopathy (bilateral, multiple, mobile, nontender and largest being 2 cm × 2.5 cm), thyromegally and hepatomegaly of 5 cm. Investigations revealed leukocytosis with relative lymphocytosis and raised inflammatory markers. Liver enzymes were elevated up to 200-300 IU/L. Markers for hepatitis B virus, hepatitis C virus, HIV, TORCH profile and Epstein — Barr virus were negative. Thyroid function test revealed T3-0.7 nmol/L, T4-64 nmol/L, thyroid stimulating hormone 64 and anti-thyroid peroxidase antibody-576 KIU (normal <35). Ultrasonography of neck revealed features of chronic thyroiditis. Excision biopsy of one of the lymphnode showed histiocytic necrotizing lymphadenitis of Kikuchi's disease [Figure 2]. The patient was treated with indomethacin 75 mg bid. As the lymphadenopathy did not resolve after 2 weeks, we added oral prednisolone (0.5 mg/kg) for a period of 4 weeks, which was tapered over the next 4 weeks. The patient is fine even after 1-year.


Fever and cervical lymphadenopathy in a young female; thinking beyond tuberculosis.

Khadanga S, Sen R, Thatoi PK, Mohanty R, Mishra KB, Karuna T - J Glob Infect Dis (2014)

(H and E, ×100) showing histiocytes, lymphocytes and few neutrophils
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4265840&req=5

Figure 2: (H and E, ×100) showing histiocytes, lymphocytes and few neutrophils
Mentions: A 28-year-old female presented with bilateral multiple cervical lymphadenopathy and fever for 6 weeks [Figure 1]. There was cervical lymphadenopathy (bilateral, multiple, mobile, nontender and largest being 2 cm × 2.5 cm), thyromegally and hepatomegaly of 5 cm. Investigations revealed leukocytosis with relative lymphocytosis and raised inflammatory markers. Liver enzymes were elevated up to 200-300 IU/L. Markers for hepatitis B virus, hepatitis C virus, HIV, TORCH profile and Epstein — Barr virus were negative. Thyroid function test revealed T3-0.7 nmol/L, T4-64 nmol/L, thyroid stimulating hormone 64 and anti-thyroid peroxidase antibody-576 KIU (normal <35). Ultrasonography of neck revealed features of chronic thyroiditis. Excision biopsy of one of the lymphnode showed histiocytic necrotizing lymphadenitis of Kikuchi's disease [Figure 2]. The patient was treated with indomethacin 75 mg bid. As the lymphadenopathy did not resolve after 2 weeks, we added oral prednisolone (0.5 mg/kg) for a period of 4 weeks, which was tapered over the next 4 weeks. The patient is fine even after 1-year.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, LN Medical College, Bhopal, Madhya Pradesh, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, A 28-year-old female presented with bilateral multiple cervical lymphadenopathy and fever for 6 weeks [Figure 1]... Excision biopsy of one of the lymphnode showed histiocytic necrotizing lymphadenitis of Kikuchi's disease [Figure 2]... The patient was treated with indomethacin 75 mg bid... As the lymphadenopathy did not resolve after 2 weeks, we added oral prednisolone (0.5 mg/kg) for a period of 4 weeks, which was tapered over the next 4 weeks... There have also been reports of a possible link with autoimmune disorders like systemic lupus erythematosus (SLE) and autoimmune thyroiditis... The classical clinical features of sub-acute fever with unilateral, discrete, and tender regional lymphadenopathy have often been confused with tuberculosis, SLE and lymphoma... SLE lymphadenitis demonstrates degenerated nuclear material in walls of blood vessels, abundant plasma cells and pericapsular inflammation... The large cells observed in Kikuchi's disease are positive for CD68, MPO, and Ki-M1P1, while they are negative for CD3, CD15, CD20, CD30 or mucin, which excludes the possibility of lymphomas... The disease is self-limiting and treatment is supportive with nonsteroidal anti-inflammatory drugs... Corticosteroids, hydroxychloroquine, methotrexate, and intravenous immunoglobulin have been used for severe cases... It usually resolves in several weeks to months with a 1-year recurrence rate of 3-4%... We report this case for the clinicians to prevent misdiagnosis and inappropriate treatment of Kikuchi's disease especially in tubercular endemic areas and for some of its atypical features.

No MeSH data available.