Histiocytic necrotizing lymphadenitis

Abstract

Summary Eleven cases of histiocytic necrotizing lymphadenitis were studied. Originally four were misdiagnosed as cervical tuberculous lymphadenitis. The characteristic symptoms and signs were local tenderness, fever, leucocytopenia and good prognosis. Antibody to Epstein-Barr virus was elevated in 2 of 3 cases. Biopsy of the affected lymph node was necessary when the differential diagnosis from lymph node tuberculosis or malignant lymphoma could not be made. The characteristic histological feature was focal necrosis without neutrophil infiltration in cortical or subcortical areas. Ultrastructurally, we found characteristic inclusions (‘tubulo-reticular structures’) in histiocytes and lymphocytes.

Case Report: Kikuchi: The great mimicker

“…Kikuchi disease was first independently described through case series in 1972 by Kikuchi and Fujimoto as a form of a benign necrotizing lymphadenitis which was most commonly misdiagnosed as tuberculosis and or lymphoma 2 . The main etiology for Kikuchi disease is still unknown but there are various studies that implicate viruses such as EBV as a potential trigger 2 , 3 .…”

“…Kikuchi disease was first independently described through case series in 1972 by Kikuchi and Fujimoto as a form of a benign necrotizing lymphadenitis which was most commonly misdiagnosed as tuberculosis and or lymphoma 2 . The main etiology for Kikuchi disease is still unknown but there are various studies that implicate viruses such as EBV as a potential trigger 2 , 3 . It is also closely related to systemic lupus erythematosus (SLE) and in fact, there are studies and case reports showing a strong association between the two disease processes with the diagnosis of SLE coming before, after or even simultaneously with Kikuchi disease 4 , 5 .…”

“…The most frequent presenting symptom was fever while the most common presenting sign was cervical lymphadenopathy 5 . It also presents together with constitutional symptoms like night sweats and weight loss which can be initially be misdiagnosed as tuberculosis or lymphoma 1 , 2 . However, Kikuchi disease has also been implicated to cause a wide range of symptoms ranging from neurological, musculoskeletal, cutaneous and glandular dysfunction 6 .…”

“…Definitive diagnosis is established by lymph node biopsy. Classic biopsy findings include necrosis without a neutrophilic infiltrate with the predominance of histiocytes and T lymphocytes 1 , 2 . Kikuchi is a benign self-limiting disease and symptoms usually resolves spontaneously within 4 months in majority of cases with supportive treatment 1 , 6 .…”

Linfadenitis necrotizante histiocitaria o enfermedad de Kikuchi: Apariencia radiológica mediante TC

“…(8), en mujeres japonesas jóvenes. Desde esta época casos anecdóti-cos y series más o menos amplias han sido publicadas no sólo en Japón sino en nuestro medio y en otras partes del mundo (9)(10)(11)(12)(13)(14). Su prevalencia posiblemente es superior a la descrita dada su natural tendencia a autolimitarse.…”