Intermittent Lymphadenopathy! Kikuchi Disease!

Dr. Collins presented a fascinating case of a young woman with 2 months of intermittent cervical lymphadenopathy, intermittent fevers, malaise, and mylagias who was found to have Kikuchi Disease after a lymph node biopsy.

Kikuchi disease is a rare disease that mostly affects women. Dr. Collins's case is a classic presentation. Associated lab findings can include leukopenia with elevated CRP and LDH. It is diagnosed on excisional lymph node biopsy. It is also known as histiocytic necrotizing lymphadenitis based on pathology findings.

Kikuchi disease is benign and self-limited but typically leads to an extensive work up to rule out more sinister diagnoses (lymphoma, TB lymphadenitis, and other infections). Some people treat Kikushi disease with steroids though there is no data on if this improves outcomes.

Interestingly, Kikuchi disease is associated with SLE for unclear reasons. There have been numerous case reports on this association in which SLE followed a prior diagnosis of Kikuchi disease. Some advocate for close follow up for clinical and serologic evidence of developing SLE after a diagnosis of Kikuchi disease.

Intermittent lymphadenopathy should trigger a short differential.

  • T cell lymphoma
    • Illness script: middle aged man with generalized lymphadenopathy
  • Kikuchi Disease
    • Illness script: young previously healthy Asian woman with regional (usually cervical) lymphadenopathy
  • Recurrent infections/immunodeficiency
  • Incompletely treated infectious
derived from AAFP differential for lymphadenopathy and neck mass.    https://www.aafp.org/afp/1998/1015/p1313.html    https://www.aafp.org/afp/2015/0515/p698.html

derived from AAFP differential for lymphadenopathy and neck mass.

https://www.aafp.org/afp/1998/1015/p1313.html

https://www.aafp.org/afp/2015/0515/p698.html