Lin Hsin-Ching, Su Chih-Ying, Huang Shun-Chen
Department of Otolaryngology, Chang Gung University, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan.
Pediatrics. 2005 Jan;115(1):e92-6. doi: 10.1542/peds.2004-0924.
Kikuchi's disease (KD), or histiocytic necrotizing lymphadenitis, is a unique form of self-limiting lymphadenitis and typically affects the head and neck regions. It usually occurs in young adults 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.
Between January 1986 and May 2002, a total of 23 patients who were younger than 16 years underwent cervical lymph node biopsies and received a diagnosis of KD. Clinical features, laboratory values, pathologic parameters, specific characteristics of our pediatric patients, and long-term follow-up results are discussed. The follow-up period averaged 8 years.
There were 8 girls and 15 boys with a mean age of 12.8. All 23 patients had affected cervical lymph nodes located in the posterior cervical triangle, and 2 cases additionally had affected nodes in the anterior triangle. Cervical lymph nodes were affected unilaterally in 82.6% (19) and bilaterally in 17.4% (4) of these patients. The dimensions of the affected lymph nodes were commonly in the range of 0.5 to 3 cm (52.2%; 12 of 23) and 3 to 6 cm (39.1%; 9 of 23). In 2 (8.7%) patients, the size of the enlarged lymph nodes reached >6 cm. Leukopenia was observed in 5 (21.7%) patients, and fever was observed in 7 (30.4%) patients. One child with KD developed systemic lupus erythematosus 5 years later. The cervical lymphadenopathy usually resolved itself without any medical treatment within 6 months after definite diagnosis was made. Neither recurrence nor persisting KD has since been noted.
KD, although rare, should be part of the differential diagnosis for posterior cervical lymphadenopathy in children, especially in patients of Asian descent. In our pediatric series, KD demonstrated a male predominance, which is in contrast to previously reported adult series demonstrating a female predominance. The children with KD require a systemic survey and regular follow-up for several years to rule out the development of systemic lupus erythematosus.
菊池病（KD），即组织细胞坏死性淋巴结炎，是一种独特的自限性淋巴结炎，通常累及头颈部区域。它常见于年轻人，女性更易患病。本研究旨在回顾作者所在机构16年间儿童KD的诊治经验。
1986年1月至2002年5月，共有23例16岁以下患者接受了颈部淋巴结活检，并被诊断为KD。文中讨论了临床特征、实验室检查值、病理参数、儿科患者的具体特点以及长期随访结果。随访期平均为8年。
有8名女孩和15名男孩，平均年龄12.8岁。所有23例患者的受累颈部淋巴结均位于颈后三角，2例患者的颈前三角淋巴结也有受累。这些患者中，82.6%（19例）为单侧颈部淋巴结受累，17.4%（4例）为双侧受累。受累淋巴结大小通常在0.5至3厘米之间（52.2%；23例中的12例）和3至6厘米之间（39.1%；23例中的9例）。2例（8.7%）患者肿大淋巴结大小超过6厘米。5例（21.7%）患者出现白细胞减少，7例（30.4%）患者出现发热。1例KD患儿5年后患系统性红斑狼疮。确诊后6个月内，颈部淋巴结病通常无需任何治疗即可自行缓解。此后未发现复发或持续性KD病例。
KD虽罕见，但应作为儿童颈后淋巴结病鉴别诊断的一部分，尤其是亚洲裔患者。在我们的儿科病例系列中，KD表现为男性居多，这与先前报道的以女性居多的成人病例系列不同。KD患儿需要进行全面检查并定期随访数年，以排除系统性红斑狼疮的发生。
