Brecht A, Stiegler Th, Lange J, de Groot K
Medizinische Klinik III, Nephrologie und Rheumatologie.
Dtsch Med Wochenschr. 2007 Apr 20;132(16):874-7. doi: 10.1055/s-2007-973631.
A 26-year-old Pakistani woman was admitted to hospital with fever, nausea and vomiting, abdominal pain and general weakness for the previous two weeks, but no diarrhea or constipation. Antibiotic therapy as an out-patient had not provided relief. She also had enlarged cervical lymph nodes. She reported that she had always been in good health before onset of the described symptoms.
Laboratory tests revealed pancytopenia and a decrease in C3 and C4. The ANA titer was positive. The serum was positive for preceding infections with EBV, CMV, Chlamydia trachomatis, HHV type 6, and toxoplasmosis. There was no evidence of current or previous infections with HIV, Bartonella henselae, Treponema pallidum, Listeria, Hantavirus, Leishmania or dengue fever. The patient's symptoms were found to be associated with Hashimoto's thyroiditis in conjunction with latent hypothyroidism. Abdominal, thoracic and cervical CT scan revealed enlarged lymph nodes, up to 2 cm in size, and enlarged spleen and liver.
Histopathology of a cervical lymph node showed features of Kikuchi (Kikuchi-Fujimoto) disease (histiocytic necrotizing lymphadenitis). Prednisone administration (2 mg/kg body weight) led to the patient's rapid recovery.
Kikuchi disease should be considered in patients with cervical but also general lymphadenopathy, after exclusion of other causes. The specific diagnosis is based on biopsy of affected lymph nodes.
一名26岁的巴基斯坦女性因过去两周出现发热、恶心、呕吐、腹痛及全身乏力入院，但无腹泻或便秘症状。门诊使用抗生素治疗无效。她还伴有颈部淋巴结肿大。她表示在出现上述症状之前一直身体健康。
实验室检查显示全血细胞减少，C3和C4降低。抗核抗体滴度呈阳性。血清检测显示既往感染过EB病毒、巨细胞病毒、沙眼衣原体、6型人疱疹病毒及弓形虫。没有证据表明目前或既往感染过人类免疫缺陷病毒、汉赛巴尔通体、梅毒螺旋体、李斯特菌、汉坦病毒、利什曼原虫或登革热。发现患者的症状与桥本甲状腺炎合并潜在甲状腺功能减退有关。腹部、胸部及颈部CT扫描显示淋巴结肿大，最大直径达2厘米，脾脏和肝脏也肿大。
颈部淋巴结组织病理学检查显示为菊池（菊池-藤本）病（组织细胞性坏死性淋巴结炎）特征。给予泼尼松（2毫克/千克体重）治疗后，患者迅速康复。
在排除其他病因后，对于有颈部及全身淋巴结肿大的患者应考虑菊池病。明确诊断基于对受累淋巴结的活检。
