Astudillo L
Service de médecine interne, CHU Purpan, Toulouse cedex, France.
Rev Med Interne. 2010 Nov;31(11):757-65. doi: 10.1016/j.revmed.2010.01.011. Epub 2010 Jun 3.
Kikuchi-Fujimoto disease is a necrotizing lymphadenitis, involving young patients, predominantly females. Lymphadenopathy is usually localized, particularly in the cervical area, mostly unilateral and tender. Fever is present in one third of cases. Associated skin lesions, arthralgia, myalgia, splenomegaly or hepatomegaly are rare. Laboratory evaluation shows a slight increase of erythrocyte sedimentation rate and leukopenia. Kikuchi-Fujimoto has been reported in association with other diseases, including systemic lupus, Still's disease, hemophagocytosis, pregnancy, other autoimmune diseases, and cancer. A viral or bacterial origin has been suspected but not confirmed. Lymph node biopsy allows the diagnosis and shows necrotizing lymphadenitis with acidophil necrosis, CD68+ histiocyte infiltrate, presence of plasmacytoid monocytes, multiple apoptotic cells (CD8+ T cell) with nuclear dust, immunoblastic reaction and the absence of neutrophils or eosinophils. The disease course is usually spontaneously favourable in few weeks or months, requiring corticosteroids only occasionally.
菊池-藤本病是一种坏死性淋巴结炎,多见于年轻患者,以女性为主。淋巴结病通常局限,尤其在颈部,多为单侧且有压痛。三分之一的病例有发热。相关的皮肤病变、关节痛、肌痛、脾肿大或肝肿大罕见。实验室检查显示红细胞沉降率略有升高和白细胞减少。菊池-藤本病已被报道与其他疾病有关,包括系统性红斑狼疮、斯蒂尔病、噬血细胞综合征、妊娠、其他自身免疫性疾病和癌症。曾怀疑有病毒或细菌起源,但未得到证实。淋巴结活检可确诊,显示坏死性淋巴结炎伴嗜酸性坏死、CD68+组织细胞浸润、浆细胞样单核细胞存在、多个凋亡细胞(CD8+T细胞)伴核尘、免疫母细胞反应且无中性粒细胞或嗜酸性粒细胞。该病病程通常在数周或数月内自发好转,仅偶尔需要使用皮质类固醇。