Iszlai Zoltán, Török László, Tóth Erika, Karosi Tamás
1 Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Osztály Miskolc, Szentpéteri kapu 72-76., 3526 Magyarország.
2 Országos Onkológiai Intézet, Daganatpatológiai Központ, Sebészeti és Molekuláris Patológiai Osztály Budapest Magyarország.
Orv Hetil. 2022 Jul 3;163(27):1061-1065. doi: 10.1556/650.2022.32559.
The Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis) is an autolimited process, which can be caused by viral agents like Epstein-Barr virus, human herpes virus, HIV, B19 parvovirus, paromyxoviruses, SARS-CoV-2, Toxoplasma and Yersinia. The correct diagnosis is based on histological findings. A 45-year-old female patient presented in our ambulatory room with a unilateral neck mass, fever, dysphonia and dysphagia. The patient was double-tested positive for SARS-CoV-2 approximately 1 month before the symptoms started. Before examination, the nasopharyngeal rapid test for SARS-CoV-2 resulted negative. After hospitalization, intravenous antibiotic (Augmentin, 3 x 1.2 g; Klion, 2 x 100 mg) and steroid (Solu-Medrol, 2 x 125 mg) therapy were administered. The neck and chest CT described a right-sided retropharyngeal abscess with bilateral neck lympadenopathy. Urgent tracheotomy, neck dissection and lymph node biopsy were made. The intraoperative findings excluded the presence of the abscess. The histological findings confirmed the necrotizing histiocytic lymphadenitis. Despite of the fact that the Kikuchi-Fujimoto disease is autolimited, we can see that, in this particular case, the lymphadenopathy after the SARS-CoV-2 infection caused a life-threatening situation. The formed extratissular liquid imitated the image of a retropharyngeal abscess. In the searched worldwide literature, similar intervention for this type of process was not described. Tracheotomy, neck dissection and removing the lymph nodes as ,,trigger zones used the full recovery of the patient. In the future, we consider important proving and clarifying the correlation between SARS-CoV-2 and Kikuchi-Fujimoto disease.
菊池-藤本病(组织细胞坏死性淋巴结炎)是一种自限性疾病,可由多种病毒病原体引起,如EB病毒、人类疱疹病毒、HIV、B19细小病毒、副粘病毒、SARS-CoV-2、弓形虫和耶尔森菌。正确的诊断基于组织学检查结果。一名45岁女性患者因单侧颈部肿块、发热、声音嘶哑和吞咽困难前来我们的门诊就诊。该患者在症状开始前约1个月SARS-CoV-2检测呈双阳性。检查前,SARS-CoV-2鼻咽快速检测结果为阴性。住院后,给予静脉抗生素(阿莫西林克拉维酸钾,3次,每次1.2g;克林霉素,2次,每次100mg)和类固醇(甲泼尼龙,2次,每次125mg)治疗。颈部和胸部CT显示右侧咽后脓肿伴双侧颈部淋巴结病。进行了紧急气管切开术、颈部清扫术和淋巴结活检。术中发现排除了脓肿的存在。组织学检查结果证实为坏死性组织细胞性淋巴结炎。尽管菊池-藤本病是自限性的,但在这个特殊病例中,我们可以看到,SARS-CoV-2感染后的淋巴结病导致了危及生命的情况。形成的组织外液体模仿了咽后脓肿的影像。在检索的全球文献中,未描述针对此类病情的类似干预措施。气管切开术、颈部清扫术以及切除作为“触发区”的淋巴结使患者完全康复。未来,我们认为证明和阐明SARS-CoV-2与菊池-藤本病之间的相关性很重要。