Age / Sex : 14 / M

Chief complaint : fever, palpable mass

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : 박희진, Hee Jin Park, 강북삼성병원, Kangbuk Samsung hospital

Histiocytic necrotizing lymphadenitis (Kikuchi disease)

Discussion

Findings:

CT: Homogenous nodal enlargement, perinodal infiltration, central nodal necrotic change

USG: Unilateral(86%), neck level V(92%), conglomerated(68%), preserved central echogenic hilum(98%), perinodal fat swelling (65%) caused by perinodal edema

Differential Diagnosis:

Lymphoma

Tuberculosis

SLE

Kimura disease

Metastatic LN

Discussion:

Kikuchi-Fujimoto disease

= Kikuchi’s disease

= Histiocytic necrotizing lymphadenitis

Kikuchi-Fujimoto disease(KFD) is a benign and self-limited disorder characterized by regional lymphadenopathy with tenderness usually accompanied with mild fever and night sweats

The onset is acute or subacute : evolving over a period of 2~3 weeks

Cervical lymphadenopathy (60~90%)

Tender & painful LN involving posterior cervical triangle

Frequently with axillary/supraclavicular LN involvement

LN: 0.5~4cm, up to 5~6cm size, single nodal group involve (80%)

Rare, but generalized lymphadenopathy can occur (1~22%)

Fever (30~50%), weight loss, N/V, sore throat, night sweats

References:

1. Ryoo, Inseon, et al. "Comparison of ultrasonographic findings of biopsy-proven tuberculous lymphadenitis and Kikuchi disease." Korean journal of radiology 16.4 (2015): 767-775.