Kikuchi Disease Clinical Presentation

  • Author: John Boone, MD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Jan 10, 2012
 

History

Kikuchi disease most frequently manifests as a relatively acute onset of cervical adenopathy associated with fever and a flulike prodrome.

  • Lymphadenopathy
    • Cervical nodes are affected in about 80% of cases.
    • Posterior cervical nodes are frequently involved (65-70% of cases).
    • Lymphadenopathy is isolated to a single location in 83% of cases, but multiple chains may be involved.
    • Cases of generalized adenopathy involving axillary, inguinal, and mesenteric nodes are unusual.
  • A flulike prodrome with fever is present in 50% of cases. The following are less common symptoms:
    • Headache
    • Nausea, vomiting
    • Malaise, fatigue
    • Weight loss
    • Arthralgias, myalgias
    • Night sweats
    • Rash (up to 30%)
    • Thoracic/abdominal pain
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Physical

  • Lymphadenopathy
    • Lymphadenopathy is isolated to 1 location in 83% of patients, although multiple nodal chains may be involved.
    • Cervical nodes are affected in 80% of patients; of these, 65-70% involve posterior triangle cervical nodes.
    • Less commonly affected nodes include those in axillary, mediastinal, celiac, abdominal, and inguinal locations.
    • The nodes are usually described as painless or mildly tender.
    • The nodes tend to be 2-3 cm in diameter, although masses of multiple nodes may reach 6 cm.
    • The nodes are usually firm and mobile, but they are not fluctuant or draining.
  • Extranodal findings
    • Skin[20, 21]
      • The incidence of skin involvement varies from 5-30%.
      • Findings are varied and nonspecific and include maculopapular lesions, morbilliform rash, nodules, urticaria, and malar rash, which may resemble that of SLE.
      • Skin lesions resolve in a few weeks to months.
    • Hepatosplenomegaly
      • This finding is not uncommon.
      • Monitor lactase dehydrogenase (LDH) levels.
    • Neurologic involvement
      • Neurologic involvement is rare but has included conditions such as aseptic meningitis, acute cerebellar ataxia, and encephalitis.[22]
      • Patients with aseptic meningitis may report headache, but they do not exhibit nuchal rigidity or positive Kernig or Brudzinski signs. Cerebrospinal fluid (CSF) findings are similar to those noted in patients with aseptic meningitis of viral etiology.
    • Rarely involved extranodal sites include the bone marrow, myocardium, uvea, and thyroid and parotid glands.
    • Arthritic involvement was reported in the case of a 14-year-old body.[2]
    • Widespread involvement of multiple organ systems in Kikuchi disease has been described in solid-organ transplant patients.
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Contributor Information and Disclosures
Author

John Boone, MD  Consulting Staff, Department of Otolaryngology, Naval Hospital Oak Harbor

John Boone, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Charles S Kuzma, MD  Consulting Staff, Clinical Research Coordinator, First Health of the Carolinas Cancer Center

Charles S Kuzma, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology, and California Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Karen Seiter, MD  Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College

Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology

Disclosure: Novartis Honoraria Speaking and teaching; Novartis Consulting fee Speaking and teaching; Eisai Honoraria Speaking and teaching; Celgene Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Lawrence H Brent, MD  Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Abbott Honoraria Speaking and teaching; Centocor Consulting fee Consulting; Genentech Grant/research funds Other; HGS/GSK Honoraria Speaking and teaching; Omnicare Consulting fee Consulting; Pfizer Honoraria Speaking and teaching; Roche Speaking and teaching; Savient Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

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