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      Drugs & Diseases > Hematology

      Kikuchi Disease Clinical Presentation

      Updated: Aug 04, 2022
      • Author: John Boone, MD; Chief Editor: Sara J Grethlein, MD, MBA, FACP  more...
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      Presentation

      History

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

      Lymphadenopathy features are as follows:

      • 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 signs and symptoms:

      • Headache
      • Nausea, vomiting
      • Malaise, fatigue
      • Weight loss
      • Arthralgias, myalgias
      • Night sweats
      • Rash (up to 30%)
      • Thoracic/abdominal pain
      Next:

      Physical Examination

      Characteristics of lymphadenopathy are as follows:

      • Lymphadenopathy is isolated to a single 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 are as follows:

      • Skin [32, 33] : 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 systemic lupus erythematosus (SLE); skin lesions resolve in a few weeks to months

      • Hepatosplenomegaly: This finding is not uncommon; monitor lactate dehydrogenase (LDH) levels

      • Neurologic involvement: Neurologic involvement is rare but has included conditions such as aseptic meningitis, acute cerebellar ataxia, and encephalitis [34] ; 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: Asymmetric polyarthritis, enthesitis, and dactylitis of the toes was reported in the case of a 14-year-old boy [35]

      • Widespread involvement of multiple organ systems in Kikuchi disease has been described in solid-organ transplant patients

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