Histiocytic Necrotizing Lymphadenitis Involving the Neck: Radiology-Pathology Correlation

Kikuchi-Fujimoto Disease: A Case of Febrile Cervical Lymphadenopathy With Hematological Abnormalities

Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign but rare disorder associated with febrile cervical lymphadenopathy in young adults. Here, we discuss a case of a young female patient presenting with left tender cervical lymphadenopathy that progressed bilaterally with a fever of unknown origin. Laboratory parameters showed persistent leukopenia, especially neutropenia, which fluctuated with the degree of symptom severity. Two months were taken to confirm the diagnosis of KFD based on the histological interpretation of the lymph node biopsy. Supportive management with analgesics and paracetamol formed the main treatment. This case highlights the challenges and importance of diagnosing KFD to exclude other serious conditions such as lymphoma, tuberculosis, or lupus lymphadenitis that share similar clinical manifestations as KFD.

Group A Streptococcus Necrotizing Lymphadenitis: A Case Report

Necrotizing lymphadenitis (NL) is a rare entity that can occur as a complication of bacterial cervical lymphadenitis (CL) and is characterized by unilateral or bilateral cervical lymphadenopathy. NL most commonly presents in females and most reports have been in Japan. In this case, we present a 37-year-old male with no significant past medical history who presented with an unusual presentation and clinical course of NL. Initial workup for Epstein-Barr Virus (EBV) and other infectious etiology was negative. Yet, aspiration later revealed Group A Streptococcus. When the patient's pain and swelling did not subside with the initial antibiotic and supportive treatment, the patient underwent a repeat aspiration and biopsy that revealed a necrotic mass or lymph node. NL is uncommon and rarely due to infectious etiology. However, this marks a case in which a Group A Streptococcus was shown to be associated with subsequent necrotic lymph nodes and should allow practitioners to further consider an infectious etiology in the differential diagnosis of NL.

Cervical lymph nodes, a diagnostic dilemma

Cervical lymph nodes could be a starting sign for a complex diagnosis work-up. Depending on co-morbidities, medical unit and physician's previous experience, the differential diagnosis includes thyroid malignancy, lymphoma, chronic infectious disorders, etc.