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Park SG, Koo HR, Jang K, Myung JK, Song CM, Ji YB, Park JS, Tae K. Efficacy of Ultrasound-Guided Needle Biopsy in the Diagnosis of Kikuchi-Fujimoto Disease. Laryngoscope 2020; 131:E1519-E1523. [PMID: 33002212 DOI: 10.1002/lary.29160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/06/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Ultrasound-guided fine-needle aspiration cytology (US-FNAC) is a well-established procedure performed to establish the diagnosis of Kikuchi-Fujimoto disease (KFD). Ultrasound-guided core needle biopsy (US-CNB) is an alternative diagnostic tool for KFD. However, the efficacy of US-CNB is not well evaluated. This study aimed to evaluate the efficacy of US-CNB and compare it with that of US-FNAC in the diagnosis of KFD. STUDY DESIGN Retrospective cohort study. METHODS We analyzed 170 patients who were diagnosed with KFD between January 2009 and May 2019. US-FNAC, US-CNB, and excisional biopsy were performed in 47, 114, and 9 patients, respectively. Diagnostic accuracies of US-FNAC and US-CNB were analyzed and compared. RESULTS Of the 170 patients, 45 and 125 were men and women, respectively. The mean age was 26.9 ± 9.1 years. The most common symptom was cervical lymphadenopathy, followed by fever, headache, and myalgia. The diagnosis of KFD was established primarily by US-FNAC in 21 (44.7%) of the 47 patients, by US-CNB in 109 (95.6%) of the 114 patients, and by excisional biopsy in all 9 patients. There was no specific major complication related to US-FNAC and US-CNB. CONCLUSION US-CNB can be considered safe and effective and used as the primary modality for the pathological diagnosis of KFD. LEVEL OF EVIDENCE 4. Laryngoscope, 131:E1519-E1523, 2021.
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Affiliation(s)
- Sang Gyu Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hye Ryoung Koo
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kiseok Jang
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jae Kyung Myung
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jeong Seon Park
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Moon IS, Kim DW, Baek HJ. Ultrasound-based diagnosis for the cervical lymph nodes in a tuberculosis-endemic area. Laryngoscope 2014; 125:1113-7. [PMID: 25388942 DOI: 10.1002/lary.25030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS No previous ultrasound (US) studies have investigated the diagnostic accuracy of specific US-based diagnostic protocol for cervical lymph node (LN) lesions in a tuberculosis-endemic area. This study aimed to assess the accuracy of US-based diagnosis of cervical LNs in a tuberculosis-endemic area. STUDY DESIGN This was a retrospective cohort study. METHODS We enrolled 495 consecutive patients who underwent US examination of the LNs in the neck. A single radiologist carried out the US examination, and established a US-based diagnosis at the time of the examination in each of the patients. We calculated the diagnostic accuracy of US for LNs in the neck by using the final results as a reference standard. RESULTS Of 476 study cases, the number of tuberculous, nontuberculous benign, malignant, and indeterminate US category cases was 74, 224, 152, and 26, respectively. Confirmed diagnoses in these cases were as follow: tuberculous LN (n = 69), nontuberculous benign LN (n = 249), and malignant LN (n = 158). The sensitivity, specificity, positive and negative predictive values, and accuracy of tuberculous, malignant, and nontuberculous benign US categories were 90.9%, 96.4%, 81.1%, 98.4%, and 95.6%; 92.8%, 96.6%, 93.4%, 96.3%, and 95.3%; and 92.2%, 95.0%, 95.1%, 92.0%, and 93.6%, respectively. All US categories showed a high sensitivity and specificity. CONCLUSIONS The present US-based diagnostic protocol for cervical LNs in a tuberculosis-endemic area may be useful. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- In S Moon
- Department of Radiology , Busan Paik Hospital, Inje University School of Medicine, Busan, South Korea
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Necrotizing Cervical Lymphadenitis Caused by Mycobacterium simiae in an HIV-Positive Patient: Imaging with (18)F-FDG PET/CT. Nucl Med Mol Imaging 2011; 45:220-2. [PMID: 24900008 DOI: 10.1007/s13139-011-0088-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/24/2011] [Indexed: 10/18/2022] Open
Abstract
Mycobacterium simiae (M. simiae) is an opportunistic pathogen rarely associated with human disease, although in recent years M. simiae has been detected with increasing frequency in human immunodeficiency virus (HIV)-infected patients, usually causing disseminated infection with fever, diarrhea and weight loss. We report the case of an HIV-positive man, who was referred for an (18)F-FDG PET/CT to evaluate a solitary pulmonary nodule. The PET/CT showed incidental large necrotic cervical lymph nodes, compatible with necrotizing cervical lymphadenitis. Biopsy and culture of one of the affected lymph nodes were positive for M. simiae. We present the first report of (18)F-FDG PET/CT imaging of an infectious process caused by M. simiae in humans.
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Kikuchi-fujimoto disease associated with myasthenia gravis: a case report. Case Rep Med 2010; 2010. [PMID: 20814564 PMCID: PMC2931430 DOI: 10.1155/2010/903252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/13/2010] [Indexed: 11/17/2022] Open
Abstract
Kikuchi-Fujimoto disease is a self-limited benign condition of unknown etiology characterized by cervical lymphadenopathy, fever, and leucopenia. An autoimmune hypothesis has been suggested and an association with systemic lupus erythematosus, Sjogren's disease, and antiphospholipid syndrome has been noted. We report a 27-year-old male who presented for evaluation of weakness and he was diagnosed with seropositive generalized myasthenia gravis and underwent a thymectomy. He was stable until five months post-thymectomy, when he developed a high fever associated with nontender cervical lymphadenopathy, chills, and night sweats. Histopathology of a cervical lymph gland biopsy was compatible with Kikuchi-Fujimoto lymphadenitis. He improved spontaneously and was asymptomatic at the followup six months later. Our case expands the association of Kikuchi-Fujimoto disease with autoimmune disorders to include myasthenia gravis.
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Spooner BB, Rahman I, Langford N, Ferner RE. Recurrent Kikuchi-Fujimoto disease. BMJ Case Rep 2010; 2010:2010/may19_1/bcr1120092469. [PMID: 22750925 DOI: 10.1136/bcr.11.2009.2469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 27-year-old, UK-born, Asian woman who suffered a rare recurrence of Kikuchi-Fujimoto disease. She presented with tender lymphadenopathy of the neck, fever and a prodrome of flu-like symptoms. She had a past medical history of biopsy-proven Kikuchi-Fujimoto disease of her right axilla 2 years earlier, which required no treatment. Following her repeat admission, a cervical lymph node biopsy confirmed a diagnosis of recurrent Kikuchi-Fujimoto disease. She did not improve despite treatment with paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). She was started on high-dose prednisolone and her symptoms, pyrexia, and inflammatory markers settled within 24 h. She continually improved and the prednisolone was slowly reduced over 9 months. Kikuchi-Fujimoto is a rare, benign, self-limiting disease that presents with lymphadenopathy and fever. It rarely reoccurs. The severity, recurrence and the different body site make this an unusual case.
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Seo JH, Shim HS, Park JJ, Jeon SY, Kim JP, Ahn SK, Hur DG, Ahn SY, Kwon OJ. A clinical study of histiocytic necrotizing lymphadenitis (Kikuchi's disease) in children. Int J Pediatr Otorhinolaryngol 2008; 72:1637-42. [PMID: 18789543 DOI: 10.1016/j.ijporl.2008.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 07/30/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Histiocytic necrotizing lymphadenitis (HNL) is a cervical lymphadenitis that occurs rarely in children. This study was conducted to identify the clinical characteristics of lymphadenitis in children and compare the clinical characteristics observed in children and adults. SUBJECT AND METHODS The clinical characteristics, diagnosis, treatment, and prognosis of the 20 patients 18 years of age or younger who were diagnosed with HNL based on histological tests conducted at Gyeongsang University Hospital from January 1998 to December 2006 were analyzed. RESULTS HNL affected males and females at a 1:1 ratio, but HNL was more common in boys (8:3) among the children and HNL affected more girls among the adolescents (2:7). Cervical lymphadenopathy was the main symptom. The antinuclear antibody test was positive in three patients. Two relapse cases were reported, but both patients recuperated within several months without complications. CONCLUSIONS HNL affected males and females at an equal incidence (1:1). But HNL occurred more often in male children than in female children, and more often in female adolescents than in male adolescents. Relapse occurred in 10% of the cases. HNL could progress into systemic lupus erythematosus in the three cases that were ANA-positive. Thus, a long follow-up period is important.
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Affiliation(s)
- Ji Hyun Seo
- Department of Pediatrics, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, South Korea
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Chase SP, Templer JW, Miick R, Diaz-Arias AA. Cervical Lymphadenopathy Secondary to Kikuchi-Fujimoto Disease in a Child: Case Report. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808700614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While most cases of cervical lymphadenopathy resolve with conservative management, persistent adenopathy can lead to costly investigations and invasive treatments. One cause of persistent adenopathy, as well as a variety of other associated systemic symptoms, is Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis). This rare entity can he diagnosed only by excisional biopsy on the basis of its characteristic histologic appearance. We describe a case of persistent cervical lymphadenopathy secondary to Kikuchi-Fujimoto disease in an 11-year-old girl.
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Affiliation(s)
- Steven P. Chase
- From the Department of Otolaryngology–Head and Neck Surgery, University of Missouri School of Medicine, Columbia
| | - Jerry W. Templer
- From the Department of Otolaryngology–Head and Neck Surgery, University of Missouri School of Medicine, Columbia
| | - Ronald Miick
- Department of Pathology and Anatomic Sciences, University of Missouri School of Medicine, Columbia
| | - Alberto A. Diaz-Arias
- Department of Pathology and Anatomic Sciences, University of Missouri School of Medicine, Columbia
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Atwater AR, Longley BJ, Aughenbaugh WD. Kikuchi's disease: case report and systematic review of cutaneous and histopathologic presentations. J Am Acad Dermatol 2008; 59:130-6. [PMID: 18462833 DOI: 10.1016/j.jaad.2008.03.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 01/30/2008] [Accepted: 03/10/2008] [Indexed: 11/29/2022]
Abstract
Kikuchi's disease, also known as histiocytic necrotizing lymphadenitis, is a systemic illness with classic clinical findings of cervical lymphadenopathy and fever. Diagnosis is confirmed by lymph node histology, which reveals paracortical foci of necrosis and a histiocytic infiltrate. Kikuchi's disease has been associated with a number of infections, but no single source has been identified. Diverse, often nonspecific, cutaneous findings have been described in up to 40% of cases. Description of the histopathologic findings of skin lesions is limited to single case reports and one case series. We describe a 24-year-old woman with fevers, lymphadenopathy, hepatic and hematologic abnormalities, and a skin eruption involving the face, neck, trunk, and extremities with characteristic lymph node and cutaneous histopathologic findings. We completed a systematic review of the clinical presentations and histopathology of Kikuchi's disease.
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Affiliation(s)
- Amber Reck Atwater
- Department of Dermatology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin 53715, USA
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Satavahana Chowdary V, Vinay Kumar EC, Swarna Latha G, Sudha Rani R. Kikuchi - Fujimoto disease. Indian J Otolaryngol Head Neck Surg 2006; 58:287-90. [PMID: 23120318 DOI: 10.1007/bf03050845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Kikuchi - fujimoto disease also known as histiocytic necrotizing lymphadenitis is an idiopathic benign self limiting condition with a favourable outcome, usually affecting young women. The following cases have burn reported for clinical interest and for the rarity of the reports about this condition in ENT literature. In our series, we had 2 female patients aged 18 years and 25 years respectively and a male patient aged 45 years, presenting with fever, bilateral tender multiple cervical adenopathy including posterior triangle nodes not responding to routine antibiotics and anti-inflammatory drug treatment. ENT findings were within normal limits. Routine clinical investigations were within normal limits except for the raised ESR. Biopsy from one of the enlarged glands revealed necrotizing lymphadenitis. All the patients subsequently showed significant improvement locally in the neck and systemically without any further active treatment.
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Affiliation(s)
- V Satavahana Chowdary
- Dept. of ENT & Head and Neck Surgery, Dept. of Pathology, Apollo Hospitals, Jubilee Hills, Hyderabad. (A.P)
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Kamath MP, Bhojwani K, Naik R, Kumar R, Chakravarthy Y. Tuberculosis Mimicking Kikuchi's Disease. EAR, NOSE & THROAT JOURNAL 2006. [DOI: 10.1177/014556130608500221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Kikuchi's disease is an idiopathic self-limiting necrotizing lymphadenitis. Clinically, it mimics tuberculous cervical lymphadenopathy. The disease is diagnosed by histopathologic study. The only specific treatment that has been reported is empiric steroid therapy. We report a case of tuberculosis that was originally thought to be Kikuchi's disease in a 24-year-old man. When the patient's condition worsened during a course of steroid therapy, he underwent surgical exploration, which revealed the presence of tuberculous lymphadenitis. The patient was switched to antituberculosis drug therapy, and his improvement was dramatic.
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Affiliation(s)
| | - Kiran Bhojwani
- Department of ENT, Kasturba Medical College, Mangalore, Karnataka State, India
| | - Ramdas Naik
- Department of ENT, Kasturba Medical College, Mangalore, Karnataka State, India
| | - Rajiv Kumar
- Department of ENT, Kasturba Medical College, Mangalore, Karnataka State, India
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Abstract
Histiocytic necrotizing lymphadenitis (HNL) also known as Kikuchi or Kikuchi-Fujimato disease is a benign and self-limiting disease. The entity was first described in 1972 by Kikuchi and Fujimato in Japan independently. HNL is prevalent in Asia, although it may be seen in a wide geographic distribution. It commonly affects young women. Cervical lymphadenopathy is the most prominent symptom and should be differentiated from lymphoproliferative, autoimmune, and postinfectious diseases. Apoptosis is the main process, taking role in pathogenesis of the disease. Although it is a well-known entity among pathologists, little is written in ear, nose, and throat literature. In this study, we report 2 male patients with HNL presenting with enlarged cervical lymph nodes with a brief review of literature.
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Affiliation(s)
- Serap Koybasi
- Department of Otolaryngology, Abant Izzet Baysal University, Bolu, Turkey.
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12
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Lin HC, Su CY, Huang CC, Hwang CF, Chien CY. Kikuchi's Disease: A Review and Analysis of 61 Cases. Otolaryngol Head Neck Surg 2003; 128:650-3. [PMID: 12748557 DOI: 10.1016/s0194-59980223291-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE: Kikuchi's disease (KD), or histiocytic necrotizing lymphadenitis, is a rare self-limiting disorder that typically affects the cervical lymph nodes. It has occasionally been misdiagnosed as malignant lymphoma or another serious diseases; hence, clinicians should be made more aware of this disease.
METHODS: From January 1986 to January 2001, a series of 61 patients who underwent a biopsy of a cervical lymph node and proved histologically to have KD were enrolled in this study. We retrospectively reviewed the clinical records and pathologic parameters of each patient. The patients were followed up from 6 months to 14.3 years (mean, 6.9 years).
RESULTS: There were 34 women and 27 men (1.26:1 ratio; age range, 6 to 46 years; mean age, 21 years). The affected cervical lymph nodes were commonly located in the posterior cervical triangle (54 of 61, or 88.5%). Unilateral and bilateral cervical lymph nodes were affected in 54 and 7 patients, respectively. The dimensions of affected lymph nodes were commonly in the range of 0.5 to 4 cm (57 of 61, or 93.4%). In 2 patients, the size of the enlarged lymph nodes was greater than 6 cm. Leukopenia was observed in 14 patients (23%); fever, in 18 patients (29.5%). Five patients had a past history of tuberculosis. Two patients developed systemic lupus erythematosus, 1 month and 5 years later, respectively. The cervical lymphadenopathy usually resolved without any medical treatment within 6 months after definite diagnosis was made. In 3 patients, the enlarged lymph nodes eventually disappeared after more than 1 year. No recurrence has since been noted.
CONCLUSION: The results of this study support the theory that KD is a self-limiting disorder that does not require any specific management. The female predominance was not as striking as in the studies performed in Western countries. We suggest that the patients with KD require a systemic survey and regular follow-up for several years; 2 of our patients developed systemic lupus erythematosus. An effective communication between the otolaryngologist and pathologist is needed because the clinical and pathologic characteristics of KD are essential in making an accurate diagnosis.
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Affiliation(s)
- Hsin-Ching Lin
- Department of Otolaryngology, Kaohsiung Hsien, Taiwan Republic of China
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Abstract
We describe a rare but typical case of Kikuchi-Fujimoto disease (KFD). Two subcutaneous nodules appeared suddenly on the right of the neck of a 15-year-old girl. Microscopy of a surgical specimen of the larger nodule showed necrotizing lymphadenitis. Prompt treatment with mepirizole resulted in the disappearance of the smaller nodule. No recurrence was noted during 6 months of follow-up. KFD is a rare, self-limiting, necrotizing histiocytic lymphadenitis that needs to be differentiated from malignant lymphoma. Any nodal biopsy showing fragmented nuclei, necrosis, and karyorrhexis without prominent neutrophils should alert the physician to consideration of KFD, especially in a young woman presenting with cervical lymphadenopathy.
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Affiliation(s)
- Chih-Hung Lee
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan
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Liao AC, Chen YK. Cervical lymphadenopathy caused by Kikuchi disease: positron emission tomographic appearance. Clin Nucl Med 2003; 28:320-1. [PMID: 12642715 DOI: 10.1097/01.rlu.0000057562.26451.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alfred C Liao
- Department of Nuclear Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Ramirez AL, Johnson J, Murr AH. Kikuchi-Fujimoto's disease: an easily misdiagnosed clinical entity. Otolaryngol Head Neck Surg 2001; 125:651-3. [PMID: 11743471 DOI: 10.1067/mhn.2001.120431] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- A L Ramirez
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 400 Parnassus Ave., San Francisco, CA 94131, USA
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Moorchung N, Shah RS, Tiwari RK. KIKUCHIS DISEASE. Med J Armed Forces India 2001; 57:241-2. [PMID: 27365609 DOI: 10.1016/s0377-1237(01)80054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- N Moorchung
- Graded Specialist (Pathology), Military Hospital, Saugor
| | - R S Shah
- Senior Advisor (Pathology), Command Hospital (Central Command), Lucknow
| | - R K Tiwari
- Classified Specialist (Surgery), Military Hospital, Saugor
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Abstract
UNLABELLED Chronic adenopathies usually reveal lymphoma or infectious disease, particularly tuberculosis. CASE REPORT We report a case of Kikuchi-Fujimato's disease revealed by cervical adenopathies, associated with fever and inflammatory syndrome. CONCLUSION The diagnosis of Kikuchi-Fujimato's disease lies on histological examination. Resolution is faster with steroids.
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Affiliation(s)
- M V Vodoff
- Service de pédiatrie 1, hôpital Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
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