Clinical Characteristics of Subacute Necrotizing Lymphadenitis

Lee, Hyung Seok; Tae, Kyung; Jang, Kyung Jin; Lee, Eung Jun; Kim, Sun Kon

Abstract

BACKGROUND AND OBJECTIVES: Subacute necrotizing lymphadenitis or Kikuchi's disease is a self-limiting process of uncertain etiology that predominantly affects young women aged 20-30 years. Epstein-Barr virus (EBV), human herpesvirus-6 and toxoplasma have been suggested as potential etiologic agents. Even though this disease is self-limited, benign process, many cases are misidentified as malignant lymphoma. The purpose of this study is to report the clinicopathologic finding, radiologic finding and many laboratory tests and to elaborate the criteria that are useful in distinguishing this entity from lymphoma.
MATERIALS AND METHODS
Authors evaluated 24 patients, who were diagnosed as subacute necrotizing lymphadenitis on excisional biopsy or fine needle aspiration cytology with retrospective chart review.
RESULTS
The most common symptoms were cervical lymphadenopathy (96%), fever (76%) and cervical tenderness (72%). The most common site of the involvement of cervical lymph node were the upper, middle jugular and spinal accessary chains. The bilateral involvement of cervical lymph node was 69% and unilateral involvement was 31%. Microscopically, the characteristic finding was the wide area of florid nuclear dusts engulfed by histiocytes or distributed extracellularly and absence of polymorphonuclear leukocytes and plasma cells.
CONCLUSION
This disease may be easily mistaken for malignant lymphoma clinically, pathologically, radiologically. So we should consider open biopsy of lymph node in the patients which had localized cervical adenopathy associated with fever and night sweat and all of which were unresponsive to antibiotic therapy, especially in young women.