Kikuchi-Fujimoto Disease in 21-Year-Old Man
The patient was a 21-year-old man with chief complaints of chills, fever, cervical lymphadenopathy and myalgia. On admission vital signs were as: T = 39°C, PR = 90/min, RR = 15/min, BP = 100/60 mmHg. The patient was conscious and orient. Physical examination of chest, heart, abdomen, extremities and neurologic examination were normal. He had swelling and tenderness of cervical area and multiple enlarged lymph nodes were palpable. Examination of pharynx revealed no erythema or exudation. Tonsils were normal. Laboratory findings were as follow:\nCBC: WBC = 15700, Hb = 13.6 g/dl, Plt = 209,000, ESR = 92 mm, CRP = 24 mg/l, BUN = 18 mg/dl, Cr = 1 mg/dl, Na = 143 meq/dl, K = 4.5 meq/dl, FBS = 78 mg/dl. ALT = 25 U/L, AST = 33 U/L, PT = 12.5 s, PTT = 28 s, ALP = 278 U/L, LDH = 1398 U/L, CPK = 52 IU/L, INR = 1. Urine analysis and peripheral blood smear were normal. Wright, widal, HBs-Ag and HIV-Ab were negative. EBV, CMV and toxoplama antibodies (IgM and IgG) were negative.\nCervical soft tissue sonography showed multiple lymph nodes with different size. The largest was 9 * 15 mm.\nCeftriaxone and azithromycin was started for him. Cervical lymph node excisional biopsy was performed. Microscopic examination showed reactive follicular hyperplasia and some areas of monocytoid lymphoid cells hyperplasia with vast areas of necrosis without neutrophilic infiltration. No sign of malignancy was seen. Final diagnosis was Kikuchi-Fujimoto necrotizing lymphadenitis. Prednisolone 25 mg daily was started for him. Fever disappeared and general condition improved gradually. The patient was discharged with good condition and outpatient follow-up.