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Cao Dinh H, Doan DM, Tran KQ, Tran TT, Nguyen SL. Kikuchi-Fujimoto disease co-occuring with Hashimoto thyroiditis: A case report and literature review. Ann Clin Biochem 2024:45632241280595. [PMID: 39256357 DOI: 10.1177/00045632241280595] [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: 09/12/2024]
Abstract
We introduce a 16-year-old female who presented with tender cervical lymphadenopathy, prolonged fever, and hypothyroidism. After excluding common causes of fever of unknown origin, a surgical biopsy of cervical lymph nodes revealed Kikuchi-Fujimoto disease. The patient showed improvement with a short-term course of NSAIDs. An increased titre of thyroperoxidase antibody led to a diagnosis of Hashimoto's thyroiditis during stable condition. This report underscores the importance of considering Kikuchi-Fujimoto disease in the differential diagnosis of prolonged fever of unknown origin with lymphadenopathy and highlights the association with Hashimoto's thyroiditis, advocating for vigilance regarding hypothyroidism in long-term follow-up after Kikuchi-Fujimoto disease recovery.
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Affiliation(s)
- Hung Cao Dinh
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
- Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Dung Manh Doan
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Khanh Quang Tran
- Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Trung The Tran
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Si Luc Nguyen
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
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Grewal S, Jawad AS. Recurrence of Kikuchi-Fujimoto Disease following influenza vaccination, diagnosis aided using ultrasound examination. Rheumatol Adv Pract 2024; 8:rkae104. [PMID: 39233786 PMCID: PMC11374019 DOI: 10.1093/rap/rkae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/06/2024] Open
Affiliation(s)
- Simran Grewal
- Department of Rheumatology, Royal London Hospital, London, UK
| | - Ali S Jawad
- Department of Rheumatology, Royal London Hospital, London, UK
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Zhang W, Yang G, Xu J, Ni T, Tang W, Zhou M. Analysis of bleeding after ultrasound-guided needle biopsy of benign cervical lymph nodes. BMC Surg 2023; 23:71. [PMID: 36991353 DOI: 10.1186/s12893-023-01964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
AIM Summarized the incidence of bleeding after ultrasound-guided coarse needle biopsy (US-CNB) of benign cervical lymph nodes. METHODS We retrospectively examined the clinical and follow-up records of 590 patients with benign cervical lymph node disease who underwent US-CNB at our hospital during February 2015-July 2022 and were confirmed to have the disease by CNB and surgical pathology. The number of cases, types of diseases, and degree of bleeding of all patients with bleeding after US-CNB were statistically analyzed. RESULTS Of the 590 patients, bleeding was noted in 44 cases(7.46%), and the infectious lymph node bleeding rate was 9.48%. Infectious lymph nodes were more likely to bleed than noninfectious lymph nodes after CNB, ,x2 = 8.771; P = 0.003, Lymph nodes with pus were more likely to bleed than solid lymph nodes after CNB, x2 = 4.414; P = 0.036,. CONCLUSION The bleeding of all patients after CNB was minor bleeding. Infected lymph nodes bleed more frequently than noninfected lymph nodes. Lymph nodes with mobility and a large pus cavity, are more likely to bleed after CNB.
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Affiliation(s)
- Wenzhi Zhang
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang.
- Department of Pathology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital), No.208 Huancheng East Road, 310003, Hangzhou, Zhejiang, China.
| | - Gaoyi Yang
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Jianping Xu
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Tu Ni
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Wei Tang
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Meiling Zhou
- Department of Pathology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital), No.208 Huancheng East Road, 310003, Hangzhou, Zhejiang, China
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Park S, Kim JY, Ryu YJ, Lee H. Kikuchi Cervical Lymphadenitis in Children: Ultrasound Differentiation From Common Infectious Lymphadenitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2069-2078. [PMID: 33263358 DOI: 10.1002/jum.15584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate ultrasound (US) features of enlarged cervical lymph nodes (LNs) to differentiate between Kikuchi disease (KD) and other common types of infectious lymphadenitis in an East Asian pediatric patient population. METHODS A total of 142 pediatric patients with KD and 45 patients with infectious lymphadenitis (suppurative lymphadenitis [n = 29], nontuberculous mycobacterial lymphadenitis [n = 9], and tuberculous lymphadenitis [n = 7]) were included. The clinical characteristics, laboratory results, and US features of LNs were reviewed. The area under the curve (AUC) from a receiver operating characteristic curve analysis was used as a diagnostic accuracy measure. RESULTS A multiple clustered adjacent pattern, bilaterality, an even size, posterior neck involvement, no enlargement, an elongated-to-ovoid shape, homogeneous hypoechogenicity, a well-defined margin, presence of an echogenic fatty hilum, no intranodal gross necrosis, increased perinodal fat echogenicity, and no increased echogenicity of the adjacent sternocleidomastoid muscle were significant US features of the affected LNs to discriminate KD from infectious lymphadenitis (P < .05). Homogeneous hypoechogenicity in KD showed the highest AUC (0.930) as a single variable (95% confidence interval, 0.88-0.96). The AUCs were increased in 3 combination models with 2 US features: homogeneous echogenicity and 1 of 3 other US features (increased perinodal fat echogenicity, 0.935; number of affected LNs, 0.947; and LN shape, 0.949). CONCLUSIONS Homogeneous hypoechogenicity of LNs was a significant US feature with the highest diagnostic accuracy in differentiating KD from common infectious lymphadenitis on a univariate analysis. In the combination model, US features of an elongated-to-ovoid shape and homogeneous hypoechogenicity showed the highest diagnostic accuracy.
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Affiliation(s)
- Sunyoung Park
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Visible Lymphadenopathy in Kikuchi-Fujimoto Disease. J Pediatr 2020; 226:300. [PMID: 32526233 DOI: 10.1016/j.jpeds.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022]
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Park JE, Ryu YJ, Kim JY, Kim YH, Park JY, Lee H, Choi HS. Cervical lymphadenopathy in children: a diagnostic tree analysis model based on ultrasonographic and clinical findings. Eur Radiol 2020; 30:4475-4485. [PMID: 32189052 DOI: 10.1007/s00330-020-06794-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To establish a diagnostic tree analysis (DTA) model based on ultrasonography (US) findings and clinical characteristics for differential diagnosis of common causes of cervical lymphadenopathy in children. METHODS A total of 242 patients (131 boys, 111 girls; mean age, 11.2 ± 0.3 years; range, 1 month-18 years) with pathologically confirmed Kikuchi disease (n = 127), reactive hyperplasia (n = 64), lymphoma (n = 24), or suppurative lymphadenitis (n = 27) who underwent neck US were included. US images were retrospectively reviewed to assess lymph node (LN) characteristics, and clinical information was collected from patient records. DTA models were created using a classification and regression tree algorithm on the basis of US imaging and clinical findings. The patients were randomly divided into training (70%, 170/242) and validation (30%, 72/242) datasets to assess the diagnostic performance of the DTA models. RESULTS In the DTA model based on all predictors, perinodal fat hyperechogenicity, LN echogenicity, and short diameter of the largest LN were significant predictors for differential diagnosis of cervical lymphadenopathy (overall accuracy, 85.3% and 83.3% in the training and validation datasets). In the model based on categorical parameters alone, perinodal fat hyperechogenicity, LN echogenicity, and loss of fatty hilum were significant predictors (overall accuracy, 84.7% and 86.1% in the training and validation datasets). CONCLUSIONS Perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum were significant US findings in the DTA for differential diagnosis of cervical lymphadenopathy in children. KEY POINTS • Diagnostic tree analysis model based on ultrasonography and clinical findings would be helpful in differential diagnosis of pediatric cervical lymphadenopathy. • Significant predictors were perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea. .,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ji Young Park
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyoung Soo Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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Lee JM, Hwang JY, Bae J, Kim MR, Kim YW, Park SE, Yeom JA, Roh J. Acoustic radiation force impulse imaging of biopsy-proven Kikuchi disease: initial experiences for evaluating feasibility in pediatric patients. Ultrasonography 2018; 38:58-66. [PMID: 29914233 PMCID: PMC6323305 DOI: 10.14366/usg.17067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/24/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose This study evaluated the feasibility of acoustic radiation force impulse (ARFI) elastography and characterized the sonographic features of lymph nodes (LNs) with Kikuchi disease in pediatric patients. Methods Seventy-six cervical LN biopsies were performed for the diagnosis of cervical lymphadenopathy. ARFI imaging was performed, and the characteristic ultrasound features of the biopsied LNs and the contralateral LNs were analyzed. We also reviewed clinical and conventional ultrasonographic findings. Results On histology, 56 patients were diagnosed with Kikuchi disease. These LNs were large and elongated, with increased perinodal echogenicity and capsular thickening. In 38 of them, ARFI elastography was performed, and the median shear wave velocity (SWV) of the biopsied LNs with Kikuchi disease (2.19 m/sec; range, 1.45 to 4.57 m/sec) was higher than of the contralateral LNs (1.72 m/sec; range, 0.95 to 2.65 m/sec; P<0.001). In patients with reactive hyperplasia, the mean SWV of the biopsied LNs (2.00 m/sec; range, 1.49 to 2.26 m/sec) was higher than that of the contralateral LNs (1.55 m/sec; range, 1.21 to 2.32 m/sec; P=0.031). Conclusion The SWV of LNs with Kikuchi disease was significantly higher than that of the contralateral LNs. Morphologically, LNs with Kikuchi disease showed an enlarged, elongated, and oval shape, increased perinodal echogenicity, and capsular thickening. In addition to the conventional ultrasonographic findings, the application of ARFI is feasible even in pediatric patients for the evaluation of cervical lymphadenopathy.
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Affiliation(s)
- Jeong-Min Lee
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jihyun Bae
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Mae Ran Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong-Woo Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Eun Park
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jieun Roh
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Fidai SS, Cipriani NA, Ginat DT. Histiocytic Necrotizing Lymphadenitis Involving the Neck: Radiology-Pathology Correlation. Head Neck Pathol 2018; 13:648-651. [PMID: 29858834 PMCID: PMC6854164 DOI: 10.1007/s12105-018-0936-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 10/14/2022]
Abstract
Histiocytic necrotizing lymphadenitis is an uncommon autoimmune condition characterized by fever, leukopenia, and neck swelling. Diagnostic imaging, including ultrasound and CT, typically demonstrates conglomerates of enlarged cervical lymph nodes with hypervascular cortices and areas of necrosis. Ultimately, the diagnosis is confirmed with the histopathologic findings of paracortical coagulative necrosis with karyorrhectic debris, abundant histiocytes, and absence of neutrophils. Other potential etiologies, such as other causes of infectious lymphadenitis, tuberculosis, lymphoma, and systemic lupus erythematosus, must be excluded. These features are exemplified in this sine qua non radiology-pathology correlation article.
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Affiliation(s)
- Shiraz S. Fidai
- grid.170205.10000 0004 1936 7822Department of Pathology, University of Chicago, Chicago, IL USA
| | - Nicole A. Cipriani
- grid.170205.10000 0004 1936 7822Department of Pathology, University of Chicago, Chicago, IL USA
| | - Daniel T. Ginat
- grid.170205.10000 0004 1936 7822Department of Radiology, University of Chicago, 5841 S Maryland Avenue, Chicago, IL 60637 USA
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