Kikuchi Disease Manifesting as Multifocal Lymphadenopathy and Splenomegaly: Ultrasonography, CT, and ¹⁸F-FDG PET/CT Findings Mimicking Lymphoma

Abstract

Kikuchi disease is a type of benign, self-limiting necrotizing lymphadenitis that occurs most commonly in young women and usually manifests as palpable cervical lymph nodes and fever. Patients with an unusual location of lymph node involvement can be misdiagnosed with malignant disease. Here, we report a case of Kikuchi disease in a 15-year-old girl presenting with persistent fever for 2 weeks. Imaging studies, including ultrasonography, CT, and 18 F-fluorodeoxyglucose PET/CT, revealed splenomegaly and enlarged lymph nodes in the neck, axilla, abdomen, retroperitoneum, and inguinal region. Laparoscopic excision of the celiac lymph nodes confirmed histiocytic necrotizing lymphadenitis, also known as Kikuchi disease. Conservative treatment with corticosteroids improved the patient's condition.

Abdominal Kikuchi-Fujimoto lymphadenopathy: an uncommon presentation of a rare disease

“…However, more than 47 cases of intra-abdominal KFD have been described in the literature. Of those, most had mesenteric lymphadenopathies, and concomitant extra-abdominal lymphadenopathies were often present 7 14–16…”

“…A sequential workup aims to avoid invasive diagnostic procedures unless absolutely necessary, particularly when, as in this case, no superficial nodes were identified for excision and definitive diagnosis required biopsy of mesenteric lymph nodes. Positron emission tomography (PET)/CT imaging has been studied as an alternative diagnostic modality for KFD, but at the time of writing, imaging techniques did not provide sufficient diagnostic evidence to replace lymph node biopsy as the diagnostic technique of choice 16. However, application of PET/CT scanning to seek easily accessible affected superficial lymph nodes should be considered in patients with deep node involvement who are either ineligible for surgery or refuse intra-abdominal biopsy.…”

La enfermedad de Kikuchi-Fujimoto: una gran imitadora. A propósito de un caso

“…La presentación clínica más común de la EKF son las linfoadenopatías regionales en la mayoría de los pacientes y un síndrome febril prolongado en el 30 al 50 % de los casos. La principal ubicación de las adenopatías son en el cuello, principalmente en el triángulo posterior (99 %), seguido a nivel axilar (7 %), región inguinal (6 %), mesenterio (2 %) y área retroperitoneal (1 %) 11 .…”