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Volume 43, Number 5, October 2010

Clinical Presentations, Laboratory Results and Outcomes of Patients with Kikuchi’s Disease: Emphasis on the Association Between Recurrent Kikuchi’s Disease and Autoimmune Diseases


Chien-Yu Cheng, Wang-Huei Sheng, Yi-Chun Lo, Chen-Shuan Chung, Yee-Chun Chen, Shan-Chwen Chang


Received: February 25, 2009    Revised: June 30, 2009    Accepted: August 20, 2009   

 

Corresponding author:

Shan-Chwen Chang, Division of Infectious Diseases, Department of Internal Medicine, National Taiwan
University Hospital, 7 Chung Shan South Road, Taipei, Taiwan.
E-mail: changsc@ntu.edu.tw



 

Background and purpose: 

Kikuchi’s disease (KD), also known as histiocytic necrotizing lymphadenitis, is a benign and self-limiting disease of unknown etiology that mainly affects young women. There is limited data on the long-term prognosis of patients with KD.



 

Methods:

We describe the clinical manifestations and outcomes of 195 patients, diagnosed as having KD at National Taiwan University Hospital from March 1989 to September 2006.



 

Results:

All together, 53.3% of our patients presented with tender lymphadenopathy, 37.9% with fever and 16.9% with headache. The most common laboratory findings were elevated erythrocyte sedimentation rate (78.9%), elevated serum lactate dehydrogenase (52.5%), elevated C-reactive protein (38.3%), monocytosis (26.9%), elevated serum alanine aminotransferase (23.3%) and leukopenia (18.9%). A total of 183 patients followed a benign course, with spontaneous resolution of fever and lymphadenopathy. However, 14 patients (14.6%) with follow-up of more than 6 months had clinical recurrence of KD; hence, long-term follow-up is suggested. Five of these patients developed an autoimmune disease, namely, systemic lupus erythematosus (n = 2), Graves’ disease (n = 2), or mixed connective tissue disease (n = 1). One patient with recurrent KD died of intracranial hemorrhage due to thrombocytopenia.



 

Conclusion:

The prognosis for KD patients is generally optimistic; however, a concurrent autoimmune
disease or the risk of developing an autoimmune disease requires careful monitoring.



 

Key words:

autoimmune disease, histiocytic necrotizing lymphadenitis, Kikuchi’s diseas