Kikuchi’s disease

Inleiding

Histiocytaire aandoeningen zijn zeer zeldzaam (incidentie bij volwassenen minder dan 5 per miljoen) en hematologen worden er maar incidenteel mee geconfronteerd. Hieronder volgen enkele globale adviezen voor diagnostiek en therapie, waarbij de tekst beperkt is in de zorg voor volwassenen.

Kikuchi’s disease

Officiële naam: histiocytic necrotizing lymphadenopathy. Komt voornamelijk bij jonge vrouwen voor (vaak van Aziatische afkomst) in de vorm van (meestal eenzijdige) cervicale lymfadenopathie, bij 50% gepaard gaande met koorts. De klieren verdwijnen meestal binnen 1 tot 4 maanden. Er wordt een verband gelegd met auto-immuunziekten, zoals SLE, welk ziektebeeld ook uitgesloten moet worden.

Literatuurlijst

1. Kerkhof M, van der Valk H, van Zaanen HCT. Een jonge vrouw met cervicale lymfadenopathie en B-symptomen; denk ook aan de ziekte van Kikuchi-Fujimoto. Ned Tijdschr Hematol 2009;6:116-120.
2. Lin HC, Su CY, Huang CC, Hwang CF, Chien CY. Kikuchi’s disease: a review and analysis of 61 cases. Otolaryngol Head Neck Surg 2003;128:650-3. Voor tekst abstract, zie hieronder:
   OBJECTIVE: Kikuchi’s disease (KD), or histiocytic necrotizing lymphadenitis, is a rare self-limiting disorder that typically affects the cervical lymph nodes. It has occasionally been misdiagnosed as malignant lymphoma or another serious diseases; hence, clinicians should be made more aware of this disease.
   METHODS: From January 1986 to January 2001, a series of 61 patients who underwent a biopsy of a cervical lymph node and proved histologically to have KD were enrolled in this study. We retrospectively reviewed the clinical records and pathologic parameters of each patient. The patients were followed up from 6 months to 14.3 years (mean, 6.9 years).
   RESULTS: There were 34 women and 27 men (1.26:1 ratio; age range, 6 to 46 years; mean age, 21 years). The affected cervical lymph nodes were commonly located in the posterior cervical triangle (54 of 61, or 88.5%). Unilateral and bilateral cervical lymph nodes were affected in 54 and 7 patients, respectively. The dimensions of affected lymph nodes were commonly in the range of 0.5 to 4 cm (57 of 61, or 93.4%). In 2 patients, the size of the enlarged lymph nodes was greater than 6 cm. Leukopenia was observed in 14 patients (23%); fever, in 18 patients (29.5%). Five patients had a past history of tuberculosis. Two patients developed systemic lupus erythematosus, 1 month and 5 years later, respectively. The cervical lymphadenopathy usually resolved without any medical treatment within 6 months after definite diagnosis was made. In 3 patients, the enlarged lymph nodes eventually disappeared after more than 1 year. No recurrence has since been noted.
   CONCLUSION: The results of this study support the theory that KD is a self-limiting disorder that does not require any specific management. The female predominance was not as striking as in the studies performed in Western countries. We suggest that the patients with KD require a systemic survey and regular follow-up for several years; 2 of our patients developed systemic lupus erythematosus. An effective communication between the otolaryngologist and pathologist is needed because the clinical and pathologic characteristics of KD are essential in making an accurate diagnosis.