Kikuchi Disease with Generalized Lymph Node, Spleen and Subcutaneous Involvement Detected by Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.

Alshaima Alshammari,Rasha Ashkanani,Nafisa Kazem,Evangelia Skoura

doi:10.4274/mirt.25338

Alshaima Alshammari, Rasha Ashkanani + Show 2 more

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https://doi.org/10.4274/mirt.25338

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Abstract

Kikuchi-Fujimoto disease, known as Kikuchi disease, is a rare benign and self-limiting disorder that typically affects the regional cervical lymph nodes. Generalized lymphadenopathy and extranodal involvement are rare. We report a rare case of a 19-year-old female with a history of persistent fever, nausea, and debilitating malaise. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed multiple hypermetabolic generalized lymph nodes in the cervical, mediastinum, axillary, abdomen and pelvic regions with diffuse spleen, diffuse thyroid gland, and focal parotid involvement, bilaterally. In addition, subcutaneous lesions were noted in the left upper paraspinal and occipital regions. An excisional lymph node biopsy guided by 18F-FDG PET/CT revealed the patient’s diagnosis as Kikuchi syndrome.

Highlights

Kikuchi-Fujimoto disease (KFD) known as Kikuchi disease or histiocytic necrotizing lymphadenitis is a rare idiopathic and self-limiting disorder that typically affects the regional cervical lymph nodes [1]
The patient underwent imaging with fluorine18-fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) to investigate the cause of fever. 18F-FDG PET/CT scan showed multiple hypermetabolic lymph nodes with generalized involvement: in the neck (Figure 1), mediastinum (Figure 2), axillary (Figure 2), abdomen and pelvic regions with diffuse spleen uptake (Figure 3)
Later studies suggested that up to 30% of patients with KFD have been reported to be initially misdiagnosed as malignant lymphoma and that some of them received unnecessary chemotherapy [20]

Summary

Introduction

Molecular Imaging and Radionuclide Therapy, published by Galenos Publishing. Alshammari et al Kikuchi Disease with Generalized Lymphadenopathy the condition was reported in children [10]. Its treatment is largely supportive, mainly with anti-inflammatory and antimicrobial drugs; differentiating it from other more serious conditions is important to guide management [15,16,17]. The patient had normal values of urea, creatinine, and serum electrolytes. She was investigated for SLE, but her antinuclear factor, double-stranded DNA, and anti-neutrophil cytoplasmic antibody were all negative. The patient underwent imaging with fluorine18-fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) to investigate the cause of fever. 18F-FDG PET/CT scan showed multiple hypermetabolic lymph nodes with generalized involvement: in the neck (Figure 1), mediastinum (Figure 2), axillary (Figure 2), abdomen and pelvic regions with diffuse spleen uptake (Figure 3). An excisional cervical lymph node biopsy guided by 18F-FDG PET/CT was performed.

Literature Review and Discussion

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Conclusion