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G338(P) Subacute cervical lymphadenopathy: Could this be Kikuchi Disease?
  1. S Suhumaran1,
  2. SN Selvanathan1,
  3. VK Sahu1,
  4. KC Thoon2
  1. 1General Paediatrics, KK Women’s and Children’s Hospital, Singhealth, Singapore
  2. 2Paediatric Infectious Diseases, KK Women’s and Children’s Hospital, Singhealth, Singapore

Abstract

Aims To describe clinical characteristics of childhood Kikuchi Disease (KD) so as to increase awareness among clinicians; this would hopefully lead to early recognition and appropriate management. We also sought to determine risk factors for recurrent KD.

Methods This was a retrospective review of children <16 years-of-age with histologically proven KD from 2005 to 2012. We retrieved clinical records and collected data on clinical characteristics, laboratory findings, treatment and outcomes. Chi-Square analysis was performed to determine risk factors for recurrent KD.

Results Fifty-two patients were identified; 56% (29/52) were male, with a median age of 11.1 years (92.3% were older than 7 years-of-age). Thirty-one children (59.6%) presented with fever, with a median duration of 10 days. At presentation, 24 children (46.1%) had complaints of fever and neck swelling, 21 had neck swelling alone, while 7 presented only with fever. Median duration of neck swelling at presentation was 28 days. Despite this, all cases had prominent cervical lymphadenopathy detected on physical examination.

Two children (3.8%) had a history of Kawasaki disease, 2 had lymphoma/ leukaemia previously requiring chemotherapy, and 2 had a family history of Systemic Lupus Erythematosus (SLE). Five (9.6%) had a recent history of cervical lymphadenitis. Out of 32 children tested for antinuclear antibody (ANA) titres, 5 were positive; only 1 had a titre >1/800.

None of the patients responded to antibiotic therapy, and all required complete excision biopsy, with a median time to diagnosis of 9.5 days. Sixteen patients (30.8%) did not respond to complete excision and required adjunctive steroid therapy. Median duration of steroid therapy was 16 days.

Median duration of follow-up was 1 year. Six children (11%) had recurrent KD. The only risk factor identified for recurrent KD was fever at initial presentation (p = 0.032). One patient, who was diagnosed with KD at 5 years of age, subsequently developed SLE at age 15 (he was ANA negative throughout presentation and subsequent follow-up).

Conclusion Kikuchi Disease should be considered in children with subacute cervical lymphadenopathy with or without prolonged fever. These children are at risk of developing subsequent SLE and long-term follow-up is required.

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