DOI QR코드

DOI QR Code

다발성 림프절염과 비장종대로 발현하여 림프종으로 오인된 기쿠치병의 초음파, CT, 18F-FDG PET/CT 소견

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

  • 하모인 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 제보경 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 이응석 (고려대학교 의과대학 안산병원 병리과) ;
  • 이성욱 (고려대학교 의과대학 안산병원 소아청소년과)
  • Moin Ha (Department of Radiology, Korea University College of Medicine, Ansan Hospital) ;
  • Bo-Kyung Je (Department of Radiology, Korea University College of Medicine, Ansan Hospital) ;
  • Eung-Seok Lee (Department of Pathology, Korea University College of Medicine, Ansan Hospital) ;
  • Seong Wook Lee (Department of Pediatrics, Korea University College of Medicine, Ansan Hospital)
  • 투고 : 2020.01.16
  • 심사 : 2020.03.20
  • 발행 : 2020.11.01

초록

기쿠치병은 주로 아시아에 거주하는 젊은 여성에서 경부 림프절 비대와 열을 주소로 나타나는 조직구 괴사성 림프절염이며 자연적으로 치유되는 양성질환이다. 기쿠치병이 전형적으로 발현하는 위치가 아닌 림프절에서 발생하면 진단이 어려워지고 악성 질환으로 오인되기도 한다. 저자들은 2주간 지속되는 발열을 주소로 내원하여 시행한 초음파와 CT, 18F-fluorodeoxyglucose PET/CT에서 비장 종대와 경부, 액와부, 복강, 후복강, 서혜부 림프절 비대를 보여 림프종을 의심하였던 15세 여자 환아 증례를 보고한다. 복강 림프절 절제술로 기쿠치병을 진단하였다. 이후, 환자는 스테로이드로 보존적인 치료를 받고 발열 증상이 호전되어 퇴원하였다.

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 18F-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.

키워드

참고문헌

  1. Kikuchi M. Lymphadenitis showing focal reticulum cell hyperplasia with nuclear debris and phagocytes: a clinicopathological study. Acta Haematol Jpn 1972;35:379-380
  2. Fujimoto Y, Kojima Y, Yamaguchi K. Cervical subacute necrotizing lymphadenitis: a new clinicopathologic entity. Naika 1972;20:9207
  3. Bosch X, Guilabert A, Miquel R, Campo E. Enigmatic Kikuchi-Fujimoto disease: a comprehensive review. Am J Clin Pathol 2004;122:141-152
  4. Kim JE, Lee EK, Lee JM, Bae SH, Choi KH, Lee YH, et al. Kikuchi-Fujimoto disease mimicking malignant lymphoma with 2-[18F]fluoro-2-deoxy-D-glucose PET/CT in children. Korean J Pediatr 2014;57:226-231
  5. Kang HM, Kim JY, Choi EH, Lee HJ, Yun KW, Lee H. Clinical characteristics of severe histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease) in children. J Pediatr 2016;171:208-212.e1
  6. Vijayaraghavan R, Chandrashekar R, A Saraswathi, Belagavi CS. Kikuchi-Fujimoto's disease involving mesenteric nodes: a report and review of literature. BMJ Case Rep 2011;2011:bcr1020114945
  7. Lo WC, Chang WC, Lin YC, Hsu YP, Liao LJ. Ultrasonographic differentiation between Kikuchi's disease and lymphoma in patients with cervical lymphadenopathy. Eur J Radiol 2012;81:1817-1820
  8. Kwon SY, Kim TK, Kim YS, Lee KY, Lee NJ, Seol HY. CT findings in Kikuchi disease: analysis of 96 cases. AJNR Am J Neuroradiol 2004;25:1099-1102
  9. You SH, Kim B, Yang KS, Kim BK. Cervical necrotic lymphadenopathy: a diagnostic tree analysis model based on CT and clinical findings. Eur Radiol 2019;29:5635-5645
  10. Zou Q, Jiao J, Yang T, Zhang Y. Role of 18F-FDG PET/CT in the assessment of Kikuchi-Fujimoto disease and its differential diagnosis from non-Hodgkin lymphoma. J Nucl Med 2019;60:1073