[Generalized lymphadenitis associated with Hashimoto's thyroiditis]

Abstract

History and admission findings: A 26-year-old Pakistani woman was admitted to hospital with fever, nausea and vomiting, abdominal pain and general weakness for the previous two weeks, but no diarrhea or constipation. Antibiotic therapy as an out-patient had not provided relief. She also had enlarged cervical lymph nodes. She reported that she had always been in good health before onset of the described symptoms.

Investigations: Laboratory tests revealed pancytopenia and a decrease in C3 and C4. The ANA titer was positive. The serum was positive for preceding infections with EBV, CMV, Chlamydia trachomatis, HHV type 6, and toxoplasmosis. There was no evidence of current or previous infections with HIV, Bartonella henselae, Treponema pallidum, Listeria, Hantavirus, Leishmania or dengue fever. The patient's symptoms were found to be associated with Hashimoto's thyroiditis in conjunction with latent hypothyroidism. Abdominal, thoracic and cervical CT scan revealed enlarged lymph nodes, up to 2 cm in size, and enlarged spleen and liver.

Therapy and clinical course: Histopathology of a cervical lymph node showed features of Kikuchi (Kikuchi-Fujimoto) disease (histiocytic necrotizing lymphadenitis). Prednisone administration (2 mg/kg body weight) led to the patient's rapid recovery.

Conclusion: Kikuchi disease should be considered in patients with cervical but also general lymphadenopathy, after exclusion of other causes. The specific diagnosis is based on biopsy of affected lymph nodes.