Two Cases of Kikuchi Disease Presenting with Aseptic Meningitis and Encephalitis

Abstract

Kikuchi disease, also called histiocytic necrotizing lymphadenitis, is an idiopathic and generally self-limiting disease affecting young adults and children. Kikuchi disease does not commonly manifest neurological complications at its initial presentation. We herein report two cases of Kikuchi disease that initially presented with aseptic meningitis and encephalitis rather than the more common signs of lymphadenopathy, rash, and arthritis. A 15-year-old boy presented with aseptic meningitis with an extremely high intracranial pressure. A 28-year-old man presented with dysesthesia of the right lower extremity, coinciding with abnormal magnetic resonance imaging findings. In both cases, painful cervical lymphadenopathy was observed following the central nervous system symptoms. Both patients improved after treatment with steroids. Kikuchi disease occasionally affects the central nervous system, to which lymphadenitis may be observed subsequently. A repeated, careful physical examination of the cervical lymph nodes may be helpful for the diagnosis.

Keywords: Kikuchi disease; aseptic meningitis; encephalitis; neurological symptoms; painful cervical lymphadenopathy.

Figure.

Transverse fluid-attenuated inversion recovery (FLAIR)-weighted imaging shows an area with a high signal intensity (circle) in the left parietal lobe (A). The high signal intensity disappeared after the administration of a steroid (B).