Case Presentation:
A 23 year‐old Japanese male with a past medical history of Kikuchi disease (Histiocytic Necrotizing Lymphadenitis) presented with fever, malaise and left axillary lymphadenopathy. 25 days before admission, he felt his left axillary lymphnode was swollen and he had a mild grade of fever. He felt pain in his left axilla which was slightly improved by oral acetaminophen. 10 days before admission, he felt his axillary lymphadenopathy getting worse and he developed a high‐grade fever, malaise, and shaking chill. Though he took oral NSAIDs, his pain was not improved, so he was admitted to our hospital. A blood test proved negative for HIV, cytomegalovirus IgM and IgG antibody, and positive for EBV‐VCA IgG antibody and EBNA. Antinuclear antibody was negative. Axillary sonography was performed and showed axillary lymphadenopathy. We suspected Kikuchi disease, and axillary lymphnode biopsy was performed on day 3 of admission. We prescribed oral NSAIDs and acetaminophen for his axillary pain, but it proved ineffective. Finally the diagnosis of Kikuchi disease was confirmed by the histology of his axillary lymphnode. He was unresponsive to oral NSAIDs. So he was treated with intravenous methylprednisolone pulse therapy, 500mg once daily for 3 days, after which his symptoms of fever and left axillary pain were much improved.
Discussion:
There is no specific treatment for Kikuchi disease. Because Kikuchi disease is self‐limiting, most patients with this disease are treated symptomatically (e.g. NSAIDs or rest). When patients suffer from persistent severe symptoms and recurrence, oral predonisolone therapy is indicated. However the response to oral prednisolone is not always immediate and not all patients respond to oral prednisolone therapy. It was reported that some Japanese patients responded rapidly to intravenous methylprednisolone pulse therapy without any adverse event. The patient in this case was improved rapidly following intravenous methylpredonisolone pulse therapy.
Conclusions:
Methylpredonisolone pulse therapy is warranted in patients with Kikuchi disease who suffer from prolonged severe symptoms, do not respoind to symptomatic treatment and desire a faster return to work.