Swollen Glands In The Neck – It’s Not Always Cancer
This is an actual case. Details have been changed slightly to maintain confidentiality.
A 45-year-old lady who was normally fit and well came to my clinic with complaints of small glands that she felt in her neck.
She visited a local general practitioner, who prescribed her a course of antibiotics, but things did not seem to improve. She did not complain of fever or weight loss and was normally active at her job, however, the glands had become painful and she was concerned about them.
On examination, the glands felt quite hard and were only felt on the right side of the neck. Obviously, it was quite concerning to both the patient and myself and hence an ultrasound scan of the neck along with a biopsy of the lymph nodes was performed.
There was a worry that this might either be tuberculosis or some form of cancer. Both of these conditions would impact her job and family life.
After a wait of around three days, the reports finally revealed a condition called Kikuchi disease.
This is a rare condition and was my fifth case in the last 10 years. I thought I would talk about this condition briefly in today’s ‘The Patient Files’ article.
Understanding Kikuchi Disease
Kikuchi disease, also known as Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis, is a rare but benign condition. It primarily affects the lymph nodes, which are small glands that play a crucial role in the immune system by filtering harmful substances and fighting infections.
Who Does It Affect?
Kikuchi disease most commonly affects young adults, particularly women under the age of 40. Although it can occur in people of all ages and genders, it is less common in older adults and young children. The disease is found worldwide but appears more frequently in people of Asian descent.
How Does It Occur?
The exact cause of Kikuchi disease is unknown, but it is thought to be related to an abnormal immune response. Given that it frequently follows a flu-like illness, some researchers think viral infections might be the cause. However, no specific virus has been definitively linked to the condition.
Clinical Symptoms and Signs
The symptoms of Kikuchi disease can vary but often include:
Swollen lymph nodes: Usually in the neck, these nodes can become tender and painful. It is seen in 100% of cases. The glands vary between 0.5 to 4 cm.
Fever: Many patients (around 30–50%) experience a mild to moderate fever. It usually lasts for a week, but some patients have reported fevers lasting up to a month.
Fatigue: General tiredness and weakness are frequently reported.
Weight loss: Unintentional weight loss can occur in some cases.
Rash: Occasionally, a skin rash may develop.
These symptoms can last from a few weeks to several months and typically resolve on their own.
Rare cases may present as neurological symptoms. Aseptic meningitis, which is inflammation of the lining of the brain, is the most common neurological complication.
There are some cases of association with COVID-19.
Diagnosis
Diagnosing Kikuchi disease can be challenging because its symptoms are similar to those of other conditions, such as infections,, tuberculosis, lymphoma (a type of cancer), or autoimmune diseases like lupus.
A thorough medical history and physical examination are essential. Some of the commonly performed tests include:
Lymph node biopsy: The definitive diagnosis is made through a biopsy of the affected lymph node. A small sample of tissue is examined under a microscope to look for characteristic signs of the disease.
Blood tests: While blood tests are not specific for Kikuchi disease, they can help rule out other conditions.
Imaging studies: Ultrasound or CT scans may be used to evaluate the extent of lymph node involvement. This is usually unnecessary
Treatment Options
There is no specific treatment for Kikuchi disease, as it often resolves on its own over 3 to 4 months. However, supportive care can help manage symptoms.
Pain relief: Over-the-counter pain relievers like ibuprofen or acetaminophen can help reduce pain and fever.
Rest and hydration: Adequate rest and fluids are essential for recovery.
Corticosteroids: In more severe cases, doctors might prescribe steroids to reduce inflammation and speed up recovery.
Most people recover fully without long-term complications. However, a small number of cases may develop Systemic Lupus Erythematosus years later. Regular follow-up with a doctor is important to monitor progress and ensure that symptoms are improving.
Conclusion
Kikuchi disease, while rare, is a condition that primarily affects young adults and manifests through swollen lymph nodes, fever, and other flu-like symptoms.
Though its exact cause is unknown, it is generally self-limiting and responds well to supportive care. If you suspect you have symptoms of Kikuchi disease, it is crucial to seek medical advice for an accurate diagnosis and appropriate management.
Dr Vivek Baliga is a medical practitioner and the director of a diagnostic center – Baliga Diagnostics – in Bangalore. He specializes in diabetes and heart disease, and is a visiting consultant in Internal Medicine at corporate hospitals. He is married and has one son.
