[Subacute necrotizing lymphadenitis showing lymphatic blockade-mediated acute respiratory failure].
A 24-year-old woman was referred to our hospital with fever and cervical lymphadenopathy. On admission, her serum concentration of soluble IL-2 receptor had increased to 1,740 IU/ml, LDH was 2,889 IU/l, and ferritin was 2,389 ng/ml. Dyspnea became evident (PaO2 60 Torr) with a further increase of serum ferritin to 96,552 mg/ml on day 11. Chest CT findings showed the thickening of the interlobular septa, bilateral pleural effusion, and swelling of mediastinal lymph nodes, symptoms which were very similar to those associated with lymphangitis carcinomatosis. She received steroid pulse therapy (methylprednisolone, 1,000 mg/day for three days). This resulted in a rapid improvement of her dyspnea and disappearance of the lymphatic blockade-mediated pulmonary findings in two days. A cervical lymph node biopsy was performed on day 12, and revealed that she had subacute lymphadenitis (Kikuchi disease). This case suggests that acute respiratory failure should be considered in cases of Kikuchi disease when associated with a lymphatic blockade.
Aota
Yasuo
Y
First Department of Internal Medicine, Tokyo Medical University.
Iguchi
Tomotaka
T
Sasaki
Yuko
Y
Yokoyama
Tomohisa
T
Shoji
Nahoko
N
Itoh
Yoshikazu
Y
Miyazawa
Keisuke
K
Matubayashi
Jun
J
Mukai
Kiyosi
K
Ohyashiki
Kazuma
K
D000208:Acute Disease; D000328:Adult; D005260:Female; D020042:Histiocytic Necrotizing Lymphadenitis / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008196:Lymph / Q000502:physiology; D009336:Necrosis; D012131:Respiratory Insufficiency / Q000209:etiology*