A 22-year-old man came to the clinic with a painful lymphadenopathy in the left laterocervical region that had been present for 4 months and had not decreased in size with the use of antibiotics or NSAIDs. He reported several days of fever of up to 38 ºC and profuse night sweats, coinciding with cough and pharyngeal discomfort, symptoms that disappeared in a few days.
On examination, the patient had a lymphadenopathy in the left laterocervical region measuring 2 cm in diameter, not adhering to superficial or deep planes, not painful on palpation and with an elastic consistency. He also had two other lymphadenopathies of similar characteristics, approximately 1.5 cm in diameter, in the left supraclavicular region and right laterocervical region. The rest of the examination showed no findings of interest.
A complete blood count, biochemistry with tumour markers (CEA, α FP, PSA), chest X-ray, abdominal ultrasound and immunological study (ANAs, ANTI-RNP, ANTI-SSB, ANTI-Sm, ANTI-RO, ANTI-CENTROMER, RF and immunoglobulins) were performed, with normal results. Mantoux was negative.
Serology was performed, with the following results: toxoplasmosis, brucellosis, CMV, EBV, HIV, syphilis, adenovirus, mycoplasma, HBV, HCV, Salmonella typhi and paratyphi, C. psitacci, pneumoniae and trachomatis and Rickettsia negative; immunised for rubella and measles (IgG +, IgM -); positive serology for mumps (IgG + weak, IgM +).
Biopsy of the left laterocervical adenopathy was performed, with the following result: lymph node showing preserved architecture, except in an area affecting the cortical and paracortical areas where a necrotic process associated with T lymphoid proliferation was observed, consisting of highly activated lymphocytes, with the presence of immunoblasts and abundant histiocytes, many of which phagocytose cellular detritus. No granulocytes are present. The rest of the lymph node shows follicles with activated germinal centres and stimulation of the paracortical area. This biopsy was diagnostic of histiocytic necrotising lymphadenitis or Kikuchi-Fujimoto disease.
