We report the case of a 29-year-old man who consulted for fever of 38o of 48 hours of evolution, scarce cough and whitish expectoration.
On examination, hypertrophy was only observed in the left tonsil with large left jugular chain adenopathies (3x3 cm).
The suspected bacterial pharyngitis was treated with amoxicillin and ibuprofen.
However, due to the size of the lymph nodes it was decided to request infectious mononucleosis (IM) test and general analytical.
He came again at 14 days due to high fever, malaise, intense fatigue and pain in the left laterocervical region.
At this time, the exploration revealed a large left submandibular adenopathy 3 x 2 cm painful to palpation and another left supraclavicular lymph node.
No lymphadenopathy was observed in other ganglionic groups, hepatomegaly, cutaneous lesions or articular involvement.
There are no local lesions, otoscopy is normal, pharyngeal and thyroid examination are normal.
Laboratory tests showed LDH 1400 IU/l, Got 56, gpt 47 IU/l, no leukocytosis, only a mild lymphocytosis.
MI test: negative.
Tests for human immunodeficiency virus (HIV), anatomopathological analysis by needle aspiration (FNAB) and new test of IM were requested.
To avoid delays, the patient comes to a private center for FNAB and the surgeons in charge of performing it, given the size of the lymph nodes, decide to perform a biopsy.
The result of the MI test is again negative.
The evolution was favorable, persisting febricula for 20 days and with slow decrease and paulatin of the size of the adenopathies.
The result of the biopsy is reported as: histiocytic necrotizing lymphadenitis or Kikuchi disease.
This result requires a new analytical and other complementary tests to rule out possible processes associated with this disease.
The results are as follows: negative rheumatoid factor, negative antinuclear antibodies (ANAs), normal abdominal ultrasound.
