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図1 菊池病の診断アルゴリズム

  1. 表1を参照し、鑑別診断や症状に合わせた検査を行う。
  1. 病歴聴取、身体所見により、リンパ節腫大が免疫性疾患、感染症、薬剤性疾患、悪性腫瘍、沈着症のいずれであるかを評価する。
  1. リンパ節の診察は分布、大きさ、表面の性状(平滑、不整)、硬さ、可動性、圧痛の有無を評価することがポイントである。
  1. 確定診断はリンパ節生検によって行われる。
出典
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1: Kikuchi-Fujimoto disease: retrospective study of 91 cases and review of the literature.
著者: Dumas G, Prendki V, Haroche J, Amoura Z, Cacoub P, Galicier L, Meyer O, Rapp C, Deligny C, Godeau B, Aslangul E, Lambotte O, Papo T, Pouchot J, Hamidou M, Bachmeyer C, Hachulla E, Carmoi T, Dhote R, Gerin M, Mekinian A, Stirnemann J, Charlotte F, Farge D, Molina T, Fain O.
雑誌名: Medicine (Baltimore). 2014 Nov;93(24):372-382. doi: 10.1097/MD.0000000000000220.
Abstract/Text: Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenopathy, most often cervical. It has been mainly described in Asia. There are few data available on this disease in Europe. We conducted this retrospective, observational, multicenter study to describe KFD in France and to determine the characteristics of severe forms of the disease and forms associated with systemic lupus erythematosus (SLE). We included 91 cases of KFD, diagnosed between January 1989 and January 2011 in 13 French hospital centers (median age, 30 ± 10.4 yr; 77% female). The ethnic origins of the patients were European (33%), Afro-Caribbean (32%), North African (15.4%), and Asian (13%). Eighteen patients had a history of systemic disease, including 11 with SLE. Lymph node involvement was cervical (90%), often in the context of polyadenopathy (52%), and it was associated with hepatomegaly and splenomegaly in 14.8% of cases. Deeper sites of involvement were noted in 18% of cases. Constitutional signs consisted mainly of fever (67%), asthenia (74.4%), and weight loss (51.2%). Other manifestations included skin rash (32.9%), arthromyalgia (34.1%), 2 cases of aseptic meningitis, and 3 cases of hemophagocytic lymphohistiocytosis. Biological signs included lymphocytopenia (63.8%) and increase of acute phase reactants (56.4%). Antinuclear antibodies (ANAs) and anti-DNA antibodies were present in 45.2% and 18% of the patients sampled, respectively. Concomitant viral infection was detected in 8 patients (8.8%). Systemic corticosteroids were prescribed in 32% of cases, hydroxychloroquine in 17.6%, and intravenous immunoglobulin in 3 patients. The disease course was always favorable. Recurrence was observed in 21% of cases. In the 33 patients with ANA at diagnosis, SLE was known in 11 patients, diagnosed concomitantly in 10 cases and in the year following diagnosis in 2 cases; 6 patients did not have SLE, and 4 patients were lost to follow-up (median follow-up, 19 mo; range, 3-39 mo). The presence of weight loss, arthralgia, skin lesions, and ANA was associated with the development of SLE (p < 0.05). Male sex and lymphopenia were associated with severe forms of KFD (p < 0.05). KFD can occur in all populations, irrespective of ethnic origin. Deep forms are common. An association with SLE should be investigated. A prospective study is required to determine the risk factors for the development of SLE.
Medicine (Baltimore). 2014 Nov;93(24):372-382. doi: 10.1097/MD.0000000...

表1 主な鑑別疾患及び菊池病との鑑別点

出典
img
1: 著者提供

図1 菊池病の診断アルゴリズム

  1. 表1を参照し、鑑別診断や症状に合わせた検査を行う。
  1. 病歴聴取、身体所見により、リンパ節腫大が免疫性疾患、感染症、薬剤性疾患、悪性腫瘍、沈着症のいずれであるかを評価する。
  1. リンパ節の診察は分布、大きさ、表面の性状(平滑、不整)、硬さ、可動性、圧痛の有無を評価することがポイントである。
  1. 確定診断はリンパ節生検によって行われる。
出典
imgimg
1: Kikuchi-Fujimoto disease: retrospective study of 91 cases and review of the literature.
著者: Dumas G, Prendki V, Haroche J, Amoura Z, Cacoub P, Galicier L, Meyer O, Rapp C, Deligny C, Godeau B, Aslangul E, Lambotte O, Papo T, Pouchot J, Hamidou M, Bachmeyer C, Hachulla E, Carmoi T, Dhote R, Gerin M, Mekinian A, Stirnemann J, Charlotte F, Farge D, Molina T, Fain O.
雑誌名: Medicine (Baltimore). 2014 Nov;93(24):372-382. doi: 10.1097/MD.0000000000000220.
Abstract/Text: Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenopathy, most often cervical. It has been mainly described in Asia. There are few data available on this disease in Europe. We conducted this retrospective, observational, multicenter study to describe KFD in France and to determine the characteristics of severe forms of the disease and forms associated with systemic lupus erythematosus (SLE). We included 91 cases of KFD, diagnosed between January 1989 and January 2011 in 13 French hospital centers (median age, 30 ± 10.4 yr; 77% female). The ethnic origins of the patients were European (33%), Afro-Caribbean (32%), North African (15.4%), and Asian (13%). Eighteen patients had a history of systemic disease, including 11 with SLE. Lymph node involvement was cervical (90%), often in the context of polyadenopathy (52%), and it was associated with hepatomegaly and splenomegaly in 14.8% of cases. Deeper sites of involvement were noted in 18% of cases. Constitutional signs consisted mainly of fever (67%), asthenia (74.4%), and weight loss (51.2%). Other manifestations included skin rash (32.9%), arthromyalgia (34.1%), 2 cases of aseptic meningitis, and 3 cases of hemophagocytic lymphohistiocytosis. Biological signs included lymphocytopenia (63.8%) and increase of acute phase reactants (56.4%). Antinuclear antibodies (ANAs) and anti-DNA antibodies were present in 45.2% and 18% of the patients sampled, respectively. Concomitant viral infection was detected in 8 patients (8.8%). Systemic corticosteroids were prescribed in 32% of cases, hydroxychloroquine in 17.6%, and intravenous immunoglobulin in 3 patients. The disease course was always favorable. Recurrence was observed in 21% of cases. In the 33 patients with ANA at diagnosis, SLE was known in 11 patients, diagnosed concomitantly in 10 cases and in the year following diagnosis in 2 cases; 6 patients did not have SLE, and 4 patients were lost to follow-up (median follow-up, 19 mo; range, 3-39 mo). The presence of weight loss, arthralgia, skin lesions, and ANA was associated with the development of SLE (p < 0.05). Male sex and lymphopenia were associated with severe forms of KFD (p < 0.05). KFD can occur in all populations, irrespective of ethnic origin. Deep forms are common. An association with SLE should be investigated. A prospective study is required to determine the risk factors for the development of SLE.
Medicine (Baltimore). 2014 Nov;93(24):372-382. doi: 10.1097/MD.0000000...

表1 主な鑑別疾患及び菊池病との鑑別点

出典
img
1: 著者提供