菊地氏病(Kikuchi's disease)之病例報告

Kikuchi's Disease: A Case Report

菊地氏病是一種少見、良性且病因未明的的疾病，特徵是患者通常會有發燒和頸部淋巴病變。一位31歲女性有間斷性發燒及左側頸部腫塊等症狀。即使去過診所看病並使用症狀緩解藥物，這些症狀仍持續了2個月之久。後來其右耳後也出現壓痛性腫塊，因此來本院就診。頸部電腦斷層掃描發現，兩側後頸區域有數個淋巴結病變，且最大的淋巴結位於左側頸部，大小約2.2×1.2公分。細針抽吸細胞學檢查僅看出許多發炎細胞，並無發現惡性細胞存在。為了排除惡性腫瘤（例如淋巴癌）的可能性，我們實行了左側頸部淋巴結切片並送病理化驗，結果顯示為壞死性淋巴腺炎（菊地氏病）。在使用了低劑量類固醇、非類固醇抗發炎藥物（NSAID）及對乙醯氨基酚（acetaminophen）2個星期後，病人發燒及頸部腫塊情形逐漸消退，並且在追蹤一年後並無發現疾病再發。由於菊地氏病患者在康復後的數年內，有時可能會發展出紅斑性狼瘡或是有疾病再發的現象，所以都應該要規律追蹤數年。

Kikuchi's disease is a rare, benign condition of unknown etiology and is usually characterized by fever and cervical lymphadenopathy. A 31 year-old female had intermittent fever and a left cervical mass. These symptoms persisted for 2 months in spite of management with supportive treatment in a local medical clinic. When a tender, right post-auricular mass lesion was noted, she presented at our hospital. Neck CT showed multiple lymphadenopathy in bilateral post-cervical areas. The largest lymph node measured 2.2 × 1.2 cm. Fine needle aspiration cytology showed many inflammatory cells but no malignant cells. In order to exclude malignancy such as lymphoma, excisional biopsy of a left neck lymph node was done and pathology showed necrotizing lymphadenitis (Kikuchi's disease). After treatment with a low-dose steroid, NSAID and acetaminophen for 2 weeks, her fever and neck mass gradually subsided and no recurrence was found at 1-year follow-up. Because patients with Kikuchi's disease may develop systemic lupus erythematosis (SLE) or recurrences of Kikuchi's disease, they should be followed up for several years.