病例報告：與人類第六型疱疹病毒感染有關的Kikuchi氏病

Kikuchi's Disease Associated with Human Herpes Virus-6 (HHV-6) Infection: A Case Report

背景：一位12歲女孩，自2週前出現畏寒、發燒及頸部淋巴腺腫大，稍後由組織病理學證實是患了Kikuchi氏疾病（又名組織細胞壞死性淋巴炎）。此病的病因不明，其中之一可能是因為人類第六型疱疹病毒（HHV-6）感染造成。為了要進一步暸解該病毒是否與Kikuchi氏疾病有闕，我們做了兩項檢驗。方法：首先我們用間接免疫螢光法偵測該病童的血清，為求更進一步瞭解，再取病童的淋巴腺病變組織做聚合酶連鎖反應。結果：間接免疫螢光法呈現亮綠色，顯示該病童正患有急性第六型疱疹病毒感染，進一步做聚合酶鍊反應的結果發現淋巴腺中也有該病毒的基因。結論：本病例提供了另一次線索去觀察在Kikuchi氏疾病中，第六型疱疹病毒感染應該扮演著一定的角色，但是我們也不能排除兩者是獨立的事件。本病多發生在年輕東方女性，我們報告此病例，希望小兒科醫師在碰到發燒及頸部淋巴腺腫大的十多歲患童時，能想到此病。

Background: A 12-year-old girl was admitted to our hospital with a 2-week history of chills, fever and cervical lymphadenopathy. She was later confirmed by pathological findings to be a victim of Kikuchi's disease (KD, histiocytic necrotizing lymphadenitis). KD is characterized by a histiocytic response caused by variable etiologic factors, including a possible role for human herpesvirus-6(HHV-6) infection. To understand HHV-6 in KD, we had tested for it. Methods: Suspecting a possible relation between HHV-6 infection and KD, we examined the serum of the patient with indirect fluorescence assay (IFA). To understand more, later we used polymerase chain reaction (PCR) to search for HHV-6 sequences in lymphoid tissue. Results: Bright green fluorescence staining (positive HHV-6 IgM) by IFA indicated that this patient had an acute HHV-6 infection. On PCR, this case tested positive for amplified HHV-6 genomes. Conclusion: Our case offers another clue to observe the possible role of HHV-6 infection in KD, but we cannot clarify whether they are coincident or really associated. KD occurs mainly in young oriental females. Pediatric clinicians should pay more attention to this uncommon disease (KD) in teenaged patients with febrile cervical lymphadenopathy.