桥本甲状腺炎合并菊池病1例报道及诊断思路分析
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摘要
菊池病(KFD)是一种良性自限性疾病,可表现为发热、淋巴结炎及白细胞减少。该病相对罕见,年轻女性多发。对于初诊年轻患者,在考虑感染、恶性肿瘤及免疫疾病的同时要想到KFD的可能。KFD的病因及发病机制仍不十分清楚。自身免疫性疾病与KFD合并发生较少见。本文报道1例26岁的年轻女性患者,经淋巴结活检确诊为桥本甲状腺炎合并KFD,该患者确诊后给予地塞米松联合中药治疗获得较好的临床疗效。KFD可能由自身免疫功能异常导致,中药辨证论治可以作为一种不错的治疗选择。
Kikuchi-Fujimoto disease(KFD),is a benign self-limiting disease characterized by fever,lymphadenitis and leukopenia.It is a rare disease that mainly affects young women.For young patients with the aforementioned symptoms,infections,malignancies and immune diseases as well as KFD should be taken into consideration at their first consultation.The etiology and pathogenesis of KFD is still unclear.Furthermore,KFD with autoimmune diseases is rare.Here,we reported a 26-year-old female patient with KFD and Hashimoto's thyroiditis,who was confirmed by cervical lymph node biopsy.This patient was improved significantly after being treated with dexamethasone and traditional Chinese medicine.We believe that autoimmune mechanism may be involved in the mechanism of KFD and traditional Chinese medicine is a good curative method for KFD.
Kikuchi-Fujimoto disease(KFD),is a benign self-limiting disease characterized by fever,lymphadenitis and leukopenia.It is a rare disease that mainly affects young women.For young patients with the aforementioned symptoms,infections,malignancies and immune diseases as well as KFD should be taken into consideration at their first consultation.The etiology and pathogenesis of KFD is still unclear.Furthermore,KFD with autoimmune diseases is rare.Here,we reported a 26-year-old female patient with KFD and Hashimoto's thyroiditis,who was confirmed by cervical lymph node biopsy.This patient was improved significantly after being treated with dexamethasone and traditional Chinese medicine.We believe that autoimmune mechanism may be involved in the mechanism of KFD and traditional Chinese medicine is a good curative method for KFD.
引文
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[4]RUARO B,SULLI A,ALESSANDRI E,et al.Kikuchi-Fujimoto's disease associated with systemic lupus erythematous:difficult case report and literature review[J].Lupus,2014,23(9):939-944.
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[6]SANTANA A,LESSA B,GLARAO L,et al.Kikuchi-Fujimoto's disease associated with systemic lupus erythematosus:case report and review of the literature[J].Clin Rheumatol,2005,24(1):60-63.
[7]GORDON J K,MAGRO C,LU T,et al.Overlap between systemic lupus erythematosus and Kikuchi Fujimoto disease:a clinical pathology conference held by the Department of Rheumatology at Hospital for Special Surgery[J].HSS J,2009,5(2):169-177.DOI:10.1007/s11420-009-9123-x.
[8]KUCUKARDALI Y,SOLMAZGUL E,KUNTER E,et al.KikuchiFujimoto disease:analysis of 244 cases[J].Clin Rheumatol,2007,26(1):50-54.
[9]MAHAJAN T,MERRIMAN R C,STONE M J.Kikuchi-Fujimoto disease(histiocytic necrotizing lymphadenitis):report of a case with other autoimmune manifestations[J].Proc(Bayl Univ Med Cent),2007,20(2):149-151.
[10]KIM S K,KANG M S,YOON B Y,et al.Histiocytic necrotizing lymphadenitis in the context of systemic lupus erythematosus(SLE):is histiocytic necrotizing lymphadenitis in SLE associated with skin lesions?[J].Lupus,2011,20(8):809-819.DOI:10.1177/0961203310397684.
[11]HUTCHINSON C B,WANG E.Kikuchi-Fujimoto disease[J].Arch Pathol Lab Med,2010,134(2):289-293.DOI:10.1043/1543-2165-134.2.289.
[12]CHEN P H,HUANG Y F,TANG C W,et al.Kikuchi-Fujimoto disease:an amazing response to hydroxychloroquine[J].Eur J Pediatr,2010,169(12):1557-1559.DOI:10.1007/s00431-010-1256-x.
[13]YOUSSEF A,ALI R,ALI K,et al.Kikuchi-Fujimoto disease:a case report of a multi-drug resistant,grueling disease[J].Oxf Med Case Reports,2017,2017(6):95-98.DOI:10.1093/omcr/omx024.
[2]SOPENA B,RIVERA A,VAZQUEZ-TRINANES C,et al.Autoimmune manifestations of Kikuchi disease[J].Semin Arthritis Rheum,2012,41(6):900-906.DOI:10.1016/j.semarthrit.2011.11.001.
[3]BLAKE C,WANG E.Kikuchi-Fujimoto disease[J].Arch Pathol Lab Med,2010,134(2):289-293.
[4]RUARO B,SULLI A,ALESSANDRI E,et al.Kikuchi-Fujimoto's disease associated with systemic lupus erythematous:difficult case report and literature review[J].Lupus,2014,23(9):939-944.
[5]BAENAS D F,DIEHL F A,HAYE SALINAS M J,et al.KikuchiFujimoto disease and systemic lupus erythematosus[J].Int Med Case Rep J,2016(9):163-167.DOI:10.2147/IMCRJ.S106396.
[6]SANTANA A,LESSA B,GLARAO L,et al.Kikuchi-Fujimoto's disease associated with systemic lupus erythematosus:case report and review of the literature[J].Clin Rheumatol,2005,24(1):60-63.
[7]GORDON J K,MAGRO C,LU T,et al.Overlap between systemic lupus erythematosus and Kikuchi Fujimoto disease:a clinical pathology conference held by the Department of Rheumatology at Hospital for Special Surgery[J].HSS J,2009,5(2):169-177.DOI:10.1007/s11420-009-9123-x.
[8]KUCUKARDALI Y,SOLMAZGUL E,KUNTER E,et al.KikuchiFujimoto disease:analysis of 244 cases[J].Clin Rheumatol,2007,26(1):50-54.
[9]MAHAJAN T,MERRIMAN R C,STONE M J.Kikuchi-Fujimoto disease(histiocytic necrotizing lymphadenitis):report of a case with other autoimmune manifestations[J].Proc(Bayl Univ Med Cent),2007,20(2):149-151.
[10]KIM S K,KANG M S,YOON B Y,et al.Histiocytic necrotizing lymphadenitis in the context of systemic lupus erythematosus(SLE):is histiocytic necrotizing lymphadenitis in SLE associated with skin lesions?[J].Lupus,2011,20(8):809-819.DOI:10.1177/0961203310397684.
[11]HUTCHINSON C B,WANG E.Kikuchi-Fujimoto disease[J].Arch Pathol Lab Med,2010,134(2):289-293.DOI:10.1043/1543-2165-134.2.289.
[12]CHEN P H,HUANG Y F,TANG C W,et al.Kikuchi-Fujimoto disease:an amazing response to hydroxychloroquine[J].Eur J Pediatr,2010,169(12):1557-1559.DOI:10.1007/s00431-010-1256-x.
[13]YOUSSEF A,ALI R,ALI K,et al.Kikuchi-Fujimoto disease:a case report of a multi-drug resistant,grueling disease[J].Oxf Med Case Reports,2017,2017(6):95-98.DOI:10.1093/omcr/omx024.