• Clinical and Experimental Pediatrics
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• v.59 no.2
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• pp.54-58
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• 2016

Purpose: We evaluated the characteristics of patients with Kawasaki disease (KD) who presented with only fever and cervical lymphadenopathy on admission, and compared them with the characteristics of those who presented with typical features but no cervical lymphadenopathy. Methods: We enrolled 98 patients diagnosed with KD. Thirteen patients had only fever and cervical lymphadenopathy on the day of admission (group 1), 31 had typical features with cervical lymphadenopathy (group 2), and 54 had typical features without cervical lymphadenopathy (group 3). Results: The mean age ($4.3{\pm}2.1$ years) and duration of fever ($7.5{\pm}3.6$ days) before the first intravenous immunoglobulin (IVIG) administration were highest in group 1 (P=0.001). Moreover, this group showed higher white blood cell and neutrophil counts, and lower lymphocyte counts after the first IVIG administration as compared to the other groups (P =0.001, P =0.001, and P =0.003, respectively). Group 1 also had a longer duration of hospitalization and higher frequency of second-line treatment as compared to groups 2 and 3 (group 1 vs. group 2, P =0.000 and P =0.024; group 1 vs. group 3, P =0.000 and P =0.007). A coronary artery z score of >2.5 was frequently observed in group 1 than in group 3 (P = 0.008). Conclusion: KD should be suspected in children who are unresponsive to antibiotics and have prolonged fever and cervical lymphadenopathy, which indicates that KD is associated with the likelihood of requiring second-line treatment and risk of developing coronary artery dilatation.

• Pediatric Infection and Vaccine
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• v.7 no.1
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• pp.152-158
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• 2000

Purpose : Kawasaki disease is an acute illness of unknown cause that affects infants and children. Sometimes, cervical lymphadenitis that seems to be caused by bacterial or viral agents at admission would be changed to Kawasaki disease within several days of hospitalization. Lymphadenopathy is one of major presenting manifestation of both cervical lymphadenitis and Kawasaki disease. We compared Kawasaki disease with cervical lymphadenopathy as the initial manifestation with cervical lymphadenitis without other typical manifestations of Kawasaki disease. Methods : We describe and compare the clinical characteristics of 15 patients with Kawasaki disease which were misdiagnosed as cervical lymphadenitis and 125 patients with cervical lymphadenitis, retrospectively. Results : The clinical characteristics of Kawasaki disease with cervical lymphadenopathy as an initial presenting manifestation were older in age and had more frequent abnormalities in markers of systemic inflammation than kawasaki disease without cervical lymphadenopathy. They would have greater abnormalities in markers of inflammation than cervical lymphadenitis alone. They had higher mean WBC, cESR, CRP which were compared with the patients with cervical lymphadenitis. Usually, patients with cervical lymphadenitis responded to antibiotics promptly, but they did not tend to be responded to antibiotics within 48~72hrs. Conclusion : Patients with Kawasaki disease may initially present with findings that strongly suggest bacterial lymphadenitis with or without other manifestations of Kawasaki disease. If they did not response initial antibiotics administration, they should be closed observed for the possible development of the another signs of Kawasaki disease. Earlier diagnosis of Kawasaki disease can avoid the need for unnecessary procedures and antibiotics and lead to more proper therapy directed at Kawasaki disease.

• Korean Journal of Head & Neck Oncology
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• v.38 no.2
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• pp.23-27
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• 2022

Systemic lupus erythematosus(SLE) is a multisystemic disorder of autoimmune etiology. SLE can occur commonly in young women, and the early symptoms include fever, myalgia, arthralgia, weight loss, lymphadenopathy and these nonspecific symptoms develop into skin rash, splenomegaly, serositis and encephalopathy. Diagnosis of SLE requires clinical and serologic criteria, and treatment choices are hydroxyquinolone and NSAIDs for mild disease, corticosteroids and immunosuppressant for severe disease. In lupus patient, the prevalence of lymphadenopathy is 12~59%. Although lymphadenopathy is common finding in SLE, it is hard to distinguish in early phase of SLE. A 38-year-old woman visited our hospital for cervical lymphadenopathy with polyarthritis and malaise. Multiple cervical lymph nodes enlargement was found on Neck CT, and serologic laboratory test including ANA, antiphospholipid antibody, and anti-dsDNA was positive. For excluding lymphoma, PET-CT and excisional biopsy were performed. The patient finally diagnosed with SLE, and got regular follow-up without complication.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5487-5492
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• 2014

Ultrasonography is non-invasive and can give useful clues in the diagnosis of cervical lymphadenopathy, However, differential diagnosis is difficult in some situations even combined with color Doppler imaging. The present study was conducted to evaluate the clinical value of real time elastography in patients with unexplained cervical lymphadenopathy using a quantitative method. From May 2011 to February 2012, 39 enlarged lymph nodes from 39 patients with unexplained cervical lymphadenopathy were assessed. All the patients were examined by both B-mode ultrasound, color Doppler flow imaging and elastography. The method of analyzing elasto-graphic data was the calculation of the 10 parametres ("mean", "sd", "area%", "com", "kur", "ske", "con", "ent", "idm", "asm") offered by the software integrated into the Hitachi system. The findings were then correlated with the definitive tissue diagnosis obtained by lymph node dissection or biopsy. Final histology revealed 10 cases of metastatic lymph nodes, 11 cases of lymphoma, 12 cases of tuberculosis and 6 cases of nonspecific lymphadenitis. The significant distinguishing features for conventional ultrasound were the maximum short diameter (p=0.007) and absent of echogenic hilum (p=0.0293). The diagnostic accuracy was 43.6% (17/39 cases) and there were 17 patients with equivocal diagnosis. For elastography, "mean" (p=0.003), "area%" (p=0.009), "kurt" (p=0.0291), "skew" (p=0.014) and "cont" (p=0.012) demonstrated significant differences between groups. With 9 of the 17 patients with previous equivocal diagnoses (52.9%) definite and correct diagnoses could be obtained. The diagnostic accuracy for conventional ultrasound combined elastography was 69.2% (27/39 cases). There were differences in the diagnostic sensitivity of the two methods (p=0.0224). Ultrasound combined with elastography demonstrated higher rates of conclusive and accurate diagnoses in patients with unexplained cervical lymphadenopathy than conventional ultrasound. The quantitative program showed good correlation with the pathology of different lymph node diseases.

• Clinical and Experimental Pediatrics
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• v.49 no.2
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• pp.162-166
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• 2006

Purpose : There are few reports in Korean literature on the diagnostic efficacy of fine needle aspiration cytology(FNAC) for pediatric cervical lymphadenopathy. This study examined the diagnostic value of FNAC on cervical lymphadenopathy in children. Methods : Data from 57 pediatric patients(aged 0.3 to 14 years) who underwent FNAC due to cervical lymphadenopathy between January 2001 and March 2005 was reviewed retrospectively. Results : Reactive cervical lymphadenitis was the most common result of the FNAC(52.5 percent). Malignant disease were revealed in 14 percent of all cases. The sensitivity, specificity was 86 percent and 96 percent, respectively. The positive and negative predictive values for malignant disease was 75 percent and 98 percent, respectively. There were two false-positive cases on FNAC; one case of Langerhans cell histiocytosis, and another with infectious mononucleosis. A false-negative case on FNAC was found to be acute lymphocytic leukemia. In seven cases(12 percent), the final diagnosis was confirmed by an open biopsy after the FNAC. There were four FNAC cases where the specimen was not satisfactory for making a diagnosis(7 percent). There were no serious complications of the FNAC procedure. Conclusion : FNAC had a high diagnostic efficacy for evaluating children with cervical lymphadenopathy.

• Korean Journal of Bronchoesophagology
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• v.5 no.1
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• pp.22-29
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• 1999

Background： Infectious mononucleosis is a disease precipitated by Epstein-Barr virus(EBV) in mostly children, some seronegative adolescents and young adults comprising clinical symptoms such as fever, lymphadenopathy, and pharyngitis as well as laboratory findings such as hetero-phil antibodies and atypical lymphocytosis. It is confirmed by serologic test for EBV. Materials and Methods： A retrospective evaluation of 26 patients who diagnosed with infectious mononucleosis was peformed through the analysis of typical symptom, sign and laboratory findings. Results : Infectious mononucleosis occurs mostly at 3 to 10 years (74.9%), common symptoms and signs are fever, cervical lymphadenopathy, tonsillar enlargement and exudate. Positive ratio of atypical Lymphocyte(>10%) and hetrophil antibodies are 61.5%, 35.2% respectively, it is less diagnostic. EBV-viral capsid antigen(VCA) IgM are positive in all cases, so it is most diagnostic findings. Conclusion： Infectious mononucleosis should be considered as a cause of cervical lymphadenopathy and pharyngotonsillitis in children and young adults, the assessment of EBV-VCA IgM is necessary for the diagnosis.

• Korean Journal of Radiology
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• v.22 no.12
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• pp.1938-1945
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• 2021

Breast radiologists are increasingly seeing patients with axillary adenopathy related to COVID-19 vaccination. Vaccination can cause levels I-III axillary as well as cervical lymphadenopathy. Appropriate management of vaccine-related adenopathy may vary depending on clinical context. In patients with current or past history of malignancy, vaccine-related adenopathy can be indistinguishable from nodal metastasis. This article presents imaging findings of oncology patients with adenopathy seen in the axilla or neck on cross-sectional imaging (breast MRI, CT, or PET-CT) after COVID-19 vaccination. Management approach and rationale is discussed, along with consideration on strategies to minimize false positives in vaccinated cancer patients. Time interval between vaccination and adenopathy seen on breast MRI, CT, or PET-CT is also reported.

• Pediatric Infection and Vaccine
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• v.10 no.1
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• pp.123-126
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• 2003

Kikuchi disease(subacute necrotizing lymphadenitis), first reported by Kikuchi and Fujimoto in 1972, is a benign self-limiting illness characterized by fever, neutropenia and cervical lymphadenopathy and develops predominantly in young women, especially in Asia. The cause of Kikuchi disease is unknown, but postinfectious(virus or bacteria) hyperimmune reaction has been suggested. Few pediatric cases have been reported. We experienced a case of Kikuchi disease associated with Yersinia pseudotuberculosis infection in 12-year-old girl. After she was admitted with cervical lymphadenopathy and headache, followed by sustained fever with leukopenia. All symptoms and signs did not seem to be responded to antimicobial treatment. Open biopsy of cervical lymph node was performed and showed findings consistent with subacute necrotizing lymphadenitis. Serologic studies were all negative except for Y. pseudotuberculosis. Fever subsided and lymphadenopathy improved after administration of oral steroid for 1 week.

• Journal of Cardiovascular Imaging
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• v.26 no.4
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• pp.238-246
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• 2018

BACKGROUND: Kawasaki disease (KD) sometimes presents with only fever and cervical lymphadenopathy before other clinical signs materialize. This lymphadenopathy-first-presenting Kawasaki disease (LKD) may be misdiagnosed as bacterial cervical lymphadenitis (BCL). We investigated characteristic imaging and clinical data for factors differentiating LKD from BCL. METHODS: We compared imaging, clinical, and laboratory data of patients with KD and BCL. We included patients admitted to a single tertiary center between January 2015 and July 2018. RESULTS: We evaluated data from 51 patients with LKD, 63 with BCL, and 218 with typical KD. Ultrasound imaging revealed multiple enlarged lymph nodes in both LKD and BCL patients. On the other hand, computed tomography (CT) showed more abscesses in patients with BCL. Patients with LKD were younger and showed higher systemic and hepatobiliary inflammatory markers and pyuria than BCL patients. In multivariable logistic regression, younger age and higher C-reactive protein (CRP) retained independent associations with LKD. A comparison of the echocardiographic findings in LKD and typical KD showed that patients with LKD did not have a higher incidence of coronary artery abnormalities (CAA). CONCLUSIONS: LKD patients tend to have no abscesses on CT and more elevated systemic hepatobiliary inflammatory markers and pyuria compared to BCL patients. The absence of abscess on CT, younger age, and elevated CRP were the most significant variables differentiating LKD from BCL. There was no difference in CAA between LKD and typical KD.

• The Korean Journal of Cytopathology
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• v.18 no.2
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• pp.175-177
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• 2007

A case of Burkitt lymphoma diagnosed through fine needle aspiration cytology is described, A 66-year-old man presented with lymphadenopathy on the right cervical neck and axillary area. An ultrasonogram and CT scan for the cervical neck showed a multiple variable sized lymphadenopathy with pericapsular invasion and necrotic foci, Fine needle aspiration cytology (FNAC) of the cervical lymph nodes revealed very cellular and necrotic smears consisting of diffusely scattered intermediate monotonous round cells, tingible body macrophages and many mitotic figures. Histological features of the excised lymph nodes showed the classic morphological features of Burkitt lymphoma. Recognition of the characteristic cytological features can suggest the possibility of Burkitt lymphoma.