Recurring Neck Masses: Insights on Kikuchi Disease in Teens

Neck mass

Hello, Doctor.
My name is Candy.
My younger brother started showing symptoms in December of last year.
He has a lump on the left side of his neck that resembles half of an egg, which was initially painless and itch-free.
After a diagnosis by Western medicine, it was initially thought to be thyroid inflammation, but after several months, he was ultimately diagnosed with Kikuchi disease.
The lump then began to hurt.
My brother took antibiotics prescribed by the doctor for three months, which significantly reduced the size of the lump, but the hard mass remained.
The doctor suggested a surgical biopsy, but our parents refused due to concerns about the impact on his development, as he is only 14 years old.
We then turned to traditional Chinese medicine.
After a month of treatment, the lump completely disappeared, but shortly after, within about a month, it recurred.
During the recurrence, he continued to take the herbal medicine prescribed by the doctor.
However, it has since recurred approximately once a month, causing severe pain that affects his appetite.
I, as his sister, feel very distressed.
The lump fluctuates in condition, and the Chinese medicine practitioner has run out of treatment options.
At the end of June, our parents took him to see another Western doctor.
Upon examining my brother, the doctor found that the lump contained a lot of pus and immediately performed an incision and drainage procedure.
His condition improved and did not recur until a month after the surgery, when a new lump appeared, extending to the area next to the original lump.
The diagnosis indicated that it was unrelated to the first lump.
The doctor prescribed antibiotics to control the swelling, but on September 6, the lump recurred again.
The doctor only prescribed painkillers and antibiotics and ordered pus cultures, but all previous test results showed no pathogenic bacteria.
I am very worried.
Could you please share your opinion, Doctor? I have searched online for information about Kikuchi disease, and all other patients do not seem to experience such frequent recurrences.
Why does he keep relapsing? Thank you.

CANDY, 10~19 year old female. Ask Date: 2009/10/21

Dr. Chen Jianzhi reply Otolaryngology

Dear Inquirer,
Regarding your question, there are numerous potential causes for neck masses.
The only definitive way to diagnose the condition is through surgical pathology biopsy; imaging studies, fine needle aspiration, or blood tests cannot provide a conclusive diagnosis.
Therefore, it is advisable for your brother to receive treatment from a physician during this period.
Once the mass has diminished to a certain extent, he should follow the physician's recommendation to undergo a surgical biopsy for a more accurate assessment.
Sincerely,
Dr.
Chien-Chih Chen,
Physician at Taoyuan Hospital, Department of Health,
Lecturer at Fu Jen Catholic University

Reply Date: 2009/10/21

More Info

Kikuchi Disease, also known as Kikuchi-Fujimoto disease, is a rare and benign condition characterized by cervical lymphadenopathy, fever, and sometimes symptoms resembling upper respiratory infections. It primarily affects young adults and adolescents, and its exact etiology remains unclear. The disease is often misdiagnosed as lymphoma due to its similar presentation. Diagnosis is confirmed through histopathological examination of lymph node biopsy specimens, which typically reveal necrotizing lymphadenitis.

In your brother's case, the recurring neck masses and the associated pain are concerning, especially given the history of multiple treatments and interventions. While Kikuchi Disease is generally self-limiting, with most patients experiencing spontaneous resolution of symptoms, your brother's situation appears to be more complicated. The presence of pus within the lymph node and the need for drainage surgery suggest a possible secondary infection or an atypical response to the disease.

The recurrence of symptoms in Kikuchi Disease is not common, but it can occur in some patients. Factors that may contribute to recurrent episodes include:
1. Immune Response: Kikuchi Disease is thought to involve an abnormal immune response, which may lead to persistent inflammation in some individuals. If the immune system is unable to fully resolve the inflammation, it could result in recurrent lymphadenopathy.

2. Secondary Infections: The initial diagnosis of Kikuchi Disease does not preclude the possibility of secondary infections. If bacteria or other pathogens enter the lymph nodes, they can cause abscess formation, leading to the need for drainage and antibiotic treatment.

3. Underlying Conditions: In some cases, underlying autoimmune conditions or immunodeficiencies may predispose individuals to recurrent lymphadenopathy. It would be prudent for your brother to undergo a thorough evaluation to rule out any such conditions.

4. Treatment Response: The effectiveness of the treatments he has received, including antibiotics and traditional Chinese medicine, may vary. While some patients respond well to conservative management, others may require more aggressive interventions.

Given the complexity of your brother's case, it is essential to maintain close communication with his healthcare providers. Here are some recommendations:
- Follow-Up Care: Regular follow-up appointments with a healthcare provider who specializes in infectious diseases or hematology may be beneficial. They can monitor his condition and adjust treatment as necessary.

- Further Testing: If recurrent episodes continue, further diagnostic testing may be warranted. This could include imaging studies, blood tests, or even a repeat biopsy to assess for any underlying pathology.

- Pain Management: Since your brother is experiencing significant pain, it is crucial to address this symptom adequately. Pain management strategies, including medications or alternative therapies, should be discussed with his healthcare team.

- Education and Support: Educating yourself and your family about Kikuchi Disease and its management can help alleviate some anxiety. Support groups or counseling may also provide emotional support during this challenging time.

In conclusion, while Kikuchi Disease is typically self-limiting, your brother's recurrent symptoms warrant further investigation and possibly a multidisciplinary approach to his care. It is essential to work closely with his medical team to ensure he receives the appropriate treatment and support.

Similar Q&A

Understanding Kimura Disease: Symptoms, Treatment, and Gender Differences

Hello: Five months ago, I had a lump on the right side of my neck. An MRI was performed, and there were no signs of cancer. Five months have passed, and the lump has not disappeared. During my recent follow-up, a blood test showed that one of the markers had increased, but it has...

Dr. Xu Jiazhen reply Otolaryngology
I believe you have done a lot of research to understand your neck mass. Kimura's disease is a common inflammatory response, but it is not specific, meaning that coexisting with the human body does not pose significant issues. However, it is important to note that if the mass...

Understanding Kikuchi Disease: Symptoms, Effects, and Recovery Strategies

Kikuchi disease, also known as Kikuchi-Fujimoto disease, is characterized by the following symptoms: 1. Fever 2. Lymphadenopathy (swollen lymph nodes), particularly in the cervical region 3. Night sweats 4. Fatigue 5. Weight loss 6. Skin rashes (in some cases) The exact cause o...

Dr. Huang Maosen reply Smoking Cessation
Kikuchi disease is a very rare benign condition, and its etiology remains unknown. It is characterized by cervical lymphadenopathy, which may be accompanied by fever and upper respiratory tract infection symptoms. Some less common symptoms, such as nausea and vomiting, can lead t...

Persistent Groin Lymph Nodes: When to Seek Further Evaluation?

Hello, Doctor: About six months ago, I had lymphadenopathy in my neck and groin. A biopsy of the neck lymph nodes confirmed Kikuchi disease. By around January, all the neck lymph nodes had disappeared, and the symptoms of Kikuchi disease resolved as well. However, the lymph nodes...

Dr. Chen Sirong reply Oncology
KK, 22 years old, female. Should I still monitor the lymph nodes in my groin, or could it be fibrosis and I can temporarily ignore it? A: If there are no changes, it is reasonable to follow up every six months. If there are changes such as enlargement, discoloration, or hardness,...

Understanding Neck Masses: A Patient's Journey Through Diagnosis and Treatment

Hello doctor, about 13 years ago, when I was around 16 or 17 years old, I discovered a lump under my right ear on my neck. At first, it was a small bump that felt like a mosquito bite, which was itchy and painful. After about two weeks, it developed into a larger lump, though I c...

Dr. Chen Sirong reply Oncology
Yuan Yuan / 30 years old / Female 1. The tissue that was removed 13 years ago should not be a concern now. 2. It is advisable to return for follow-up appointments; regular monitoring is beneficial, ideally every 1-2 years. 3. You can visit an ENT specialist when you have a ...