ABSTRACT
Kikuchi disease is a self-limited disorder of unknown etiology characterized by focal painful lymphadenitis, fever, and weight loss that can be mistaken for malignancy. Diagnosis is established by node biopsy. Kikuchi disease is endemic in Asia; 10 cases have been reported in the US to date. We report 3 cases and review other US cases.
Subject(s)
Histiocytic Necrotizing Lymphadenitis/diagnosis , Lymph Nodes/pathology , Adolescent , Biopsy , Child , Connecticut , Diagnosis, Differential , Female , Humans , MaleABSTRACT
OBJECTIVE: To assess the long-term outcomes of patients with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome. STUDY DESIGN: Patients enrolled in a PFAPA registry were contacted and surveyed. RESULTS: Patients in the registry (n = 59) were surveyed with a follow-up time ranging from 12 to 21 years. Fifty patients had complete symptom resolution, with mean symptom duration of 6.3 years (95% CI, 5.4-7.3), and no sequelae developed. Nine patients continued to have persistent symptoms for a mean duration of 18.1 years (95% CI, 17.4-18.8). There were no differences in initial presentation between subjects with resolved PFAPA and subjects with persistent PFAPA. In subjects with persistent PFAPA, the mean duration of fever >38.3°C decreased from 3.6 days at onset to 1.8 days at follow-up (P = .01), and the mean symptom-free interval between episodes increased from 29 to 159 days (P < .005). Thirty-seven of 44 patients treated with corticosteroids reported prompt symptom resolution. Twelve patients underwent tonsillectomy or adenotonsillectomy; 9 of these patients experienced markedly reduced symptoms, and 6 patients had resolution of symptoms. Two subjects received other diagnoses. CONCLUSIONS: In long-term follow-up, most patients with PFAPA experienced spontaneous symptom resolution without sequelae. Patients with persistent symptoms had episodes of shorter duration and reduced frequency.
Subject(s)
Fever , Lymphadenitis , Pharyngitis , Stomatitis, Aphthous , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Lymphadenitis/diagnosis , Lymphadenitis/therapy , Male , Neck , Pharyngitis/diagnosis , Pharyngitis/therapy , Stomatitis, Aphthous/diagnosis , Stomatitis, Aphthous/therapy , Syndrome , Time Factors , Young AdultABSTRACT
OBJECTIVE: To determine how frequently Connecticut primary care physicians are diagnosing and treating patients with chronic Lyme disease. STUDY DESIGN: A survey was mailed to a random 33% sample of primary care physicians in Connecticut, which asked how many cases of Lyme disease and chronic Lyme disease they diagnosed and treated in the last 3 years. RESULTS: The survey had a response rate of 39.1%. Physician respondents (n = 285) fit in one of 3 groups. Group 1 included 6 of 285 (2.1%) physicians who diagnose and treat patients with chronic Lyme disease. Group 2 included 137 of 285 (48.1%) physicians who are undecided on the existence of chronic Lyme disease, but did not diagnose or treat any patients with chronic Lyme disease. Group 3 included 142 of 285 (49.8%) physicians who do not believe in the existence of chronic Lyme disease. CONCLUSION: A small percentage (2.1%) of primary care physicians diagnose and treat patients for presumed chronic Lyme disease.
Subject(s)
Family Practice , Internal Medicine , Lyme Disease , Pediatrics , Primary Health Care , Child , Chronic Disease , Connecticut , Humans , Lyme Disease/diagnosis , Lyme Disease/epidemiology , Lyme Disease/therapyABSTRACT
The six classic exanthems of childhood have many similar physical findings. Familiarity with them, as well as with important laboratory data, allows early and accurate diagnosis of these often confusing diseases. Recognition and treatment of possible sequelae also improve prognosis. In this review we discuss epidemiology, etiology, clinical manifestations, pathologic and laboratory findings, differential diagnosis, therapy, and prevention of each of the exanthems.