Kikuchi Disease: A Case Report.

BACKGROUND: Kikuchi disease, also known as Kikuchi-Fujimoto disease, is a rare, benign cause of cervical lymphadenitis. It is characterized by painful cervical lymphadenopathy with fevers, leukopenia, and an elevated erythrocyte sedimentation rate. It is diagnosed by obtaining a biopsy specimen from a lymph node that shows characteristic histopathologic findings. CASE REPORT: We highlight a 42-year-old Japanese man who presented with persistent fevers and cervical lymphadenopathy who was misdiagnosed at multiple urgent care facilities and emergency departments. He was eventually diagnosed with Kikuchi disease after a biopsy specimen was obtained from a lymph node 1 month after his symptoms began. He was treated with hydroxychloroquine and prednisone with resolution of his symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although Kikuchi disease has been previously described in various specialty medical journals, the published literature on Kikuchi disease in emergency medicine is relatively scarce. Given that cervical lymphadenopathy is a common presentation to emergency departments, it is important for emergency physicians to be cognizant of Kikuchi disease in the differential diagnosis of cervical lymphadenopathy to prevent misdiagnoses and unnecessary treatments.

Visual and verbal learning and memory in cystinosis.

Cystinosis is a rare genetic lysosomal storage disorder characterized by the accumulation of cystine in lysosomes. Many organ systems are vulnerable to this cystine accumulation including the CNS. A past study demonstrated that children with cystinosis have deficits in visual learning and memory while their verbal learning and memory and global intellectual function are spared (Spilkin, Ballantyne, & Trauner, 2009). However, no related study has been performed to assess the dissociation between visual and verbal learning and memory in adults with cystinosis who have had the benefit of longterm treatment with the cystine-depleting agent, cysteamine. In this study we assessed visual and verbal learning and memory in 15 adults with cystinosis, with a mean age of 30.2 years. The results indicate that adults with cystinosis have no significant deficits in either verbal or visual learning and memory. However, the individuals did perform better on the verbal assessment. The results suggest that if early and continued treatment is given to individuals with cystinosis there is a relative sparing of visual learning and memory that might have otherwise declined. This emphasizes the essential nature of the proper clinical management of cystinosis.