[Necrotizing histiocytic lymphadenitis (Kikuchi-Fujimoto disease): contribution of 2 cases]. / Linfadenitis histiocítica necrotizante (enfermedad de Kikuchi-Fujimoto): aportación de dos casos.

The necrotizing lymphadenitis of Kikuchi-Fujimoto is an uncommon disease in Spain. In a review of the literature we found only five cases reported until 1995. We report here two patients with the diagnosis of this entity in an area hospital during a one-year period. This fact contrasts with the low frequency of this disease reported so far in our country. The cases were two young women who were investigated because of cervical lymph node enlargement and headache. The lymph node biopsy revealed typical findings of the necrotic phase of the Kikuchi-Fujimoto disease in one case; the histology in the other case was characteristic of the so called proliferative phase. The two patients evolved spontaneously with a favorable outcome. Lymph node enlargements resolved in less than three months. All microbiological investigations performed were negative. One of the two patients was receiving intranasal calcitonin when symptoms developed. The incidence of Kikuchi-Fujimoto disease might be higher than considered. The spontaneous resolution of the disease and the requirement of the histological examination for its diagnosis are factors limiting its identification.

[Fever of unknown origin in patients infected with the human immunodeficiency virus]. / Fiebre de origen desconocido en pacientes infectados por el virus de la inmunodeficiencia humana.

BACKGROUND: To describe the clinical features and the final diagnosis of patients infected with human immunodeficiency virus who presented fever of unknown origin. METHODS: Retrospective study, from November 1989 to January 1994, of all patients infected with HIV who had fever of unknown origin and who were admitted to a community hospital in a Mediterranean area in Alicante (Spain). Fever of unknown origin was defined as fever exceeding 38.3 degrees C lasting for at least three weeks with no diagnosis in the first three days of hospitalization after fulfilling clinical exam, three blood cultures, acid-fast bacilli stain in sputum and chest-X-ray. RESULTS: Of a cohort of 231 patients, 27 (12%) were evaluated because of fever of unknown origin during their follow-up. Patients' mean age was 31 years (interval, 22-75) and intravenous drug use (81%) was the most common risk factor for HIV infection. A total of 31 episodes of fever of unknown origin were reviewed. Twenty-three (74%) episodes occurred in patients with less than 200 CD4 lymphocytes/mm3. A final diagnosis of fever of unknown origin was achieved in 24 (77%) episodes: visceral leishmaniasis (n = 11), tuberculosis (n = 9), non-Hodgkin's lymphoma (n = 1), CNS toxoplasmosis (n = 1), cryptococcal meningitis (n = 1) and drug adverse reaction (n = 1). CONCLUSIONS: HIV-infected patients with fever of unknown origin very often show severe immunodeficiency. Cryptococcal antigen testing should be carried out in the initial evaluation of fever of unknown origin in HIV-infected patients. In our area, 64% of episodes of fever of unknown origin were caused by visceral leishmaniasis or tuberculosis.