To describe an interesting case of a young male presenting with Kikuchi syndrome and high titer anti streptococcal antibodies.

Case: A fourteen and a half year old Caucasian male presented with the chief complaint of neck stiffness for two years, and multiple episodes of streptococcal pharyngitis infection of throat. He had no history of trauma, or neck swelling. On examination no abnormalities were found. His laboratory testing revealed normal hemoglobin, platelet and white cell counts, creatinine, and erythrocyte sedimentation rate, c-reactive protein (CRP) = 12 (0-4.9), creatinine phosphokinase (CPK) = 2446 (24-204) and aldolase = 23, AST = 46 (0-40), antistreptolysin O (ASO) = 1041 (0-200) and antideoxyribonuclease antibody titer = 1:170. The cervical spine MRI, bone scan and chest radiograph were within normal limits. Due to allergy to NSAIDS, he did not take any anti-inflammatory medications. He was started on PenVeek for a post-streptococcal reactive process. His neck pain resolved and few months later, he developed unilateral lymphadenopathy which on biopsy revealed Kikuchi's disease. Currently, his lymphadenopathy has resolved, he remains asymptomatic, the CPK and aldolase have normalized and his CRP remains elevated at 13.4 and ASO remains elevated at six months after initial presentation. Echocardiograms have remained negative during the six-month follow-up period.

Significance:

This case illustrates an occurrence of anti-streptococcal antibodies with Kikuchi syndrome. This occurrence of streptococcal antibodies may represent a chance association, however the persistence of high titers of anti-streptococcal antibodies raises the possibility of a causal relationship which requires further exploration.

RCIAPCON 2005 - Conference Abstracts.Pediatric Oncall [serial online] 2006 [cited 15 June 2006(Supplement 6)];3. Available from:
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kikuchi_disease.asp