I saw this young lady of 20—all worked up and shaking with fear. Her family members were behind her and were equally anxious. The story goes that she went for some vague joint pain to a specialist; she had physically normal joints, though.
He gave the possible diagnoses: rheumatic fever? rheumatoid arthritis? autoimmune disease? All the tests that he ordered—a long battery of them—were all absolutely normal, though. But the ESR was 3 mm!
She went around shopping, thanks to her anxiety. Next, the doctor found some small but insignificant glands in her neck region. He got one of them biopsied and the report said kikuchi disease. The news was immediately conveyed to the patient. The poor lady was happy that she got a diagnosis but was mortally afraid of the strange disease.
Now with malignant anxiety, she did more of medical shopping. She was further confused until she landed with me. In between, some doctor had doubted the biopsy report and put in a rider that it could be a mistaken diagnosis further compounding the issue, remotely suggesting that it could even be malignant!
What is this funny disease? Kikuchi disease, also called histiocytic necrotising lymphadenitis or Kikuchi-Fujimoto disease is an uncommon, idiopathic, generally self-limited cause of lymphadenitis. Kikuchi first described the disease in 1972 in Japan. Fujimoto and colleagues independently described Kikuchi disease in the same year.
Please understand two important points: 1) It is benign. 2) It is self-limiting and does not require any treatment. In that case what was the need to generate such morbid anxiety in the mind of the innocent patient? That is why I say that we doctors generate anxiety many a time. I wonder if I had been able to douse that flame of anxiety in that little girl. But I can well imagine the gravity of her situation! Poor thing. May God help her.
Many of our hapless patients take our words as gospel truth and then suffer the consequences. So, we must be very, very careful when we pronounce our judgement. May this article be a reminder to our careless colleagues. The moral of the story is that this girl would have been much happier without medical intervention.
Life would have been easier and a lot of money saved. Let us put ourselves in her shoes and think—empathy is the urgent need of the hour.
Professor B M Hegde
Email: hegdebm@gmail.com