Kikuchi-Fujimoto Disease: analysis of 244 cases

Kikuchi-Fujimoto Disease (KFD) was first described in Japan in 1972. The disease frequently mimics tuberculous lymphadenitis, malign lymphoma, and many other benign and malignant conditions. To our knowledge, there is no previous study comparing the clinical and laboratory characteristics of patients from different geographical parts of the world. We searched literature records beginning from 1991 and analyzed epidemiological, clinical, and laboratory data of 244 patients (including cases diagnosed in our institution) reported in 181 publications. Of the 244 cases, 33% were male and 77% were female. Mean age was 25 (1-64) and 70% was younger than 30. Most of the cases were reported from Taiwan (36%), USA (6.6%), and Spain (6.3%). Fever (35%), fatigue (7%) and joint pain (7%) were the most frequent symptoms, while lymphadenomegaly (100%), erythematous rashes (10%), arthritis (5%), hepatosplenomegaly (3%), leucopenia (43%), high erythrocyte sedimentation rate (40%), and anemia (23%) being the most common findings. KFD was associated with SLE (32 cases), non-infectious inflammatory diseases (24 cases), and viral infections (17 cases). SLE was more frequent in cases from Asia than Europe (28 and 9%, respectively). The disease was self-limiting in 156 (64%) and corticosteroid treatment was necessary in 16 (16%) of the cases. The mortality rate was 2.1%. Early diagnosis is crucial as the clinical and laboratory presentation generally imitates situations needing lengthy and costly diagnostic and therapeutic interventions. Additionally, association with SLE needs further investigation.

Kikuchi-Fujimoto disease: a rare cause of cervical lymphadenopathy

Kikuchi-Fujimoto Disease (KFD) is a self-limiting, necrotizing, histiocytic lymphadenitis (NHL) of unknown etiopathogenesis. So far in Nepal not a single case of this disease in the cervical region leading to progressive inspiratory stridor has been reported till date. Here a case of 26 years old Nepalese house wife suffering from this disease, which is histopathologically proved as KFD with complete recovery is presented.

Disseminated Kikuchi-Fujimoto disease: a case report

Subacute necrotizing lymphadenitis or Kikuchi-Fujimoto disease is a benign pathological entity diagnosed chiefly in young adults. We report a case in a 20-year-old woman who presented with swollen lymph nodes and a fever. Disseminated lymphadenopathy with nodes measuring up to 6 cm in diameter was found upon physical examination. The erythrocyte sedimentation rate was elevated to 40 mm/h and the lactic dehydrogenase level to 593 IU/l. Findings were negative from serological tests for rubella, hepatitis B, hepatitis C, HIV, and toxoplasmosis, as well as from tests for tuberculosis. A biopsy of a cervical lymph node showed nonsuppurative necrosis, karyorrhexis, and a marked histiocytic reaction consistent with Kikuchi-Fujimoto disease. No treatment was given, and a full recovery was achieved within 3 months. In this patient, the disseminated lymphadenopathy and constitutional symptoms strongly suggested a hematological malignancy and more specifically a lymphoproliferative disease.

Kikuchi-Fujimoto disease coexisted with Sjogren's syndrome

Here we described a case of primary Sjogren's syndrome that coexisted with Kikuchi-Fujimoto disease.

[Clinical analysis of histocytic necrotizing lymphadenitis]

OBJECTIVE

To understand the clinical features and histopathology of histocytic necrotizing lymphadenitis (HNL) so as to better recognize the disease.

METHODS

The clinical features, histopathology, and diagnosis of 10 patients admitted to our hospital were retrospectively analyzed.

RESULTS

The clinical features of these 10 cases included: young females were the majority; lymphadenopathy and fever were the most common clinical manifestations; some cases were accompanied by connective tissue diseases. Histopathologic examination showed distinctive necrosis and around the necrotic foci, variable proliferations of histocytes but generally without infiltration of neutrophils.

CONCLUSION

HNL has some typical histopathological alterations and relatively fine prognosis,but it tends to be misdiagnosed as lymphoma or lymphoid tuberculosis and may be accompanied by other diseases.

Tuberculosis mimicking Kikuchi's disease

Kikuchi's disease is an idiopathic self-limiting necrotizing lymphadenitis. Clinically, it mimics tuberculous cervical lymphadenopathy. The disease is diagnosed by histopathologic study. The only specific treatment that has been reported is empiric steroid therapy. We report a case of tuberculosis that was originally thought to be Kikuchi's disease in a 24-year-old man. When the patient's condition worsened during a course of steroid therapy, he underwent surgical exploration, which revealed the presence of tuberculous lymphadenitis. The patient was switched to antituberculosis drug therapy, and his improvement was dramatic.

[The clinical and pathological characteristics of histiocytic necrotizing lymphadenitis: analysis of 52 cases]

OBJECTIVE

To study the clinical manifestation and pathological features of histiocytic necrotizing lymphadenitis (Kikuchi's disease, KD).

METHODS

52 patients with KD were collected to analyze the clinical manifestation, pathological features of biopsy lymph nodes, diagnosis and treatment.

RESULTS

41 cases (79%) were female of the 52 patients. The main clinical features included persistent fever (100%), single (23%)/multi (77%)-lymphadenopathy (always in cervical region), pleomorphism erythra (35%), neutropenia (76%), elevated erythrocyte sedimentation rate (100%), insensitivity to antibiotics (100%) and sensitivity to small dosage glucocorticoid (81%). 26 cases (50%) had elevated aspartate aminotransferase and/or alanine aminotransferase, but only 7 cases (13%) had upper respiratory tract symptom like influenza. Pathological features included distinctive necrosis, loss of lymph node structure, infiltration with histiocytes and lymphocytes, absence of neutrophils. Immunohistochemical stainings showed CD(68) positive for histiocytes and CD(3), CD(45) RO positive for T lymphocytes.

CONCLUSION

Diagnosis of KD relies on the pathological examination and immunohistochemical staining.

Adverse antibiotic-induced eruptions associated with epstein barr virus infection and showing Kikuchi-Fujimoto disease-like histology

The antibiotic-induced eruption of infectious mononucleosis is a well-known clinical phenomenon. Latent viral infection with herpesviridae (eg, human herpes virus 6 (HHV-6) and Epstein-Barr virus (EBV)) is suspected to play a role in the drug hypersensitivity syndrome. The cutaneous pathologic findings have not been reported in the former, and are infrequently reported in the latter entity. Herein, we describe the biopsy findings of a cefprozil-induced rash in infectious mononucleosis and a minocycline-associated drug hypersensitivity syndrome. Biopsy of these exanthematous eruptions revealed an acute vacuolar interface superficial and deep perivascular and interstitial lymphocytic dermatitis. CD8(+) lymphocytes predominated and were associated with non-neutrophilic nuclear (karyorrhectic) debris and numerous small CD68(+) and CD123(+) monocytes. These aforementioned features have been described in cutaneous lesions of Kikuchi-Fujimoto disease, an entity whose clinicopathologic findings overlap with both infectious mononucleosis and lupus erythematosus. Serologic evidence of active and chronic active EBV infection was found in both patients, respectively. No evidence of EBV or HHV6 was found in the cutaneous lesions. Plasmacytoid monocytes (CD68(+)/CD123(+) cells), which produce type I interferon, are believed to play a role in viral immunity by protecting other cells from viral infections and promoting survival of antigen-activated T cells. Their presence in these two putative examples of viral-drug immune dysregulation could be a clue to pathogenesis and represent a common cellular component of some adverse cutaneous drug eruptions.

Kikuchi Fujimoto disease secondary to Entamoeba histolytica: case report

Kikuchi Fujimoto disease (KFD) is a rare histiocytic necrotizing lymphadenitis which has a benign self-limiting clinical course. Its origin is unknown, but an abnormal autoimmune reaction has been suggested and infection is often considered to be an inciting agent. A 50-year-old man presented with fever, malaise, fatigue and sweat of 7 days duration, and diarrhea for 2 days. Physical examination revealed five mobile and painless cervical adenopathies. Entamoeba histolytica trophozoites and cysts were detected by microscopy of feces. Parenteral ornidazole treatment was commenced. Thorax computerized tomography showed lymph node sizes congruent with infection in the mediastinum, right hilus and right axillary region. Axillary lymph node biopsy and immunohistochemical analyses were then performed, and the results were consistent with histiocytic necrotizing lymphadenitis. From day 4 of antibiotic treatment the patient's body temperature decreased and reached a normal level on day 10. After discharge the patient returned for follow-up twice and was asymptomatic; his lymph nodes were either unpalpable or were decreased in size. We could not find any previous study or case report about a probable role for E. histolytica. Amebiasis can be a triggering factor in KFD or alternatively it is possible that its occurrence is coincidental.

Kikuchi-Fujimoto's necrotizing lymphadenitis in association with discoid lupus erthematosus: a case report

BACKGROUND

Kikuchi-Fujimoto's necrotizing lymphadenitis (KFNL) is a rare, benign, self-limited condition characterized by constitutional symptoms, lymphadenopathy, and skin lesions.

OBJECTIVE

We report a case of KFNL in a 43-year-old East Indian woman with a ten-year history of discoid lupus erythematosus (DLE) of the scalp and a three-month history of a erythematous plaque on the left nasal bridge, cervical lymphadenopathy, and fever. Skin biopsy samples were taken from the face and lymph node.

RESULTS

Histopathological examination of the skin revealed a mixed infiltrate of inflammatory cells, nuclear dust, and histiocytes phagocytosing nuclear debris in the reticular dermis. The lymph node showed interfollicular liquefactive necrosis, immunoblasts, and a similar cellular infiltrate as the skin. The non-necrotic areas demonstrated follicular hyperplasia. These pathological changes are associated with a diagnosis of KFNL.

CONCLUSIONS

KFNL is reported in association with systemic lupus erythematosus, but only two other cases of systemic KFNL in association with DLE exist in the literature. This case is unique in that the patient presented with cutaneous and systemic KFNL in the setting of longstanding DLE.

[Kikuchi-Fujimoto disease mimicking thyroid metastasis]

INTRODUCTION

Kikuchi-Fujimoto lymphadenopathy is a subacute necrotizing lymphadenopathy of unknown origin. It usually affects cervical lymph nodes. Lymph node biopsy is needed for establishing the diagnosis. This disease must be considered as a possible cause of lymphadenopathy of unknown origin, certainly if classical clinical features lead to diagnostic confusion.

OBSERVATION

A 41-year-old female presented a thyroid cancer treated by thyroidectomy associated with administration of I131. She also presented a right cervical metastasis treated by surgery. She had a cervical right cervical lymphadenopathy, hypermetabolic on the FDG scan, treated by a modified neck dissection. Microscopy of the surgical specimen showed necroziting lymphadenitis.

DISCUSSION

Kikuchi-Fujimoto lymphadenopathy is a subacute necroziting lymphadenopathy of unknown origin, involved more commonly cervical lymph nodes unilaterally. It is more common in Asia, predominantly in young women. This lesion has been reported in patients of virtually any age or gender. No specific biological findings have been described. Lymph node biopsy is needed for establishing the diagnosis. The spontaneous course is usually favorable but one fatal case has been reported.

Intraparotid Kikuchi-Fujimoto disease masquerading as a parotid gland tumor

The Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a self-limiting lesion of unknown cause first described in 1972 independently by Kikuchi and Fujimoto et al. This self-limiting disorder usually occurs in Asian women in their late 20s or early 30s. Typically, it runs a benign course and appears to resolve spontaneously 1 to 6 months after definite diagnosis. The Kikuchi-Fujimoto disease usually manifests as a localized cervical lymphadenopathy; therefore, most patients with this disease are seen in ears, nose, and throat practice. Nodal involvement other than in the neck area or extranodal involvement is rare. In this situation, however, the Kikuchi-Fujimoto disease is easily confused with other less-benign conditions. We describe a case of Kikuchi-Fujimoto disease in a 30-year-old man that presented as a parotid gland tumor. This is the third study to document intraparotid Kikuchi-Fujimoto disease in the English literature. Our report illustrates the clinical features of this unusual condition and emphasizes potential confusion with other diagnoses.

Kikuchi-Fujimoto disease--a case report

The etiology of cervical lymphadenopathy is multifactorial including infections and tumoral lesions. Histiocytic necrotising lymphadenitis or Kikuchi-Fujimoto's disease is a rare cause of cervical lymphadenopathy which does not have specific clinical signs. We report herewith a case of Kikuchi's disease (KD) diagnosed by histopathology.

[Pathogenic links between Kikuchi's disease and lupus: a report of three new cases]

INTRODUCTION

Histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto's disease is a rare anatomoclinical entity whose etiology remains unknown. It is mainly reported in young adult female, presenting with cervical lymphadenopathies, fever and asthenia. The diagnosis is based on the histological examination of a lymph node biopsy. The disease course is usually uneventful, but sometimes Kikuchi-Fujimoto's disease can reveal or evolve into a cutaneous or a systemic lupus.

EXEGESIS

We report three new cases of Kikuchi's disease: the first one mimicked a systemic lupus, the second one was associated with a lupus-like rash, and a the last one was a severe case with hemophagocytic syndrome and a primo-infection with Epstein-Barr virus revealing a systemic lupus erythematosus.

CONCLUSION

Clinical and biological follow-up of patients presenting with Kikuchi's disease is necessary to look for an association with a lupus. We discuss the pathogenic links between Kikuchi's disease and lupus.

Histiocytic necrotising lymphadenitis (Kikuchi-Fujimoto disease) in Saudi Arabia: clinicopathology and immunohistochemistry

BACKGROUND

Kikuchi-Fujimoto disease (KFD) is a rare entity of uncertain cause that commonly presents as a benign self-limiting disease of unknown origin. The objective of this study was to document the clinical features, mode of presentation, histopathological and immunohisto-chemical (IHC) features of KFD at our institutions since little is known about this disease in our region.

METHODS

We reviewed the histopathological reports of all lymph nodes resected at or referred to King Abdulaziz University Hospital between 1990 and 2003 and King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia between 2000 and 2003. All cases diagnosed as KFD were identified and the histological slides and clinical data were reviewed. IHC was performed for the proliferative marker Ki-67 and the apoptosis-related markers Bcl-2 and p53.

RESULTS

In 2500 lymph node biopsies, 15 cases were diagnosed as KFD. The female to male ratio was 2.7:1. One patient presented with axillary lymphadenopathy and the others presented with cervical lymphadenopathy. Ages averaged 29 years and ranged from 13 to 46 years. There was no recurrence of the lymphadenopathy over 1 to 10 years of follow up. Bcl-2 and p53 were negative and Ki-67 was positive in 11 of 15 cases.

CONCLUSION

The results support earlier findings that KFD is a self-limiting disorder that requires no specific management. We suggest a clinical follow-up for several years. The female predominance was striking. Apoptosis-regulating proteins are not helpful in the diagnosis. KFD usually expressed the proliferation-associated nuclear antigen Ki-67. Increased awareness of KFD will minimize the risk of confusing this entity with malignant lymphoma or other serious conditions.

Kikuchi-Fujimoto disease: a case report

Kikuchi-Fujimoto disease is a rare benign cervical lymphadenopathy, which often affects young adult women. Its etiology and pathogenesis are unknown. We present the case of Kikuchi-Fujimoto disease in the Polish population and analyse the difficulties in differentiating this disease from the systemic lupus erythematosus.

Kikuchi-Fujimoto disease is a rare cause of lymphadenopathy and fever of unknown origin in children: report of two cases and review of the literature

Kikuchi-Fujimoto disease, a benign and unusual self-limiting histiocytic necrotizing lymphadenitis of unknown origin, should be included in the differential diagnosis of lymphadenopathy and fever of unknown origin. This disease mostly affects young Asian women and has rarely been reported in children, thus remaining a poorly recognized entity that is frequently confused with malignant lymphoma. The authors describe two children with Kikuchi-Fujimoto disease, with particular attention to diagnostic approach and clinical and histologic features of the disease.

Clinical and laboratory manifestations of Kikuchi's disease in children and differences between patients with and without prolonged fever

BACKGROUND

Kikuchi's disease (KD) is characterized by cervical lymphadenopathy with or without fever. It has been recognized worldwide but seldom reported in pediatric patients.

METHODS

From January 1985 through December 2001, 64 patients younger than 18 years of age with pathologic proof of KD were enrolled in this study. The clinical manifestations, laboratory data and outcomes were reviewed.

RESULTS

There were 35 male patients and 29 female patients with age ranging from 2 to 18 years and a median age of 16. All patients had cervical lymphadenopathy except 1 who had generalized lymphadenopathy. Lymph nodes of 32 patients (50%) were painful or tender or both. Lymphadenopathy was unilateral in 52 patients (82.5%). Lymphadenopathy associated with fever was observed in 21 patients (32.8%). Other signs such as skin rash, hepatomegaly or body weight loss were less common. Twenty-six patients (40.6%) had leukopenia and 2 patients had leukocytosis. Nearly one-fourth of the patients had mild liver dysfunction. Virologic or immunologic studies were normal in most patients. Patients with prolonged fever were more likely to have leukopenia (P < 0.05). All patients recovered, but 1 developed systemic lupus erythematosus 5 years later, and the other had vasculitis syndrome 2 years later.

CONCLUSIONS

The clinical presentation of KD in pediatric patients is similar to that of adults. KD is a benign, self-limiting disease; prolonged fever occurred only in 32.8% of pediatric patients in our cohort. Leukopenia was the only feature significantly associated with prolonged fever.