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Ichikawa G, Negishi Y, Chishima F, Suzuki S. Kikuchi-Fujimoto disease during early pregnancy. J Obstet Gynaecol Res 2024; 50:1056-1060. [PMID: 38511280 DOI: 10.1111/jog.15928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Kikuchi-Fujimoto disease (KFD) is rare during pregnancy. It is characterized by necrotizing lymphadenitis and often occurs in young Asian women. We report a case of KFD during pregnancy, which was difficult to diagnose. A 37-year-old pregnant female (gestational week [GW] 7+5) was admitted to our hospital because of hyperemesis gravidarum. On the eighth day of hospitalization (GW 8+6), she suddenly developed a fever (38.0°C) with skin rash and posterior pharynx redness. Blood tests showed pancytopenia and abnormal liver function. The patient was misdiagnosed with severe Epstein-Barr virus infection and administered with prednisolone. Subsequently, cervical lymphadenopathy was observed, and biopsy results led to the diagnosis of KFD. Thereafter, her symptoms improved, and she was discharged at GW 13+4. KFD must be included as a differential diagnosis for patients with fever, abnormal liver function, and pancytopenia during pregnancy.
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Affiliation(s)
- Go Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
- Department of Obstetrics and Gynecology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Yasuyuki Negishi
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan
| | - Fumihisa Chishima
- Department of Obstetrics and Gynecology, Kawaguchi Municipal Medical Center, Saitama, Japan
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
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Mahajan VK, Sharma V, Sharma N, Rani R. Kikuchi-Fujimoto disease: A comprehensive review. World J Clin Cases 2023; 11:3664-3679. [PMID: 37383134 PMCID: PMC10294163 DOI: 10.12998/wjcc.v11.i16.3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/29/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
Kikuchi-Fujimoto disease, a rare form of necrotizing lymphadenitis, is an uncommon, benign, self-limiting disorder of obscure etiology. It affects mostly young adults of both genders. Clinically, it presents with fever and lymphadenopathy of a firm to rubbery consistency frequently involving cervical lymph nodes while weight loss, splenomegaly, leucopenia, and elevated erythrocyte sedimentation rate feature in severely affected patients. Cutaneous involvement occurs in about 30%-40% of cases as facial erythema and nonspecific erythematous papules, plaques, acneiform or morbilliform lesions of great histologic heterogeneity. Both Kikuchi-Fujimoto disease and systemic lupus erythematosus share an obscure and complex relationship as systemic lupus erythematosus may occasionally precede, develop subsequently, or sometimes be associated concurrently with Kikuchi-Fujimoto disease. It is often mistaken for non-Hodgkin lymphoma while lupus lymphadenitis, cat-scratch disease, Sweet’s syndrome, Still’s disease, drug eruptions, infectious mononucleosis, and viral or tubercular lymphadenitis are other common differentials. Fine needle aspiration cytology mostly has features of nonspecific reactive lymphadenitis and immunohistochemistry studies usually show variable features of uncertain diagnostic value. Since its diagnosis is exclusively from histopathology, it needs to be evaluated more carefully; an early lymph node biopsy will obviate the need for unnecessary investigations and therapeutic trials. Its treatment with systemic corticosteroids, hydroxychloroquine, or antimicrobial agents mostly remains empirical. The article reviews clinicoepidemiological, diagnostic, and management aspects of KFD from the perspective of practicing clinicians.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Neeraj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Ritu Rani
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
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Potapenko VG, Baykov VV, Markova АY, Mikhailova NB, Ter‑Grigoryan AS, Krivolapov YА. Kikuchi–Fujimoto disease: literature review and report of four cases. ONCOHEMATOLOGY 2022. [DOI: 10.17650/1818-8346-2022-17-4-48-59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Kikuchi–Fujimoto disease, or necrotizing histiocytic lymphadenitis, is one of the rare causes of benign lymphadeno-pathy. The diagnosis is based on histological and immunohistochemical analysis of the lymph node biopsy. The article presents four clinical cases of Kikuchi–Fujimoto disease. According to the results of the primary analysis of lymph node tissue three patients were misdiagnosed with lymphoma. due to the unusual for lymphoid malignancy course the primary material was reviewed. The diagnosis of Kikuchi–Fujimoto disease was put. In three patients the disease has a re-current course. during the observation period, the course of the disease in all the presented patients is benign with normal quality of life.
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Affiliation(s)
| | - V. V. Baykov
- Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | | | - N. B. Mikhailova
- Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - A. S. Ter‑Grigoryan
- Hematological Center named after professor R.O. Yeolyan, Ministry of Health of the Republic of Armenia
| | - Yu. А. Krivolapov
- I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia
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Alosaimi S, Hijazi B, Alhumidi A, Alsaif F. A Case of Kikuchi-Fujimoto Disease Associated with Erosive Lichen Planus. Cureus 2020; 12:e7312. [PMID: 32313753 PMCID: PMC7164705 DOI: 10.7759/cureus.7312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a benign, self-limiting disorder with unknown etiology. The most frequent clinical manifestations include lymphadenopathy, fever, cutaneous lesions, arthritis, fatigue, and hepatosplenomegaly. Cutaneous manifestations of KFD, occurring in about one-third of patients, are typically non-specific, rarely presenting as symmetrically distributed lesions. The prevalence of erosive lichen planus in patients with KFD, as of this date, is unknown with no previously reported cases describing an association between the two conditions. In the following case report, we report a case presenting with bilateral symmetrical erosive lichen planus of the heel associated with KFD as being a possible, rather novel, cutaneous manifestation.
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Affiliation(s)
- Shoroq Alosaimi
- Department of Dermatology, College of Medicine, Majmaah University, Majmaah, SAU
| | | | - Ahmed Alhumidi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, SAU
| | - Fahad Alsaif
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, SAU
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5
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Xu S, Sun W, Liu J. Kikuchi-Fujimoto disease: a case report and the evaluation of diagnostic procedures. BMC Oral Health 2019; 19:223. [PMID: 31638953 PMCID: PMC6805530 DOI: 10.1186/s12903-019-0920-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease, known as histiocytic necrotizing lymphadenitis, is a benign, self-limiting and systemic disorder involving lymph nodes with unknown aetiology. First reported in Japan, there has been an increase in its incidence globally. Because of its non-specific clinical features, the disease can be easily mistaken for other forms of lymphadenitis with a high rate of misdiagnosis and mistreatment, posing a considerable challenge. CASE PRESENTATION A case of young Chinese woman with fever and cervical lymphadenopathy is presented. Physical examinations and imaging techniques were used to rule out common forms of lymphadenitis (e.g. cat-scratch disease and tuberculous lymphadenitis). Laboratory tests were then conducted to exclude others such as systemic lupus erythematosus and non-Hodgkin lymphoma. After Kikuchi-Fujimoto disease was identified, the patient was managed with symptomatic treatments. Our case was compared with relevant cases in the literature. A diagnostic flow chart was proposed to facilitate the diagnosis and treatment. CONCLUSIONS With its shared clinical features, Kikuchi-Fujimoto disease can be mistaken for other forms of lymphadenitis. A combined use of medical imaging and laboratory tests is the effective way to avoid misdiagnosis.
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Affiliation(s)
- Shenjie Xu
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, People's Republic of China.
| | - Weilian Sun
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, People's Republic of China
| | - Jiamei Liu
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, People's Republic of China
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Deaver D, Horna P, Cualing H, Sokol L. Pathogenesis, diagnosis, and management of Kikuchi-Fujimoto disease. Cancer Control 2015; 21:313-21. [PMID: 25310212 DOI: 10.1177/107327481402100407] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease (KFD) is a rare lymphohistiocytic disorder with an unknown etiopathogenesis. This disease is misdiagnosed as malignant lymphoma in up to one-third of cases and is associated with the development of systemic lupus erythematosus (SLE). METHODS The medical literature between the years 1972 and 2014 was searched for KFD, and the data were collected and analyzed regarding the epidemiology, clinical presentations, diagnosis, management, and suggested diagnostic and treatment algorithms. RESULTS Although KFD has been reported in other ethnic groups and geographical areas, it is more frequently diagnosed in young women of Asian descent. Patients with the disease typically present with rapidly evolving tender cervical lymphadenopathy, night sweats, fevers, and headache. Diagnosis is based on histopathological examination. Excisional lymph node biopsy is essential for a correct diagnosis. Apoptotic coagulation necrosis with karyorrhectic debris and the proliferation of histiocytes, plasmacytoid dendritic cells, and CD8(+) T cells in the absence of neutrophils are characteristic cytomorphology features. Interface dermatitis at the onset of KFD may be a marker for the subsequent evolution of SLE. The natural course of the disease is typically benign. Short courses of steroids, nonsteroidal anti-inflammatory drugs, or hydroxychloroquine can be administered to patients with more severe symptoms. CONCLUSIONS Although KFD was described more than 40 years ago, the etiology of this disease remains unsolved. Infectious or autoimmune processes were proposed but have not been definitively confirmed. Clinical presentation with systemic B symptoms and adenopathy may lead to an erroneous diagnosis of malignant lymphoma. The introduction of modern methods into hematopathology, including immunohistochemistry, flow cytometry, and molecular clonality studies, has decreased the probability of misdiagnosis. Until reliable prognostic markers are available, patients with KFD should have continued long-term follow-up care due to their increased risk of SLE.
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Mayooran N, O'Cathain E, Bresnihan MN, Patil N. Kikuchi-Fujimoto disease: an unusual cause of neck swelling in pregnancy. BMJ Case Rep 2015; 2015:bcr-2014-206505. [PMID: 25604502 DOI: 10.1136/bcr-2014-206505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is an unusual cause of lymphadenopathy and fever. Pregnancy associated with KFD presents as a diagnostic dilemma for clinicians. The diagnosis can be confirmed with invasive biopsies or non-invasive gene analysis. We report a case of a 24-year-old woman at 18 weeks' gestation with a neck lump and histologically confirmed KFD.
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Mrówka-Kata K, Kata D, Kyrcz-Krzemień S, Sowa P. Kikuchi-Fujimoto disease as a rare cause of lymphadenopathy--two cases report and review of current literature. Otolaryngol Pol 2013; 67:1-5. [PMID: 23374656 DOI: 10.1016/j.otpol.2012.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 02/22/2012] [Accepted: 02/23/2012] [Indexed: 11/30/2022]
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a benign and self-limited disease, characterized typically by enlargement of regional lymph nodes accompanied by fever. KFD affects predominantly young adult females of Asian origin and is rarely seen in European countries, where it may cause diagnostic difficulties. Two cases of KFD in a 33 and 27-year-old woman with mild fever, malaise, lymphadenopathy initially misdiagnosed for indolent non-Hodgkin's lymphoma was presented. The definitive diagnosis was established on the basis of histopathological examination of totally excised cervical lymph nodes. The propriety diagnosis allowed us to avoid inappropriate chemotherapy. The disease course in our patient was uneventful during the 1.5 and 12-year follow-up period. The clinical presentations, complications as well as current concepts on pathogenesis, diagnosis and treatment of the Kikuchi-Fujimoto disease was briefly reviewed in this paper. The need of a long-term follow-up of patients with Kikuchi-Fujimoto disease was emphasized.
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Affiliation(s)
- Katarzyna Mrówka-Kata
- Katedra i Oddział Kliniczny Laryngologii w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach, ul. M. Skłodowskiej-Curie 10, 41-800 Zabrze, Poland.
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Astudillo L. [Kikuchi-Fujimoto disease]. Rev Med Interne 2010; 31:757-65. [PMID: 20605287 DOI: 10.1016/j.revmed.2010.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 11/07/2009] [Accepted: 01/01/2010] [Indexed: 01/30/2023]
Abstract
Kikuchi-Fujimoto disease is a necrotizing lymphadenitis, involving young patients, predominantly females. Lymphadenopathy is usually localized, particularly in the cervical area, mostly unilateral and tender. Fever is present in one third of cases. Associated skin lesions, arthralgia, myalgia, splenomegaly or hepatomegaly are rare. Laboratory evaluation shows a slight increase of erythrocyte sedimentation rate and leukopenia. Kikuchi-Fujimoto has been reported in association with other diseases, including systemic lupus, Still's disease, hemophagocytosis, pregnancy, other autoimmune diseases, and cancer. A viral or bacterial origin has been suspected but not confirmed. Lymph node biopsy allows the diagnosis and shows necrotizing lymphadenitis with acidophil necrosis, CD68+ histiocyte infiltrate, presence of plasmacytoid monocytes, multiple apoptotic cells (CD8+ T cell) with nuclear dust, immunoblastic reaction and the absence of neutrophils or eosinophils. The disease course is usually spontaneously favourable in few weeks or months, requiring corticosteroids only occasionally.
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Affiliation(s)
- L Astudillo
- Service de médecine interne, CHU Purpan, Toulouse cedex, France.
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Alijotas-Reig J, Casellas-Caro M, Ferrer-Oliveras R, Cabero-Roura L, Vilardell-Tarres M. Recurrent Kikuchi-Fujimoto disease during pregnancy: report of case evolving into systemic lupus erythematosus and review of published work. J Obstet Gynaecol Res 2009; 34:595-8. [PMID: 18840160 DOI: 10.1111/j.1447-0756.2008.00727.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a distinctive, benign type of necrotizing lymphadenitis. KFD is a rare entity, especially during pregnancy. Although first described in Japan, subsequently it has been reported in the West. We communicate herein a case of KFD in African women with bouts during pregnancy. Diagnosis was difficult because peripheral enlarged lymph nodes were absent and an extended differential diagnosis and adequate work-up was necessary. The patient suffered a miscarriage coinciding with a KFD bout. Further pregnancies were uneventful. Follow up showed that KFD evolved into a systemic lupus erythematosus-like syndrome.
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Affiliation(s)
- Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Service of Internal Medicine I, University Hospital of Vall d'Hebron, Barcelona, Spain.
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Ifeacho S, Aung T, Akinsola M. Kikuchi-Fujimoto Disease: A case report and review of the literature. CASES JOURNAL 2008; 1:187. [PMID: 18822141 PMCID: PMC2567303 DOI: 10.1186/1757-1626-1-187] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 09/26/2008] [Indexed: 12/21/2022]
Abstract
Kikuchi-Fujimoto Disease is a rare benign, condition of necrotising histiocytic lymphadenitis. A case of a 55 year old gentleman is described here. He presented with fevers, weight loss and tender cervical lymph nodes. Kikuchi-Fujimoto disease was diagnosed after cervical lymph node biopsy. Symptomatic treatment was provided and an uneventful full recovery was made. Of significant note, this patient's daughter had Kikuchi-Fujimoto disease almost a decade earlier. Although Kikuchi-Fujimoto disease has been reported widely, we believe this is the first familial report in the literature of a case of Kikuchi-Fujimoto disease occurring in a parent and child.
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Affiliation(s)
- Sonna Ifeacho
- Department of General Medicine, Heatherwood Hospital, London Road, Ascot, SL5 8AA, UK.
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Alijotas-Reig J, Suy-Franch A, Casellas-Caro M, Vilardell-Tarres M, Cabero-Roura L. Recurrent Kikuchi-Fujimoto necrotizing lymphadenitis during pregnancy. Eur J Obstet Gynecol Reprod Biol 2008; 140:144-5. [DOI: 10.1016/j.ejogrb.2007.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 09/20/2007] [Accepted: 10/31/2007] [Indexed: 10/22/2022]
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Abstract
We describe a 20-year-old woman with autoimmune hepatitis (AIH) with cirrhosis who developed Kikuchi-Fujimoto's disease (KFD) and de novo minor features of systemic lupus erythematosus (SLE). This is the first report of a patient with histologically confirmed AIH developing KFD (histiocytic necrotizing lymphadenitis). One previous case described KFD after AIH (diagnosed clinically but without biopsy). KFD is a rare condition of unknown aetiology, first described in 1972, characterized by fever and cervical adenopathy and has a self-limiting course. KFD is associated with SLE, and SLE in turn can be associated with abnormal liver function tests, which in a minority of cases may be due to AIH. The association of AIH, KFD, and SLE in our patient suggests an autoimmune pathogenesis of KFD.
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