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Achappa B, Herath NC, Sebastian B, Dsouza NV, RAGHURAM PAVANMANIBETTU, Holla R, Chowta N, Kini JR. Kikuchi-Fujimoto disease in a tertiary care teaching hospital in Coastal South India: A 8-year retrospective study. F1000Res 2022; 11:492. [PMID: 35811790 PMCID: PMC9226704 DOI: 10.12688/f1000research.109832.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Kikuchi-Fujimoto disease (KFD) is a rare, benign condition of unknown etiology, presenting as cervical lymphadenitis. Lymphadenopathy is usually tender and maybe associated with systemic symptoms. Despite the extensive literature on this disease, it continues to be misdiagnosed owing to its misleading clinical presentation.
Methods:
A retrospective hospital-based descriptive cross-sectional study was conducted in tertiary care hospitals from 2011 to 2019. All patients with confirmed KFD diagnosis were included and after ethics committee approval the clinical details and histopathological data was retrieved from the medical records department and analyzed.
Results:
A total of 67 cases were included. The mean age was 26.9±11.3 years with a female: male ratio of 1.9:1. There were 50 patients with tender cervical lymphadenopathy which was the most common clinical presentation. The mean length and width of palpable lymph nodes were 2.3±1.0 cm and 2.2±0.7 cm respectively. Histology revealed proliferative stage in majority of patients (
n=40, 59.7%). Lymphadenopathy resolved in 83.6% within 2 months. There were 42 patients who had complete recovery with symptomatic treatment within a period of 9 months.
Conclusions:
KFD is prevalent in young, female patients of Asian descent and often presents as tender cervical lymphadenopathy. Early diagnosis with excisional lymph node biopsy is crucial to avoid unnecessary investigations and treatment. Treatment is symptomatic unless complicated, where steroid therapy is considered. KFD has an excellent prognosis with almost no risk of fatality.
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Affiliation(s)
- Basavaprabhu Achappa
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nipuni Chamathka Herath
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Bodhi Sebastian
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nikhil Victor Dsouza
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - PAVAN MANIBETTU RAGHURAM
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nithyananda Chowta
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Jyoti Ramanath Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Al Manasra AR, Al-Domaidat H, Aideh MA, Al Qaoud D, Al Shalakhti M, Al Khatib S, Fataftah J, Al-Taher R, Nofal M. Kikuchi-Fujimoto disease in the Eastern Mediterranean zone. Sci Rep 2022; 12:2703. [PMID: 35177750 PMCID: PMC8854556 DOI: 10.1038/s41598-022-06757-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Kikuchi–Fujimoto disease (KFD) is a rare benign and self-limiting syndrome. We aim to review cases of KFD at our institution as a rare illness in the Arab ethnic descent and to analyse reports from most countries in the East Mediterranean zone. This is a retrospective study in which the histopathology database was searched for the diagnosis of KFD. A full review of KFD patients’ medical records was done. Data regarding demographic features, clinical presentation, laboratory findings, comorbidities, and management protocols were obtained. Published KFD cases from east Mediterranean countries were discussed and compared to other parts of the world. Out of 1968 lymph node biopsies studied, 11 (0.6%) cases of KFD were identified. The mean age of patients with KFD was 32 years (4–59). 73% (8/11) were females. The disease was self-limiting in 5 patients (45%); corticosteroid therapy was needed in 4 patients (34%). One patient was treated with methotrexate and one with antibiotics. One patient died as a consequence of lymphoma. Jordanians and Mediterranean populations, especially those of Arab ethnic background, seem to have low rates of KFD. The genetic susceptibility theory may help to explain the significantly higher disease prevalence among East Asians. Early diagnosis of KFD—although challenging—is essential to reduce the morbidity related to this illness.
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Affiliation(s)
- Abdel Rahman Al Manasra
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, Jordan.
| | - Hamzeh Al-Domaidat
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, Jordan
| | - Mohd Asim Aideh
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, Jordan
| | - Doaa Al Qaoud
- Department of Pediatrics, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Majd Al Shalakhti
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, Jordan
| | - Sohaib Al Khatib
- Department of Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jehad Fataftah
- Department of Radiology, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Raed Al-Taher
- Department of Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Nofal
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, Jordan
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Akhavanrezayat A, Cooper JD, Hassan M, Pham BH, Nguyen QD, Farr AK. Bilateral preretinal hemorrhage associated with Kikuchi-Fujimoto disease. Am J Ophthalmol Case Rep 2021; 22:101041. [PMID: 33732946 PMCID: PMC7940994 DOI: 10.1016/j.ajoc.2021.101041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/03/2021] [Accepted: 02/20/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To present a case of a patient with human immunodeficiency virus (HIV) disease and Kikuchi-Fujimoto disease (KFD) who presented with a unique pattern of retinopathy. Observations A 7-year-old Taiwanese girl with HIV disease who was recently diagnosed with KFD had a sudden onset of blurry vision in both eyes one month after her KFD systemic symptoms had relatively resolved. Ophthalmic examination showed decreased visual acuity in both eyes (OU). On fundus examination, she had bilateral preretinal, subhyaloid, and vitreous hemorrhage that was more severe than anemic retinopathy. Conclusion Ocular manifestations in Kikuchi-Fujimoto disease are rare; however, if they occur, presentations may vary. The exact etiology of the disease has remained elusive and controversial. This case is the first report of a patient with HIV disease and KFD presenting with ocular involvement. Furthermore, bilateral preretinal, subhyaloid, and vitreous hemorrhage, which was beyond anemic retinopathy, is an unprecedented manifestation of KFD that has not been previously reported. This case highlights the necessity for clinicians to consider all possible differential diagnoses when evaluating patients with similar findings to identify the best therapeutic approach and avoid unnecessary treatment.
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Affiliation(s)
- Amir Akhavanrezayat
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Joseph D. Cooper
- Division of AIDS Medicine & Infectious Diseases, Department of Medicine, Santa Clara Valley Health & Hospital System, San Jose, CA, USA
| | - Muhammad Hassan
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Brandon H. Pham
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Arman K. Farr
- Retina Institute of The Carolina and Macular Degeneration Center, Charlotte, NC, USA
- Corresponding author.
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Park SG, Koo HR, Jang K, Myung JK, Song CM, Ji YB, Park JS, Tae K. Efficacy of Ultrasound-Guided Needle Biopsy in the Diagnosis of Kikuchi-Fujimoto Disease. Laryngoscope 2020; 131:E1519-E1523. [PMID: 33002212 DOI: 10.1002/lary.29160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/06/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Ultrasound-guided fine-needle aspiration cytology (US-FNAC) is a well-established procedure performed to establish the diagnosis of Kikuchi-Fujimoto disease (KFD). Ultrasound-guided core needle biopsy (US-CNB) is an alternative diagnostic tool for KFD. However, the efficacy of US-CNB is not well evaluated. This study aimed to evaluate the efficacy of US-CNB and compare it with that of US-FNAC in the diagnosis of KFD. STUDY DESIGN Retrospective cohort study. METHODS We analyzed 170 patients who were diagnosed with KFD between January 2009 and May 2019. US-FNAC, US-CNB, and excisional biopsy were performed in 47, 114, and 9 patients, respectively. Diagnostic accuracies of US-FNAC and US-CNB were analyzed and compared. RESULTS Of the 170 patients, 45 and 125 were men and women, respectively. The mean age was 26.9 ± 9.1 years. The most common symptom was cervical lymphadenopathy, followed by fever, headache, and myalgia. The diagnosis of KFD was established primarily by US-FNAC in 21 (44.7%) of the 47 patients, by US-CNB in 109 (95.6%) of the 114 patients, and by excisional biopsy in all 9 patients. There was no specific major complication related to US-FNAC and US-CNB. CONCLUSION US-CNB can be considered safe and effective and used as the primary modality for the pathological diagnosis of KFD. LEVEL OF EVIDENCE 4. Laryngoscope, 131:E1519-E1523, 2021.
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Affiliation(s)
- Sang Gyu Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hye Ryoung Koo
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kiseok Jang
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jae Kyung Myung
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jeong Seon Park
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Jiménez-Heffernan JA, Muñoz-Hernández P, Bárcena C. Kikuchi-Fujimoto Disease-Like Inflammatory Reaction in a Silicone Breast Implant Seroma. Acta Cytol 2020; 64:386-389. [PMID: 31962314 DOI: 10.1159/000505253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/05/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Kikuchi-Fujimoto disease (KFD) may have an autoimmune etiology and some cases have been associated with silicone breast implants. Cytomorphologic features of the disease have been well characterized by fine-needle aspiration of lymph nodes. They are so specific as to permit a precise cytologic diagnosis. Cytologic features have not been reported in fluid specimens. CASE A 33-year-old female presented with a unilateral periprosthetic silicone breast seroma. The fluid was drained, and cytological analysis revealed numerous lymphocytes with no neutrophils, karyorrhectic nuclear debris, and peculiar histiocytes with eccentrically located nuclei showing a crescentic shape. Many of those histiocytes showed intracellular apoptotic debris. CONCLUSION A Kikuchi disease-like inflammatory reaction is possible not only in axillary and cervical lymph nodes of patients with silicone breast implants but also in breast seromas. There is still not enough evidence to establish if there is an association between KFD and breast implants. A detailed cytologic examination of periprosthetic silicone breast seromas may help answer this question. In any case, pathologists must be aware of this possibility. Cytologic features are characteristic enough to permit differentiation from breast implant-associated anaplastic large-cell lymphoma.
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Affiliation(s)
- José A Jiménez-Heffernan
- Department of Pathology, University Hospital La Princesa, Madrid, Spain,
- Department of Pathology, Synlab Pathology, Madrid, Spain,
| | | | - Carmen Bárcena
- Department of Pathology, University Hospital 12 de Octubre, Madrid, Spain
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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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Kwon HH, Kim SK. Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease) preceding tuberculous pleurisy. Int J Rheum Dis 2014; 17:223-5. [DOI: 10.1111/1756-185x.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hyun Hee Kwon
- Division ofInfectious Diseases; Department of Internal Medicine; Catholic University of Daegu School of Medicine; Daegu South Korea
| | - Seong-Kyu Kim
- Division of Rheumatology; Department of Internal Medicine; Catholic University of Daegu School of Medicine; Daegu South Korea
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Hanakawa H, Orita Y, Sato Y, Takeuchi M, Ohno K, Iwaki N, Ito T, Nishizaki K, Yoshino T. Cutting needle biopsy combined with immunohistochemical study of myeloperoxidase for the diagnosis of histiocytic necrotizing lymphadenitis. Acta Otolaryngol 2013; 133:1328-32. [PMID: 24245703 DOI: 10.3109/00016489.2013.824112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Cutting needle biopsy (CNB) combined with immunohistochemical study of myeloperoxidase (MPO) is a useful minimally invasive diagnostic procedure for histiocytic necrotizing lymphadenitis (HNL). OBJECTIVES HNL is mainly diagnosed by pathological findings of open surgical biopsy (OSB) specimens. Recently the appearance of anti-MPO positive histiocytes has been reported as a highly specific pathological diagnosis for HNL. Considering the cosmetic impact and burden on the patients, we performed CNB combined with immunohistochemical study of MPO for the diagnosis of HNL. Few studies have reported the utility of this method in the diagnosis of HNL. METHODS A retrospective study was conducted using clinical data from 20 HNL patients. RESULTS CNB was performed in 8 patients and OSB in 13 (OSB after CNB in 1). MPO-positive histiocytes were observed in all of the 20 cases. The accuracy of the diagnoses was finally confirmed by the clinical courses in all cases.
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