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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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Moinet F, Molinié V, Béraud G, Polomat K, Cordel N, Sainte-Marie D, Duffas O, Duflo S, Bomahou C, Arfi S, Deligny C. Epidemiology and Characteristics of Kikuchi-Fujimoto Disease in the African-Descent Population of Martinique, French West Indies. Arthritis Care Res (Hoboken) 2016; 68:1883-1887. [DOI: 10.1002/acr.22898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/18/2016] [Accepted: 03/22/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Florence Moinet
- Centre Hospitalier Universitaire Pierre Zobda Quitman; Fort de France Martinique
| | - Vincent Molinié
- Centre Hospitalier Universitaire Pierre Zobda Quitman; Fort de France Martinique
| | | | - Katlyne Polomat
- Centre Hospitalier Universitaire Pierre Zobda Quitman; Fort de France Martinique
| | - Nadège Cordel
- Centre Centre Hospitalier Universitaire de Pointe-à-Pitre/Abymes; Pointe-à-Pitre Guadeloupe
| | | | - Olivier Duffas
- Centre Hospitalier Universitaire Pierre Zobda Quitman; Fort de France Martinique
| | - Suzy Duflo
- Centre Centre Hospitalier Universitaire de Pointe-à-Pitre/Abymes; Pointe-à-Pitre Guadeloupe
| | - Charlène Bomahou
- Centre Hospitalier Universitaire Pierre Zobda Quitman; Fort de France Martinique
| | - Serge Arfi
- Centre Hospitalier Universitaire Pierre Zobda Quitman; Fort de France Martinique
| | - Christophe Deligny
- Centre Hospitalier Universitaire Pierre Zobda Quitman; Fort de France Martinique
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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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Sharma V, Rankin R. Fatal Kikuchi-like lymphadenitis associated with connective tissue disease: a report of two cases and review of the literature. SPRINGERPLUS 2015; 4:167. [PMID: 25897412 PMCID: PMC4398681 DOI: 10.1186/s40064-015-0925-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Kikuchi-Fujimoto disease, is usually a benign self-limiting disease which typically affects young females under the age of 30 years and resolves without treatment within six months. However, when it occurs in the context of connective tissue disease, particularly systemic lupus erythematosus (SLE), it is usually associated with a flare-up of the patient's symptoms, requiring treatment, and can lead to severe, potentially life-threatening sequelae. CASE DESCRIPTION Here, we report and compare two cases of unclassifiable connective tissue disease who developed a Kikuchi-like lymphadenitis and sepsis-like clinical syndrome, including disseminated intravascular coagulation, which proved rapidly fatal. DISCUSSION AND EVALUATION In our review of the literature, we found 55 cases of Kikuchi-Fujimoto disease occurring in the context of definite connective tissue disease, 50 of which were associated with SLE. Of the 55 cases, 22 (40%) had simultaneous onset with, 19 (35%) predated the onset of and 14 (25%) developed after the associated connective tissue disease. Life-threatening autoimmune sequelae were reported in 8 cases, 2 of which were fatal. The aetiology of the association remains unknown. CONCLUSION Kikuchi-Fujimoto disease is a histopathological diagnosis, and although the classical form appears to represent a distinct entity, it is unclear whether it is always the same entity, regardless of the context in which it occurs, or whether it represents a histological pattern with a variety of possible causes. In any case, the possibility of auto-immune sequelae in patients with known autoimmune disease should always be considered if these patients present with a sepsis-like clinical syndrome and no infective source is identified.
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Affiliation(s)
- Vijay Sharma
- />Department of Pathology, Raigmore Hospital, Inverness, Scotland
- />Department of Pathology, Aberdeen Royal Infirmary, Foresterhill Aberdeen, Scotland
- />Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland
| | - Rosslyn Rankin
- />Department of Pathology, Raigmore Hospital, Inverness, Scotland
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Sopeña B, Rivera A, Vázquez-Triñanes C, Fluiters E, González-Carreró J, del Pozo M, Freire M, Martínez-Vázquez C. Autoimmune manifestations of Kikuchi disease. Semin Arthritis Rheum 2011; 41:900-6. [PMID: 22192931 DOI: 10.1016/j.semarthrit.2011.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 10/25/2011] [Accepted: 11/04/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Kikuchi's disease (KD) has been associated with the presence of autoantibodies, systemic lupus erythematosus (SLE), and other autoimmune diseases. The aim of this study was to assess the frequency of autoimmune manifestations in a KD cohort with a long follow-up. METHODS Twenty patients with histologically confirmed KD since January 1990 until December 2010 were studied; 12 of them were periodically followed up as outpatients. Another 7 patients were contacted by telephone to offer them a specific consultation and a complete autoimmunity study. RESULTS Thirteen of 20 patients were women (65%) with a mean age of 29 years (range, 15-79). The age at diagnosis was higher in men (44 vs 27 years, P < 0.05). Lymphopenia was present in 75% of the patients (15/20) and was the more frequent hematological abnormality. The mean follow-up of the 17 patients included in the autoimmunity study was 119 months (range, 15-252). Autoimmune diseases were detected in 9 women (53%): SLE was diagnosed in 4 patients (2 SLE before, 1 simultaneous, and 1 after KD), 2 patients developed primary Sjögren's syndrome after KD, 1 thyroiditis before KD, 1 SLE-like, and 1 antiphospholipid antibodies after KD. Leukocytoclastic vasculitis was found in 2 patients; 1 of them eventually developed SLE. Female sex, painful adenopathies, and cytopenias were significantly associated with autoimmune diseases. CONCLUSIONS Among patients with KD, only women developed autoimmune manifestations. Therefore, long-term follow-up and active surveillance of autoimmune diseases in patients with KD, especially women, are recommended.
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Affiliation(s)
- Bernardo Sopeña
- Thrombosis and Vasculitis Unit, Internal Medicine Service, Complexo Hospitalario Universitario of Vigo (CHUVI), Vigo, Pontevedra, Spain.
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Ichikawa K, Sugimoto K, Isobe Y, Kuwatsuru R, Sasaki M, Horiguchi I, Komatsu N. Usefulness of systemic computed tomography (CT) scanning in the detection of malignant lymphadenopathy. Medicine (Baltimore) 2011; 90:396-403. [PMID: 22033453 DOI: 10.1097/md.0b013e31823913f2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We developed a prediction model to distinguish between malignant and nonmalignant lymphadenopathies. We first analyzed clinical features of 222 patients with lymphadenopathy (161 malignant and 61 nonmalignant) in the derivation group. Through logistic regression analysis we identified 6 covariates that independently predict malignancy: age (X1), abdominal lymphadenopathy (X2), lymphadenopathy of the other sites (X3), number of enlarged lymph node regions (X4), absence of fever (X5), and largest lymph node size (X6). We determined the formula as follows: predictive score=-2.3+x1+2.8x2+1.3x3+1.6x4-2.2x5+1.8x6.A higher score correlated with increased likelihood of malignancy. With the cutoff value of 0.4, the sensitivity and specificity of the model were 91.9% and 77.0%, respectively. The validation study using 117 cases (82 malignant and 35 nonmalignant) yielded 90.2% sensitivity and 68.6% specificity. A maximum lymph node size of less than 2.0 cm on systemic computed tomography (CT) scanning indicated a low probability of malignant lymphadenopathy. In this model, 4 of the 6 covariates were obtained by CT scanning, which strongly indicates the usefulness of initial evaluation with systemic CT scanning in the detection of malignant lymphadenopathy.
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Affiliation(s)
- Kunimoto Ichikawa
- From Division of Hematology (KI, KS, YI, MS, NK), Department of Internal Medicine; Department of Radiology (RK); and Department of Public Health (IH); Juntendo University School of Medicine, Tokyo, Japan
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Das DK, Mallik MK, Dashti HAHMGH, Sathar SA, Jaragh M, Junaid TA. Kikuchi-fujimoto disease in fine-needle aspiration smears: A clinico-cytologic study of 76 cases of KFD and 684 cases of reactive hyperplasia of the lymph node. Diagn Cytopathol 2011; 41:288-95. [DOI: 10.1002/dc.21810] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 07/14/2011] [Indexed: 11/11/2022]
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Verroiotou M, Mogrampi SA, Polytidis I, Fardellas I. Kikuchi-fujimoto disease: a rare case of axillary lymphadenopathy. Lymphat Res Biol 2011; 9:115-6. [PMID: 21688981 DOI: 10.1089/lrb.2011.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease is a self-limited condition, characterized by benign lymphadenopathy. METHODS AND RESULTS We describe a case of a 56-year-old male who presented with a node growth in the left axilla, without referring any other symptoms. The patient underwent excision and biopsy of the node and the histological examination established the diagnosis of Kikuchi-Fujimoto disease. After 3 days of hospitalization, the patient was released in a perfect condition and no medical treatment was prescribed. In a regular follow-up of 3 years the patient remains asymptomatic. CONCLUSIONS Kikuchi-Fujimoto disease is an uncommon clinicopathological entity in Greece and it should always been taken under consideration in the differential diagnosis in patients presenting with lymphadenopathy. Surgical excision is the treatment of choice and the course of the disease is usually the spontaneous resolution.
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