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Asad M, Mehta AR, Mallon D. A Rare Neurological Presentation of Kikuchi-Fujimoto Disease. JAMA Neurol 2024; 81:773-774. [PMID: 38619846 DOI: 10.1001/jamaneurol.2024.0799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
This case report describes a 17-year-old boy with reduced consciousness and T2-weighted hyperintensity, focal diffusion restriction, and microhemorrhages within the deep gray nuclei and surrounding white matter.
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Affiliation(s)
- Murva Asad
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- University College London Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - Arpan R Mehta
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
- Medical Research Council Protein Phosphorylation and Ubiquitylation Unit, School of Life Sciences, University of Dundee, Dundee, United Kingdom
| | - Dermot Mallon
- University College London Queen Square Institute of Neurology, Queen Square, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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2
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Rodolfi S, Della-Torre E, Bongiovanni L, Mehta P, Fajgenbaum DC, Selmi C. Lymphadenopathy in the rheumatology practice: a pragmatic approach. Rheumatology (Oxford) 2024; 63:1484-1493. [PMID: 38109670 PMCID: PMC11147542 DOI: 10.1093/rheumatology/kead644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 12/20/2023] Open
Abstract
Lymphadenopathy is a common clinical finding and diagnostic challenge within general medicine and rheumatology practice. It may represent a primary manifestation of an underlying immune-mediated disease or indicate an infectious or neoplastic complication requiring differing management. Evaluating lymphadenopathy is of particular relevance in rheumatology, given that lymph node enlargement is a common finding within the clinical spectrum of several well-known rheumatologic disorders including RA, SLE and SS. In addition, lymphadenopathy represents a hallmark manifestation of rare immunological diseases such as Castleman disease and IgG4-related disease that must be considered in the differential diagnosis because effective targeted treatments can now impact the prognosis of these conditions. In this review we present an overview of the clinical significance of lymphadenopathy in common and rare rheumatologic diseases and propose a practical approach to lymphadenopathy in the rheumatology practice. Differential diagnosis of Castleman disease and therapeutic options for this condition of increasing rheumatologic interest will be discussed in detail.
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Affiliation(s)
- Stefano Rodolfi
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Bongiovanni
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Haematopathology Diagnostic Area, Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Puja Mehta
- Division of Medicine, University College, Centre for Inflammation and Tissue Repair, UCL Respiratory, London
- Department of Rheumatology, University College London Hospital (UCLH), London, UK
| | - David C Fajgenbaum
- Department of Medicine, Division of Translational Medicine and Human Genetics, Center for Cytokine Storm Treatment and Laboratory, Philadelphia, PA, USA
| | - Carlo Selmi
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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3
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Rana MBM, Fatima M, Rana IM, Haseeb Ul Rasool M, Abosheaishaa H, Abrudescu A, Bandagi S. Kikuchi-Fujimoto Disease With Systemic Lupus Erythematosus and Systemic Sclerosis Overlap: A Unique Clinical Presentation. Cureus 2023; 15:e44986. [PMID: 37822435 PMCID: PMC10562878 DOI: 10.7759/cureus.44986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/13/2023] Open
Abstract
Kikuchi-Fujimoto Disease (KFD), or histiocytic necrotizing lymphadenitis (HNL), is a rare self-limiting disorder presenting with fever and swollen lymph nodes. It is characterized by the focal proliferation of reticular cells, the presence of nuclear debris, and histiocytes. In advanced cases, it can present with hepato-splenomegaly and generalized lymphadenopathy. Historically, it has been associated with viral infections, as it frequently was found to be associated with upper respiratory symptoms. Alternative explanations include the immune response of T-cells leading to alteration in CD8-positive T-cell-mediated cell apoptosis. It is also speculated that KFD can be associated with rheumatological autoimmune diseases. We present a case of a 21-year-old African American female with a known diagnosis of systemic lupus erythematosus (SLE)-systemic sclerosis (SS) overlap presented with febrile lymphadenopathy and was diagnosed to have HNL on histological exam of lymph node biopsy.
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Affiliation(s)
| | - Minahil Fatima
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
| | - Iqra M Rana
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Hazem Abosheaishaa
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
- Internal Medicine/Gastroenterology, Cairo University, Cairo, EGY
| | - Adriana Abrudescu
- Rheumatology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Sabiha Bandagi
- Rheumatology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
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4
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Dhamrah U, Ireifej B, Ummar S, Batool N, Song D, Sheth N, Shrestha AB, Jaiswal V. Case of recurring Kikuchi disease and autoimmune hepatitis. Clin Case Rep 2022; 10:e6459. [PMID: 36267822 PMCID: PMC9576961 DOI: 10.1002/ccr3.6459] [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] [Received: 07/11/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022] Open
Abstract
We present a case of a 47-year-old female patient with a history of diagnosed Kikuchi disease and autoimmune hepatitis 13 years ago who presented with recurrent fevers and a desquamative rash on the lower extremities. Computed tomography neck showed enlarged lymph nodes, and with her daily fevers and skin rashes the presentation was concerning for recurrence of her Kikuchi disease. The patient was also found to have an elevated anti-smooth muscle antibody titer, and subsequent liver biopsy confirmed the diagnosis of autoimmune hepatitis. She was started on methylprednisolone with improvement. Our case emphasizes the association of Kikuchi disease with autoimmune conditions other than systemic lupus erythematosus. Given the recurrence of the disease after a decade of quiescence, long-term follow-up of patients with Kikuchi disease should be implemented.
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Affiliation(s)
- Umaima Dhamrah
- Department of Internal MedicineNYC Health & Hospitals/Elmhurst Hospital CenterElmhurstNew YorkUSA
| | - Branden Ireifej
- Department of Internal MedicineNYC Health & Hospitals/Elmhurst Hospital CenterElmhurstNew YorkUSA
| | - Sibghatallah Ummar
- Department of MedicineBahria University Medical & Dental College KarachiPakistan
| | - Nuzhat Batool
- Department of Internal MedicineNYC Health & Hospitals/Elmhurst Hospital CenterElmhurstNew YorkUSA
| | - David Song
- Department of Internal MedicineNYC Health & Hospitals/Elmhurst Hospital CenterElmhurstNew YorkUSA
| | - Nirali Sheth
- Department of Internal MedicineNYC Health & Hospitals/Elmhurst Hospital CenterElmhurstNew YorkUSA
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5
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Soares L, Rebelo Matos A, Mello Vieira M, Cruz R, Caixas U. Generalized Lymphadenopathy as the First Manifestation of Systemic Lupus Erythematosus. Cureus 2022; 14:e30089. [PMID: 36381693 PMCID: PMC9641619 DOI: 10.7759/cureus.30089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
Abstract
Lymphadenopathy (LAP) is a common but nonspecific feature of many diseases, representing a vast spectrum of etiologies such as infectious or inflammatory diseases, malignancies, and drugs. In systemic lupus erythematosus (SLE), it can be the first manifestation. We present the case of a 20-year-old female with a history of fever, night sweats, anorexia, and asthenia for five months. She also had diffuse generalized LAP. Although malignant etiologies were our major concern, an extensive workup for malignancy and infections was unrevealing. However, an autoimmune workup led to the diagnosis of SLE. This case shows that SLE can present as generalized LAP with constitutional symptoms, and hence it should be considered in the differential diagnosis.
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Chisholm KM, Bohling SD, Tsuchiya KD, Paulson VA. A Malignant Mimicker: Features of Kikuchi-Fujimoto Disease in the Pediatric Population. Pediatr Dev Pathol 2022; 25:538-547. [PMID: 35583198 DOI: 10.1177/10935266221103882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Kikuchi-Fujimoto disease (KFD) is a rare, benign, and self-limited disease that presents with cervical lymphadenopathy and systemic symptoms. Histologic evaluation is often necessary to differentiate KFD from other entities. METHODS Electronic medical records and diagnostic material were reviewed for 14 children diagnosed with KFD and 6 children diagnosed with infectious mononucleosis (IM) from 2013-2021. Four cases of KFD were further characterized using targeted DNA-based next-generation sequencing. RESULTS Systemic symptoms were present in 86% (n = 12/14) of KFD patients, the most common being fever. Laboratory values worrisome for malignancy included cytopenia(s) (n = 9/12), elevated ESR and/or CRP (n = 9/12), elevated ferritin (n = 7/7), and elevated LDH (n = 7/10). Histologically, lymph nodes showed characteristic necrotic foci without neutrophils surrounded by MPO+ "crescentic" histiocytes. Immunoblasts and CD123+ plasmacytoid dendritic cells (pDCs) were also increased surrounding the necrosis. IM lymph nodes showed similar features when necrosis was present but increases in pDCs were patchy and rare neutrophils were seen in the necrotic foci. Molecular analysis of 4 KFD cases did not identify pathogenic variants. CONCLUSION While the signs/symptoms of KFD are worrisome, there are pathologic features that help differentiate it from potential mimics. We did not identify characteristic molecular features to aid in the work-up of these cases.
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Affiliation(s)
- Karen M Chisholm
- Department of Laboratories, 7274Seattle Children's Hospital, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Sandra D Bohling
- Department of Laboratories, 7274Seattle Children's Hospital, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Karen D Tsuchiya
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Vera A Paulson
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
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7
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Wang S, Du B, Li X, Li Y. Positron emission tomography/computed tomography hypermetabolism of Kikuchi-Fujimoto disease mimicking malignant lymphoma: a case report and literature review. J Int Med Res 2021; 49:3000605211032859. [PMID: 34334002 PMCID: PMC8326629 DOI: 10.1177/03000605211032859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Kikuchi–Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a benign, self-limiting inflammatory disorder of unknown etiology and pathogenesis. This report presents a rare case involving a man with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) hypermetabolism caused by KFD mimicking malignant lymphoma. The PET/CT maximum intensity projection showed multiple hypermetabolic lymphadenopathies and homogeneous FDG uptake in the bone marrow and spleen. Malignant lymphoma was initially suspected. The patient then underwent excision biopsy of one enlarged right cervical lymph node that was selected because it showed the highest FDG uptake in PET/CT, and examination of this biopsy specimen confirmed the diagnosis of KFD. PET/CT is useful for assessing the general condition of patients and can help to select lymph nodes for excision biopsy based on the highest FDG uptake. However, KFD can predispose to localized FDG uptake and limit the specificity of PET/CT by mimicking malignancy. Thus, positive results of PET/CT should be interpreted with caution.
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Affiliation(s)
- Shu Wang
- Department of Nuclear Medicine, 159407The First Hospital of China Medical University, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Bulin Du
- Department of Nuclear Medicine, 159407The First Hospital of China Medical University, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Xuena Li
- Department of Nuclear Medicine, 159407The First Hospital of China Medical University, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Yaming Li
- Department of Nuclear Medicine, 159407The First Hospital of China Medical University, The First Hospital of China Medical University, Shenyang, P.R. China
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Yu SC, Chang KC, Wang H, Li MF, Yang TL, Chen CN, Chen CJ, Chen KC, Shen CY, Kuo PY, Lin LW, Lin YM, Lin WC. Distinguishing lupus lymphadenitis from Kikuchi disease based on clinicopathological features and C4d immunohistochemistry. Rheumatology (Oxford) 2021; 60:1543-1552. [PMID: 33169134 DOI: 10.1093/rheumatology/keaa524] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/18/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Distinguishing Kikuchi disease (KD) from lupus lymphadenitis (LL) histologically is nearly impossible. We applied C4d immunohistochemical (IHC) stain to develop diagnostic tools. METHODS We retrospectively investigated clinicopathological features and C4d IHC staining in an LL-enriched development cohort (19 LL and 81 KD specimens), proposed risk stratification criteria and trained machine learning models, and validated them in an external cohort (2 LL and 55 KD specimens). RESULTS Clinically, we observed that LL was associated with an older average age (33 vs 25 years; P=0.005), higher proportion of biopsy sites other than the neck [4/19 (21%) vs 1/81 (1%); P=0.004], and higher proportion of generalized lymphadenopathy compared with KD [9/16 (56%) vs 7/31 (23%); P=0.028]. Histologically, LL involved a larger tissue area than KD did (P=0.006). LL specimens exhibited more frequent interfollicular pattern [5/19 (26%) vs 3/81 (4%); P=0.001] and plasma cell infiltrates (P=0.002), and less frequent histiocytic infiltrates in the necrotic area (P=0.030). Xanthomatous infiltrates were noted in 6/19 (32%) LL specimens. Immunohistochemically, C4d endothelial staining in the necrotic area [11/17 (65%) vs 2/62 (3%); P<10-7], and capillaries/venules [5/19 (26%) vs 7/81 (9%); P=0.048] and trabecular/hilar vessels [11/18 (61%) vs 8/81 (10%); P<10-4] in the viable area was more common in LL. During validation, both the risk stratification criteria and machine learning models were superior to conventional histological criteria. CONCLUSIONS Integrating clinicopathological and C4d findings could distinguish LL from KD.
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Affiliation(s)
- Shan-Chi Yu
- Department of Pathology and Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Microbiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsuan Wang
- Department of Pathology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Meng-Fang Li
- Department of Pathology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Nan Chen
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Jung Chen
- Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ko-Chin Chen
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chieh-Yu Shen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Yen Kuo
- Department of Pathology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Long-Wei Lin
- Department of Pathology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Yueh-Min Lin
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Chou Lin
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
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9
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Huang C. The Differential Diagnosis of Bilateral Pleural Effusion and Multiple Mediastinal Lymphadenopathies Includes Kikuchi-Fujimoto Disease. J Investig Med High Impact Case Rep 2021; 8:2324709620933422. [PMID: 32517589 PMCID: PMC7288820 DOI: 10.1177/2324709620933422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Kikuchi-Fujimoto disease is an uncommon lymphohistiocytic disorder that frequently presents with acute or subacute clinical disease course. Cervical lymphadenopathy is the most common involved lymph node. Very rare cases of pathologic diagnosis of Kikuchi-Fujimoto disease with bilateral pleural effusion and multiple mediastinal lymphadenopathies have been reported in the literature. In this article, we report the case of a 60-year-old male presented with bilateral pleural effusion and multiple mediastinal lymphadenopathies. He received video-assisted thoracoscopic surgery of the right pleura and thoracoscopic excision of the mediastinal lymph node. The pathologic findings from the lymph node and pleura were compatible with Kikuchi-Fujimoto disease. He was treated with oral hydroxychloroquine and oral prednisolone. A computed tomography scan of the chest 4 months later showed regressive mediastinal lymphadenopathy and bilateral pleural effusion. Our case is a first reported case of Kikuchi-Fujimoto disease diagnosis by the pathology of the lymph node and pleura in the literature. Results from our case suggest that Kikuchi-Fujimoto disease should be included in the differential diagnosis of bilateral pleural effusion and multiple mediastinal lymphadenopathies.
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Affiliation(s)
- Chienhsiu Huang
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Town, Chiayi County
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10
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Danai MM, Kaye SP, Gong R, McKnight H. A Rare Pediatric Case of Persistent Kikuchi-Fujimoto Disease and Underlying Systemic Lupus Erythematosus. J Clin Rheumatol 2021; 27:e111-e112. [PMID: 31972742 DOI: 10.1097/rhu.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mahtab M Danai
- From the School of Medicine, University of California, Davis
| | - Shaina P Kaye
- University of California, Davis, Children's Hospital
| | - Raymond Gong
- Department of Pathology, University of California, Davis, Medical Center, Sacramento, CA
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11
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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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12
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Hurtado-Díaz J, Espinoza-Sánchez ML, Rojas-Milán E, Cimé-Aké E, de Los Ángeles Macias M, Romero-Ibarra L, Vera-Lastra OL. Kikuchi-Fujimoto Disease: Report of a Case with Progression to Lupus Nephritis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927351. [PMID: 33677464 PMCID: PMC7949488 DOI: 10.12659/ajcr.927351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient: Female, 28-year-old Final Diagnosis: Kikuchi-Fujimoto Lymphadenitis • lupus nephritis Symptoms: Agitation • anxiety • arthralgia • diarhea • fatigue • fever • headache • lymfadenopathy • sweating • weigh loss Medication: — Clinical Procedure: — Specialty: Rheumatology
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Affiliation(s)
- Jorge Hurtado-Díaz
- Department of Internal Medicine, High Specialty Medical Unit, Specialty Hospital, Dr. Antonio Fraga Mouret, La Raza National Medical Center, México City, Mexico
| | - María Lucero Espinoza-Sánchez
- Department of Internal Medicine, High Specialty Medical Unit, Specialty Hospital, Dr. Antonio Fraga Mouret, La Raza National Medical Center, México City, Mexico
| | - Eduardo Rojas-Milán
- Department of Internal Medicine, High Specialty Medical Unit, Specialty Hospital, Dr. Antonio Fraga Mouret, La Raza National Medical Center, México City, Mexico
| | - Erik Cimé-Aké
- Department of Internal Medicine, High Specialty Medical Unit, Specialty Hospital, Dr. Antonio Fraga Mouret, La Raza National Medical Center, México City, Mexico
| | - María de Los Ángeles Macias
- Department of Pathological Anatomy, High Specialty Medical Unit, Specialty Hospital, Dr. Antonio Fraga Mouret, La Raza National Medical Center, México City, Mexico
| | - Lizeth Romero-Ibarra
- Department of Internal Medicine, Hospital General Regional N° 251, Metepec, Mexico
| | - Olga Lidia Vera-Lastra
- Department of Internal Medicine, High Specialty Medical Unit, Specialty Hospital, Dr. Antonio Fraga Mouret, La Raza National Medical Center, México City, Mexico.,Division of Postgraduate Studies, Faculty of Medicine, National University Autonomous of Mexico, México City, Mexico
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13
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Huang J, Zheng JX, Yang Y, Zhu D. Necrotizing lymphadenitis : A case report and literature review. Z Rheumatol 2020; 80:274-282. [PMID: 33241524 DOI: 10.1007/s00393-020-00929-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Necrotizing lymphadenitis is a rare disease. It is often misdiagnosed because of the lack of typical clinical manifestations. It is worth noting that necrotizing lymphadenitis may be a precursor lesion of systemic lupus erythematosus or tumours, so regular follow-up is needed to facilitate early diagnosis. Here, we report a case and conduct a literature analysis summarizing the clinical features of necrotizing lymphadenitis and its treatment and management practices. CASE PRESENTATION A 16-year-old young woman presented with fever and lymphadenopathy as the main clinical manifestations, accompanied by a rash during fever that disappeared as the fever subsided. After completing imaging and laboratory examinations, we excluded other diseases such as infections, autoimmune diseases, and malignant tumours. Finally, we diagnosed the patient with necrotizing lymphadenitis based on the results of lymph node biopsy. The symptoms of the patient improved after glucocorticoid treatment, and she was followed up for half a year without recurrence of symptoms. CONCLUSION In the clinic, young women with fever and lymphadenopathy as major symptoms should be screened for necrotizing lymphadenitis to facilitate early diagnosis and treatment. Although necrotizing lymphadenitis is self-limiting, its clinical manifestations are similar to those of many diseases. Therefore, it is easily misdiagnosed. An in-depth understanding of the disease is conducive to early diagnosis and treatment in the clinic, thereby reducing further damage to the body and reducing unnecessary evaluation and treatment.
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Affiliation(s)
- J Huang
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Yuzhong District, 400042, Chongqing, China
| | - J-X Zheng
- Department of Rheumatology and Immunology, the Affiliated Hospital of North Sichuan Medical College, 637000, Nanchong, China
| | - Y Yang
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Yuzhong District, 400042, Chongqing, China.
| | - D Zhu
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Yuzhong District, 400042, Chongqing, China.
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14
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Rare Presentation of Self-Limiting Kikuchi-Fujimoto Disease in Relapsing Nature. Case Rep Med 2020; 2020:9785104. [PMID: 33014067 PMCID: PMC7525287 DOI: 10.1155/2020/9785104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background Kikuchi–Fujimoto disease (KFD) is a rare, benign, and self-limiting disease that is commonly associated with cervical lymphadenopathy and fever. The disease has a wide spectrum of clinical manifestations, and definitive diagnosis is based on the histological appearance in the excision biopsy of the lymph nodes. Recurrence of KFD is reported rarely. Case Presentation. A 56-year-old Iranian woman with a background history of thrombocytopenia presented with fever, malaise, loss of appetite, and weight loss with cervical lymphadenopathy. The excision biopsy of the cervical lymph nodes confirmed the diagnosis of KFD, and she made a full recovery with improvement of symptoms, regression of cervical lymph nodes, and normalization inflammatory markers. One year after remission, she presented with similar clinico-biochemical profile, and repeat biopsy confirmed KFD. Conclusion Although the rate of recurrence of the disease is very low, the treating physician should consider the possibility and confirm it histologically.
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Quadir A, Peacock K, Hsu P, Singh-Grewal D, Alexander S. A familial case of Kikuchi-Fujimoto disease in dizygotic twins. Pediatr Rheumatol Online J 2020; 18:62. [PMID: 32778173 PMCID: PMC7418326 DOI: 10.1186/s12969-020-00457-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease (KFD) or necrotizing histiocytic lymphadenitis, was described separately by both Kikuchi and Fujimoto in Japan in the early 1970's. Despite its rarity in the pediatric population, it is an important differential in persistent lymphadenopathy. Familial cases of KFD in the literature are rare. Here we describe the first reported case of KFD in non-identical twin sisters. CASE PRESENTATION Twin 1 presented with a 3-week history of worsening right-sided cervical lymphadenopathy, daily fevers, significant lethargy, weight loss and arthralgia of her knees and ankles at the age of 12 years in 2015. She had had an unremarkable medical history. A biopsy of her lymph nodes showed histiocytic necrosis consistent with KFD. Twin 2 presented with a three-week history of lethargy, fatigue, weight loss and left-sided posterior cervical chain lymphadenopathy at 16 years of age in 2018. She had a history of frequently relapsing nephrotic syndrome and celiac disease. A biopsy of her lymph nodes was undertaken and showed histiocytic necrosis consistent with KFD. CONCLUSIONS KFD is a rare but self-limiting pathological process of necrotizing histiocytic lymphadenitis. Although further research is needed, there is an increasing amount of evidence which suggests a multifactorial pathological basis of disease. The two cases we document here are the first reported cases of familial KFD in dizygotic HLA-identical twins which reinforces the likely HLA-linkage in the etiology of KFD.
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Affiliation(s)
- Ashfaque Quadir
- Department of General Medicine, The Children's Hospital at Westmead, Westmead, Sydney, NSW, 2145, Australia.
| | - Ken Peacock
- grid.413973.b0000 0000 9690 854XDepartment of General Medicine, The Children’s Hospital at Westmead, Westmead, Sydney, NSW 2145 Australia
| | - Peter Hsu
- grid.413973.b0000 0000 9690 854XDepartment of Immunology, The Children’s Hospital at Westmead, Westmead, Sydney, NSW 2145 Australia
| | - Davinder Singh-Grewal
- grid.430417.50000 0004 0640 6474Department of Rheumatology, The Sydney Children’s Hospitals Network, Westmead and Randwick, Sydney, NSW 2145 Australia
| | - Stephen Alexander
- grid.413973.b0000 0000 9690 854XDepartment of Nephrology, The Children’s Hospital at Westmead, Westmead, Sydney, NSW 2145 Australia
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Vithoosan S, Karunarathna T, Shanjeeban P, Piranavan P, Matthias T, Gamlaksha D, Liyadipita A, Kulatunga A. Kikuchi-Fujimoto disease associated with systemic lupus erythematosus complicated with hemophagocytic lymphohistiocytosis: a case report. J Med Case Rep 2019; 13:173. [PMID: 31167644 PMCID: PMC6551871 DOI: 10.1186/s13256-019-2100-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/28/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease, which was originally described in young women, is a benign condition characterized by necrotizing lymphadenitis and fever. Even though the clinical course is usually self-limiting, it can be associated with recurrences and rarely can be associated with systemic lupus erythematosus or can be complicated with hemophagocytic lymphohistiocytosis. We report the case of a 17-year-old Sri Lankan Sinhalese schoolboy who presented with fever and cervical lymphadenopathy diagnosed as Kikuchi-Fujimoto disease and was complicated with hemophagocytic lymphohistiocytosis subsequently. Later he fulfilled the criteria for systemic lupus erythematosus. CASE PRESENTATION A 17-year-old previously healthy Sinhalese schoolboy presented with high-grade fever associated with chills and rigors associated with loss of appetite and loss of weight for more than 40 days. On examination, he had bilateral firm matted tender cervical lymphadenopathy and firm hepatomegaly. An excision biopsy of his right cervical lymph node revealed necrotizing lymphadenitis and immunohistochemistry of a lymph node biopsy favored Kikuchi disease. Initial antinuclear antibody and anti-double-stranded deoxyribonucleic acid tests were negative and his C3 and C4 levels were normal. An infections screening was negative. He was treated with steroids. While in hospital he developed hemophagocytic lymphohistiocytosis and renal impairment. Later his antinuclear antibody titer became positive in 1:160 and fulfilled the diagnostic criteria for systemic lupus erythematosus. He was managed with steroids and immune suppressive drugs and showed remarkable improvement. CONCLUSION Although Kikuchi-Fujimoto disease is uncommon in male patients, it needs to be considered in patients with lymphadenopathy and fever. The disease can be complicated with hemophagocytic lymphohistiocytosis and the patients need continuous monitoring for the possible development of systemic lupus erythematosus later in the course.
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Khan ST, Naqvi R, Rashid R, Naqvi SA. A rare presentation of Kikuchi Disease with Hemolytic Uremic Syndrome. Pak J Med Sci 2019; 35:586-588. [PMID: 31086556 PMCID: PMC6500850 DOI: 10.12669/pjms.35.2.735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 11/15/2022] Open
Abstract
Kikuchi disease (KD) or also known as Kikuchi Fujimoto disease is named after scientists Kikuchi and Fujimoto who describe the disease in Japan in 1972. KD originally reported from Asia but later case reports from different regions of world have been published. It is a benign condition of necrotizing histiocytic lymphadenitis which mimic like Lymphoma, diagnosis of KD is based on histo-pathological findings from lymphnodes. It is a rare condition and mostly case reports have been published, it can have an association with other pathologies. We aim to report a case where KD has been found in a young woman in association with hemolytic uremic syndrome and acute kidney injury.
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Affiliation(s)
- Salwa Tauseeq Khan
- Salwa Tauseeq Khan, MBBS. Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Rubina Naqvi
- Rubina Naqvi, MBBS, MD (Nephrology). Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Rahma Rashid
- Rahma Rashid, MBBS, FCPS (Pathology). Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sana Abbas Naqvi
- Sana Abbas Naqvi, MBBS. Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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18
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Combalia A, Fustà-Novell X, García-Herrera A, Ferrando J. Kikuchi-Fujimoto Disease with Scalp Involvement. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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19
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Liu X, Huang S, Jiang G. Report of a rare case of histiocytic necrotizing lymphadenitis with bilateral pleural effusion diagnosed via cervical lymph node biopsy. SAO PAULO MED J 2018; 136:368-371. [PMID: 28767989 PMCID: PMC9881695 DOI: 10.1590/1516-3180.2016.0333170217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/17/2017] [Indexed: 02/02/2023] Open
Abstract
CONTEXT Histiocytic necrotizing lymphadenitis (HNL) is a rare disorder that is often benign and self-limiting. There have been reports of co-occurrence of HNL with other diseases, including systemic lupus erythematosus, hemophagocytic syndrome and antiphospholipid syndrome. CASE REPORT Here, we report a case in which a patient experienced unexplained fever, swelling of the cervical lymph node and bilateral pleural effusion and was ultimately diagnosed with HNL based on results from a lymph node biopsy. After treatment with glucocorticoid, the patient regained normal body temperature, the swelling of the lymph nodes disappeared and the pleural effusion was reabsorbed. CONCLUSIONS The pathogenesis of HNL remains unclear, and pleural effusion is rarely reported in HNL patients. We presented this case to improve diagnostic awareness of this condition among clinicians and help reduce the likelihood of misdiagnosis.
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Affiliation(s)
- Xuchun Liu
- MD. Specialist, Department of Respiratory Medicine, Chizhou People’s Hospital, Chizhou, Anhui, China.
| | - Shubin Huang
- MD. Specialist, Department of Pathology, Chizhou People’s Hospital, Chizhou, Anhui, China.
| | - Guohua Jiang
- MD, PhD. Professor, Department of Respiratory Medicine, Chizhou People’s Hospital, Chizhou, Anhui, China.
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20
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A Challenging Case of Kikuchi-Fujimoto Disease Associated with Systemic Lupus Erythematosus and Review of the Literature. Case Rep Hematol 2018; 2018:1791627. [PMID: 29785310 PMCID: PMC5896377 DOI: 10.1155/2018/1791627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/28/2017] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
Kikuchi–Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare disease that is frequently underdiagnosed due to clinical features that are similar to those of non-Hodgkin lymphomas, systemic lupus erythematosus (SLE), or infectious reactive lymphadenopathy. An excisional biopsy is required. We report a young Caucasian female diagnosed with KFD with skin lesions, complicating with SLE. The clinical course, laboratory, and CT findings are described, as are histopathologic features, for a better recognition of this rare disorder in clinical practice.
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21
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Dalugama C, Gawarammana IB. Fever with lymphadenopathy - Kikuchi Fujimoto disease, a great masquerader: a case report. J Med Case Rep 2017; 11:349. [PMID: 29246252 PMCID: PMC5732422 DOI: 10.1186/s13256-017-1521-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/20/2017] [Indexed: 12/05/2022] Open
Abstract
Background Kikuchi Fujimoto disease is an uncommon benign condition of necrotizing histiocytic lymphadenitis commonly seen in East Asian and Japanese populations. It commonly presents with fever, cervical lymphadenopathy, and elevated inflammatory markers. Diagnosis of Kikuchi Fujimoto disease is based on histopathological studies of the involved lymph nodes. The presentation of Kikuchi Fujimoto disease can mimic many sinister conditions including lymphoma. Treatment is mainly supportive provided that accurate diagnosis is made and sinister conditions like lymphoma ruled out. Case presentation We report the case of an 18-year-old Sri Lankan Moor woman who presented with fever and cervical lymphadenopathy for 1 month. She had elevated inflammatory markers with high lactate dehydrogenase and ferritin levels. She had an extensive work-up including an excision biopsy of an involved lymph node and bone marrow biopsy. Finally, a diagnosis of Kikuchi Fujimoto disease was based on histopathology of the lymph node and negative bone marrow biopsy. Conclusions Although Kikuchi Fujimoto disease is a self-limiting condition, it is a great masquerader which mimics the clinical features of many sinister conditions including tuberculosis, lymphoma, and adult-onset Still’s disease. Early recognition of the disease is of crucial importance in minimizing potentially harmful and unnecessary evaluations and treatments.
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Affiliation(s)
- Chamara Dalugama
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
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22
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Combalia A, Fustà-Novell X, García-Herrera A, Ferrando J. Kikuchi-Fujimoto Disease with Scalp Involvement. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:657-659. [PMID: 29197466 DOI: 10.1016/j.ad.2017.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/10/2017] [Accepted: 09/03/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Combalia
- Unidad de Dermatología, Hospital Clinic de Barcelona, Barcelona, España.
| | - X Fustà-Novell
- Unidad de Dermatología, Hospital Clinic de Barcelona, Barcelona, España
| | - A García-Herrera
- Unidad de Patología, Hospital Clinic de Barcelona, Barcelona, España
| | - J Ferrando
- Unidad de Dermatología, Hospital Clinic de Barcelona, Barcelona, España
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23
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Michailidou D, Kribis M, Kataria R, Sedaliu K, Dumitrescu M. Facial and limb angioedema with parotitis and Kikuchi-like necrotizing lymphadenitis preceding neuropsychiatric systemic lupus erythematosus in a young African American male. Lupus 2017; 27:676-680. [PMID: 28849689 DOI: 10.1177/0961203317726379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Angioedema has been observed in a few cases secondary to systemic lupus erythematosus (SLE). Herein, we report a rare case where a young healthy male initially presented with angioedema, lymphadenopathy and parotitis and later on developed neuropsychiatric manifestations at the very onset of his SLE disease. This case illustrates the importance of prompt clinical consideration of lupus with unusual and atypical preceding manifestations.
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Affiliation(s)
- D Michailidou
- 1 Department of Internal Medicine, 1939 Bridgeport Hospital , Yale University, Bridgeport, CT, USA
| | - M Kribis
- 1 Department of Internal Medicine, 1939 Bridgeport Hospital , Yale University, Bridgeport, CT, USA
| | - R Kataria
- 1 Department of Internal Medicine, 1939 Bridgeport Hospital , Yale University, Bridgeport, CT, USA
| | - K Sedaliu
- 1 Department of Internal Medicine, 1939 Bridgeport Hospital , Yale University, Bridgeport, CT, USA
| | - M Dumitrescu
- 2 Division of Rheumatology, 1939 Bridgeport Hospital , Yale University, Bridgeport, CT, USA
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24
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Clinical association between Kikuchi׳s disease and systemic lupus erythematosus: A systematic literature review. Semin Arthritis Rheum 2017; 47:46-52. [DOI: 10.1016/j.semarthrit.2017.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 01/21/2017] [Accepted: 01/23/2017] [Indexed: 12/17/2022]
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Systemic Lupus Erythematosus Associated Pitfalls on 18F-FDG PET/CT: Reactive Follicular Hyperplasia, Kikuchi-Fujimoto Disease, Inflammation and Lymphoid Hyperplasia of the Spleen Mimicking Lymphoma. Nucl Med Mol Imaging 2017; 52:74-79. [PMID: 29391916 DOI: 10.1007/s13139-017-0471-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 11/27/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is associated with a variety of inflammatory processes that can affect the lymph nodes, brain, kidneys, and spleen. We present two patients with SLE in whom SLE-associated conditions complicated interpretation of 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging of the lymph nodes and the spleen. The imaging findings mimicked lymphoma, but histopathological evaluation showed benign processes including reactive follicular hyperplasia in the lymph nodes, Kikuchi-Fujimoto disease in perisplenic lymph nodes, and inflammatory changes and lymphoid hyperplasia in the spleen.
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26
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Afzal W, Arab T, Ullah T, Teller K, Doshi KJ. Generalized Lymphadenopathy as Presenting Feature of Systemic Lupus Erythematosus: Case Report and Review of the Literature. J Clin Med Res 2016; 8:819-823. [PMID: 27738484 PMCID: PMC5047021 DOI: 10.14740/jocmr2717w] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 12/03/2022] Open
Abstract
Lymphadenopathy could represent a vast spectrum of etiologies including infectious and non-infectious diseases. Besides proper history taking, physical examination, and laboratory investigations, a tissue diagnosis is often necessary to unmask the cause of generalized lymphadenopathy. Here we present a 23-year-old woman who was admitted for diffuse generalized lymphadenopathy, fatigue, malaise, weight loss, nausea, and bilateral lower extremity edema. She reported a history of seizures as well as stroke 2 years prior with no other medical conditions present. Although malignant and infectious etiologies were initially the primary targets for workup, her history of seizures and stroke remained a dilemma. Extensive workup for malignant and infectious diseases was unrevealing; however, rheumatologic workup was eventually positive for systemic lupus erythematosus (SLE). This case illustrates that extensive generalized diffuse lymphadenopathy may be a presenting feature of SLE and should be considered in the differential diagnosis of patients presenting with diffuse lymphadenopathy and constitutional symptoms.
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Affiliation(s)
- Wais Afzal
- Department of Internal Medicine, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY 11418, USA
| | - Talal Arab
- Department of Internal Medicine, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY 11418, USA
| | - Tofura Ullah
- Department of Clinical Research, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY 11418, USA
| | - Katerina Teller
- Department of Internal Medicine, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY 11418, USA
| | - Kaushik J Doshi
- Department of Internal Medicine, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY 11418, USA
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Baenas DF, Diehl FA, Haye Salinas MJ, Riva V, Diller A, Lemos PA. Kikuchi-Fujimoto disease and systemic lupus erythematosus. Int Med Case Rep J 2016; 9:163-7. [PMID: 27418858 PMCID: PMC4935008 DOI: 10.2147/imcrj.s106396] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Kikuchi-Fujimoto disease, or histiocytic necrotizing lymphadenitis, is an infrequent idiopathic disorder. It has been associated with autoimmune disorders, of which systemic lupus erythematosus is the most outstanding. The basis of its diagnosis relies on the histological examination of lymph nodes, which typically reveals necrosis surrounded by histiocytes with crescentic nucleus, immunoblasts and plasma cells, and absence of neutrophils. We report the case of a 27-year-old Argentinian female patient without any relevant past medical history to demonstrate the correlation between Kikuchi-Fujimoto disease and systemic lupus erythematosus.
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Affiliation(s)
| | | | | | - Verónica Riva
- Pathology Department, Hospital Privado Universitario de Córdoba Medical Center
| | - Ana Diller
- Pathology Department, Hospital Privado Universitario de Córdoba Medical Center
| | - Pablo A Lemos
- Clinical Medicine Department
- Instituto Universitario de Ciencias Biomédicas, Universitary Institute, Córdoba, Argentina
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28
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Rue KS, Rodger DC, Rao NA. Retinopathy in lupus transitioned to Kikuchi-Fujimoto disease. Am J Ophthalmol Case Rep 2016; 3:43-46. [PMID: 29503907 PMCID: PMC5757397 DOI: 10.1016/j.ajoc.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/13/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose We present a patient with systemic lupus erythematosus with significant vaso-occlusive retinal findings mimicking antiphospholipid antibody syndrome, who developed Kikuchi-Fujimoto disease. Observations Our patient was initially diagnosed with systemic lupus erythematosus with antiphospholipid antibody syndrome given consistent serologic markers and profound retinal vascular ischemia. However, on subsequent follow up, she presented with fever and lymphadenopathy and underwent lymph node biopsy, which declared histologic findings of Kikuchi-Fujimoto disease. Repeat markers for antiphospholipid antibody syndrome were negative and she was taken off lifelong anticoagulation. Conclusions and importance Systemic lupus erythematosus and Kikuchi-Fujimoto disease may have many similar features and even biomarkers, and given the potential overlap of presentation, clinicians must carefully distinguish between these diseases to prevent unnecessary treatment.
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Affiliation(s)
- Kelly S Rue
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Damien C Rodger
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Narsing A Rao
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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29
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Erfanian Taghvaei MR, Mirzaie M, Parsa A, Ghiasi Moghadam T. A Case of Recurrent Kikuchi-Fujimoto Disease. Jundishapur J Microbiol 2015; 8:e25654. [PMID: 26421139 PMCID: PMC4584135 DOI: 10.5812/jjm.25654v2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/19/2015] [Accepted: 04/10/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction: Kikuchi-Fujimoto Disease (KFD) is a benign, self-limited, inflammatory disorder, first reported in Japan. This condition is more prevalent among women and typically occurs in the third decade of life. It normally manifests as persistent, isolated cervical adenopathy with a recurrence rate of 3%. The identification of this condition is of high significance, given the risk of misdiagnosis with other disorders such as malignant lymphoma and extensive necrosis. Case Presentation: The patient was a 32-year-old female diagnosed with Kikuchi-Fujimoto disease via neck lymph node biopsy in August 2006 in the city of Mashhad, Iran. The disease regressed with proper follow-up, although after eight years the patient was readmitted to the hospital with severe weight loss, high fever, and uncommon symptoms of generalized adenopathy in cervical, axillary and inguinal regions. Conclusions: Although KFD is an uncommon condition, it should be featured in the list of differential diagnoses of tender lymphadenopathy, especially lymphadenopathy localized to the cervical region. We reported a case of KFD with a prolonged relapse of eight years. Full recovery with a good response to corticosteroid regimen was achieved after the recurrence.
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Affiliation(s)
| | - Maryam Mirzaie
- Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Maryam Mirzaie, Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118828888, Fax: +98-5118828560, E-mail:
| | - Ali Parsa
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
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30
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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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31
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Vencato E, Manfredi R, Zamò A, Chilosi M, Beccari S, De Franceschi L. A rare disorder in an orphan disease: Kikuchi-Fujimoto disease in a young-adult patient with sickle cell anemia. Am J Hematol 2014; 89:1151-2. [PMID: 24962876 DOI: 10.1002/ajh.23792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 06/16/2014] [Accepted: 06/19/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Elisa Vencato
- Department of Medicine; University of Verona and AOUI-Verona; Verona Italy
| | - Riccardo Manfredi
- Department of Pathology and Diagnostics; University of Verona and AOUI-Verona; Verona Italy
| | - Alberto Zamò
- Department of Pathology and Diagnostics; University of Verona and AOUI-Verona; Verona Italy
| | - Marco Chilosi
- Department of Pathology and Diagnostics; University of Verona and AOUI-Verona; Verona Italy
| | - Serena Beccari
- Department of Pathology and Diagnostics; University of Verona and AOUI-Verona; Verona Italy
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Ruaro B, Sulli A, Alessandri E, Fraternali-Orcioni G, Cutolo M. Kikuchi-Fujimoto's disease associated with systemic lupus erythematous: difficult case report and literature review. Lupus 2014; 23:939-44. [PMID: 24739458 DOI: 10.1177/0961203314530794] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 03/11/2014] [Indexed: 11/16/2022]
Abstract
Kikuchi-Fujimoto's disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign and self-limiting disease of unknown aetiology. KFD tends to affect a young population under 30 years of age and predominantly females. KFD is a rare pathology and its association with systemic lupus erythematosus (SLE) is not frequent. Herein, we present the case of a male Italian patient with SLE in association with KFD with 5 years of follow-up, where a differential diagnosis from infection or lymphoproliferative disease was problematic.
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Affiliation(s)
- B Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - A Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - E Alessandri
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - G Fraternali-Orcioni
- Department of Pathology, Anatomic Pathology Division, San Martino University Hospital, Genova, Italy
| | - M Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
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Ciampi E. Optic neuritis revealing Kikuchi-Fujimoto's disease: clinical commentary. Mult Scler 2014; 20:1143-4. [PMID: 24598268 DOI: 10.1177/1352458514526441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- E Ciampi
- Universitat Autònoma de Barcelona, Spain
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Kikuchi–Fujimoto disease. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2013.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Di Lernia V, Bajocchi G, Piana S. Subacute cutaneous lupus erythematosus onset preceded by Kikuchi-Fujimoto disease. Dermatol Pract Concept 2014; 4:47-9. [PMID: 24520513 PMCID: PMC3919839 DOI: 10.5826/dpc.0401a06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/16/2013] [Indexed: 10/31/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is an uncommon clinicopathological entity characterized by fever and lymphadenopathy, predominantly involving cervical lymph nodes, accompanied by chills and leukopenia. The diagnosis relies primarily on the presence of typical morphological features in the swelling lymph nodes. KFD can occur as a benign and self-limiting lymphadenopathy, but it can sporadically precede, postdate or coincide with the diagnosis of systemic lupus erythematosus (SLE). The authors report a case of subacute cutaneous lupus erythematosus (SCLE) in a 42-year-old female preceded by prolonged fever, anemia, leukopenia, and cervical necrotizing lymphadenopathy. About two months later, the patient developed facial and scalp plaques suggestive of lupus skin disease. Histologic and immunologic investigations lead to the diagnosis of SCLE. It is not clear whether KFD associated with lupus skin disease are true KFD or a histopathologic feature of SLE.
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Affiliation(s)
- Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Gianluigi Bajocchi
- Rheumatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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Auerbach A, Summers TA, Zhang B, Aguilera NS. Splenic manifestations of chronic autoimmune disorder: a report of five cases with histiocytic necrotizing change in four cases. Histopathology 2013; 63:19-28. [DOI: 10.1111/his.12143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/19/2013] [Indexed: 12/27/2022]
Affiliation(s)
| | - Thomas A Summers
- Department of Pathology; Walter Reed National Military Medical Center; Bethesda; MD; USA
| | - Binxue Zhang
- Henry M. Jackson Foundation; Combat Wound Initiative Program (CWIP); Gaithersburg; MD; USA
| | - Nadine S Aguilera
- Department of Pathology; University of Virginia Health System; Charlottesville; VA; USA
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Kong E, Chun K, Hong Y, Hah J, Cho I. 18F-FDG PET/CT findings in patients with Kikuchi disease. Nuklearmedizin 2013; 52:101-6. [PMID: 23681151 DOI: 10.3413/nukmed-0513-12-06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 11/07/2012] [Indexed: 01/20/2023]
Abstract
PURPOSE Kikuchi disease (KD) is a benign and self-limited syndrome characterized by cervical lymphadenopathy. This study evaluated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) findings in patients with KD and analyzed their imaging features. PATIENTS, MATERIAL, METHODS We evaluated the FDG PET/CT findings of 22 patients (14 men, 8 women) with KD, ranging in age from 9 to 73 years. All patients had been diagnosed based on the pathological findings of biopsy. We examined the locations, metabolic activity and size of hypermetabolic lymph nodes (LNs) on FDG PET/CT imaging with medical history including laboratory results. RESULTS Among the 22 patients, we identified 619 hypermetabolic LNs which had maximum standard uptake value (SUVmax) above 3.0. The 16 patients were studied with FDG PET/CT to identify the cause of fever, another 5 patients for their neck masses, and the remaining patient for his left inguinal mass. Hypermetabolic LNs were noted in neck (18 bilaterally, 2 right, 1 left) of 21 patients, axilla of 10, mediastinum of 9, abdomen of 17, pelvis of 6, and inguinal area of 3. The SUVmax of FDG uptake in affected LNs by patient base analysis were 6.2-29.4. Of the 619 hypermetabolic LNs identified, 440 LNs (71.1%) were less than 10 mm in their short axis determined by CT, and were occasionally aggregated. No patient showed solid organ hypermetabolic lesion in FDG PET/CT. CONCLUSION Kikuchi disease could present multiple hypermetabolic LNs in body on FDG PET/CT. Based on the physical findings, consideration of the generalized distribution of the relatively small-sized hypermetabolic LNs, FDG PET/CT may be useful as a diagnostic tool in cases of Kikuchi disease.
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Affiliation(s)
- E Kong
- Departement of Nuclear Medicine, Yeungnam University Hospital, Republic of Korea.
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Kikuchi's disease masquerading as prolonged fever. Indian J Pediatr 2013; 80:175-6. [PMID: 22766905 DOI: 10.1007/s12098-012-0832-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
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A Rare Case of Kikuchi Fujimoto's Disease with Subsequent Development of Systemic Lupus Erythematosus. Case Rep Rheumatol 2012; 2012:325062. [PMID: 23346446 PMCID: PMC3546453 DOI: 10.1155/2012/325062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/14/2012] [Indexed: 12/12/2022] Open
Abstract
Kikuchi Fujimoto's disease (KFD) is a rare, immune-mediated, self-limiting disorder with unique histopathological features. KFD is usually seen in young Asian females; however, cases have been reported throughout the world and in all ethnicities. It has been recognized that there is a rare association between Systemic Lupus Erythematosus (SLE) and KFD via sporadic case reports. The exact pathophysiological relationship between these two diseases is still unclear. We report a case of a young Asian female who presented with persistent fever and lymphadenopathy and was diagnosed with Kikuchi Fujimoto's disease based on lymph node biopsy; although an SLE workup was done, she did not meet the American Rheumatology Association (ARA) diagnostic criteria for lupus, and the lymph node biopsy did not show features of SLE. She improved clinically with a short course of steroid therapy. Two months later, the patient presented with central facial rash and arthralgia. SLE workup was repeated, a skin biopsy was done, and the results at this time supported a diagnosis of SLE.
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Méni C, Chabrol A, Wassef M, Gautheret-Dejean A, Bergmann JF, Mouly S. [An atypical presentation of Kikuchi-Fujimoto disease]. Rev Med Interne 2012. [PMID: 23200797 DOI: 10.1016/j.revmed.2012.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease) is a rare clinical entity characterized by the association of enlarged lymph nodes in the posterior cervical region and fever. The disease is more frequent in young women. CASE REPORT We report a 41-year-old African patient who presented with atypical features of Kikuchi's disease including cutaneous lupus, haemophagocytosis, and lymphocytic meningitis. The ethnic origin and the clinical presentation were initially suggestive of tuberculous meningitis. However, microbiological analyses remained negative, histological findings were suggestive of Kikuchi's disease and HHV6 DNA integration was documented in our patient. CONCLUSION Kikuchi's disease should be suspected in an African patient when lymphocytic meningitis is associated with enlarged cervical lymph nodes, hemophagocytosis and HHV6 DNA integration.
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Affiliation(s)
- C Méni
- Service de médecine interne A, hôpital Lariboisière, université Paris Cité-Diderot, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
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Sasapu A, Casperson JBE, Craver R, Gedalia A, Abraham G. A 16-year-old African American girl with necrotizing lymphadenitis. Clin Pediatr (Phila) 2012; 51:998-1000. [PMID: 22914850 DOI: 10.1177/0009922812456899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Appalanaidu Sasapu
- Children's Hospital and LSU Health Sciences Center, New Orleans, LA 70118, USA
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Seong GM, Kim JH, Lim GC, Kim J. Clinicopathological review of immunohistochemically defined Kikuchi-Fujimoto disease-including some interesting cases. Clin Rheumatol 2012; 31:1463-9. [PMID: 22875699 DOI: 10.1007/s10067-012-2036-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/21/2012] [Accepted: 07/11/2012] [Indexed: 12/19/2022]
Abstract
Kikuchi-Fujimoto Disease (KFD) is a benign, self-limited disease characterized by tender regional lymphadenopathy with fever. KFD remains a poorly defined disease, and no clear diagnostic criteria are available. Here, we assess the clinical, laboratory, and histopathologic findings of KFD cases and report two unusual cases. Forty KFD patients that underwent lymph node (LN) biopsy and diagnosed by immunohistochemical staining, from January 2003 to November 2010, were enrolled in this retrospective study. The patients had a mean age of 29.3 years, and 29 (72.5 %) were women. Affected LNs were mainly located unilaterally in the cervical area. Mean LN size was 15.3 mm. Twenty-eight (70 %) patients had LN tenderness, and 25 (62.5 %) patients had fever. Leukopenia was observed in 18 of 35 evaluable patients. C-reactive protein and erythrocyte sedimentation rate were elevated in most patients. Anti-nuclear antibody was positive in four of 19 evaluable patients, but all had been diagnosed with concurrent systemic lupus erythematosus. Histologically, the 40 cases were classified into three types, that is, as proliferative (37.5 %), necrotizing (55.0 %), or xanthomatous (7.5 %). Interesting cases: Case 1 was a 35-year-old female with KFD and uveitis, retinal vasculitis, and superior sagittal sinus thrombosis. Case 2 was a 47-year-old male with KFD and bone marrow involvement and presented with severe bicytopenia. Although KFD is an uncommon self-limited benign disorder, it must be included in the differential diagnosis of lymphadenopathy with fever and cytopenia. It is important that the clinical features of KFD be understood to reach a correct diagnosis.
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Affiliation(s)
- Gil Myeong Seong
- Department of Internal Medicine, Jeju National University Hospital, #1753-3, Ara-1 Dong, Jeju, Republic of Korea.
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Diez-Morrondo C, Pantoja-Zarza L, Manjón-Haces JA. Kikuchi Fujimoto's disease appearing as systemic lupus erythematosus. ACTA ACUST UNITED AC 2012; 8:153-5. [PMID: 22222987 DOI: 10.1016/j.reuma.2011.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 08/31/2011] [Accepted: 09/06/2011] [Indexed: 11/29/2022]
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Mahajan T, Merriman RC, Stone MJ. Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis): report of a case with other autoimmune manifestations. Proc (Bayl Univ Med Cent) 2011; 20:149-51. [PMID: 17431451 PMCID: PMC1849878 DOI: 10.1080/08998280.2007.11928275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign and self-limited disease that mainly affects young women. Patients present with localized lymphadenopathy, fever, and leukopenia in up to half of the cases. KFD can occur in association with systemic lupus erythematosus. We present the case of a patient with KFD and systemic lupus erythematosus, as well as relapsing polychondritis. This patient had persistently low C4 complement levels, so she was evaluated for a genetic defect in complement production and was found to have two "null" C4 alleles. We believe that this may have contributed to the development of her diseases.
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Affiliation(s)
- Tina Mahajan
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
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Abstract
BACKGROUND Kikuchi-Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare, benign, autoimmune condition characterized by lymphadenopathy, fever, and neutropenia. KFD has also been frequently reported in association with systemic lupus erythematosus (SLE). REPORT We report a case of skin manifestations in KFD characterized by malar rash, photosensitivity, panniculitic lesions, positive antinuclear antibodies and nDNA, and negative extractable nuclear antigen. A biopsy performed on deep nodules on the arms revealed an infiltrate of monocytic cells. Electron microscopy showed no lymphocytic infiltrate at or below the basal membrane and no necrotic keratinocytes within the basal cells of the epidermis. CONCLUSION Histological and ultrastructural data showed that skin manifestations of KFD and SLE share some common features. Electron microscopy analysis can help discriminate between the two diagnoses.
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Affiliation(s)
- Francesca Prignano
- Department of Dermatological Sciences University of Florence, Piazza dell'Indipendenza, Florence, Italy.
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Abraham M, Lazareth I, Bonardel G, Albiges L, Dechaud C, Marini V, Michon-Pasturel U, Molinier V, Priollet P. [Kikuchi disease and lupus: case report, literature review and FDG PET/CT interest]. ACTA ACUST UNITED AC 2011; 36:274-9. [PMID: 21757306 DOI: 10.1016/j.jmv.2011.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 05/11/2011] [Indexed: 12/17/2022]
Abstract
Kikuchi disease is a rare entity characterized by lymphadenopathy and fever. Pathology study of lymph node biopsies provides the diagnosis. The disease course is favorable. The disease can occur isolated, or associated with other pathologies including lupus or mixed connective tissue disease. We report a case of Kikuchi disease in a 35-year-old woman, occurring 12 years after the diagnosis of overlap syndrome with antiphospholipid antibodies. The patient was given prednisone 25mg per day and long-term hydroxychloroquine. FDG PET/CT showed FDG-avidity nodular masses. After bolus corticosteroid therapy, outcome was favorable with disappearance of metabolic hyperactivity on the FDG PET/CT. The bolus prednisone treatment could then be discontinued. In the 61 cases of Kikuchi disease and lupus associations previously published, Kikuchi disease was diagnosed after lupus in only 13 % of the observations. In these cases, use of FDG PET/ CT was not reported. For us, FDG PET/CT was useful for diagnosis, for choosing the biopsy site and for follow-up.
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Affiliation(s)
- M Abraham
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, France
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47
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Kim SK, Kang MS, Yoon BY, Kim DY, Cho SK, Bae SC, Her MY. Histiocytic necrotizing lymphadenitis in the context of systemic lupus erythematosus (SLE): Is histiocytic necrotizing lymphadenitis in SLE associated with skin lesions? Lupus 2011; 20:809-19. [PMID: 21562017 DOI: 10.1177/0961203310397684] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Histiocytic necrotizing lymphadenitis (HNL), or Kikuchi's disease, is a benign and self-limiting lymphadenopathy that typically affects young Asian females. It presents with lymphadenopathy, usually cervical, accompanied by fever, chills and leukopenia. Although the association between systemic lupus erythematosus (SLE) and HNL is rare, the number of reports of HNL in SLE patients is increasing. We present nine cases of HNL in patients with SLE. Among the seven patients with diverse skin manifestations, three had skin manifestations that were histologically compatible with SLE. A review of previous reports in the literature showed that cutaneous involvement was commonly found in HNL in association with SLE. In the patients who had simultaneous onset of both diseases, lupus flare-ups were commonly observed. We suggest that HNL in SLE patients is associated with cutaneous manifestations. This report contributes to our understanding of the relationship between these diseases.
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Affiliation(s)
- S K Kim
- Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, South Korea
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49
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Fonseca E, Fernández-Torres RM. Managing Acute and Complex Dermatological Situations. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Yamashita T, Shibata K, Nagano S, Aishima S, Yoshimura T. [A case of subacute necrotizing lymphadenitis with recurrent aseptic meningitis associated with persistent high titer of anti-nuclear antibody occurring over a short period of time]. Rinsho Shinkeigaku 2010; 50:728-31. [PMID: 21061554 DOI: 10.5692/clinicalneurol.50.728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 35-year-old woman developed recurrent aseptic meningitis three times over a period of 16 months. Each episode followed swelling of her cervical lymph nodes. During the third episode, microscopic findings of biopsied specimens from a cervical lymph node indicated subacute necrotizing lymphadenitis (SNL). While she responded poorly to NSAIDs, steroids rapidly improved her fever, headache and swollen lymph nodes. Since the first episode, anti-nuclear antibody (ANA) and anti-SS-A antibody was positive and the titer of ANA increased with each episode. SNL is a benign and self-limited disease, and the appearance of autoantibodies is usually transient. It is possible that a persistent immune abnormality is related to recurrences of aseptic meningitis with SNL.
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