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Sandakly N, El Koubayati G, Sarkis J, Naderi S, Sebaaly D, Haddad F. Kikuchi-Fujimoto disease associated with a flare-up of a leukocytoclastic vasculitis: A rare case report and review of literature. Medicine (Baltimore) 2024; 103:e37626. [PMID: 38552071 PMCID: PMC10977597 DOI: 10.1097/md.0000000000037626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Kikuchi-Fujimoto disease (KFD) also known as histiocytic necrotizing lymphadenopathy is an exceedingly rare cause of cervical lymphadenopathy, commonly accompanied by systemic symptoms such as fever, fatigue, night sweats, myalgia, skin rash. PATIENT CONCERNS In this paper, we report the case of a 22-year-old female patient who experienced a flare-up of leukocytoclastic vasculitis that was complicated by the appearance of a cervical lymph node with dysphagia, fever and nausea. DIAGNOSIS Infectious and autoimmune workup came back negative. INTERVENTIONS Excisional lymph node biopsy was done and the pathology results were consistent with histiocytic necrotizing lymphadenitis in keeping with Kikuchi-Fujimoto disease. OUTCOMES Patient improved on intravenous corticosteroids and was discharged on per os prednisone. Six month follow-up shows complete resolution of her symptoms. LESSONS KFD should be ruled out in patients with autoimmune or inflammatory diseases who develop lymphadenopathies.
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Affiliation(s)
- Nicolas Sandakly
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Georgio El Koubayati
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Jeannette Sarkis
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Samah Naderi
- Department of Pathology, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Delivrance Sebaaly
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Pathology, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Fady Haddad
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
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2
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Ichikawa T, Furukawa R, Shimojima Y, Hoshino Y, Kishida D, Sekijima Y. Immune-mediated necrotizing myopathy with concomitant development of Kikuchi-Fujimoto disease. Int J Rheum Dis 2024; 27:e14894. [PMID: 37653623 DOI: 10.1111/1756-185x.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Immune-mediated necrotizing myopathy (IMNM) is a distinct type of idiopathic inflammatory myositis, pathologically characterized by myofiber necrosis and degeneration in the absence of lymphocyte infiltration. Herein, we present a case of IMNM with concomitant development of Kikuchi-Fujimoto disease (KFD), characterized by histiocytic necrotizing lymphadenitis, in a 36-year-old woman who had a treatment history for rheumatoid arthritis (RA). Treatment with oral prednisolone and tacrolimus as immunosuppressants resulted in the remission of the skeletomuscular involvement and lymphadenopathy. To the best of our knowledge, this is the first report of IMNM and KFD developing concomitantly during the clinical course of RA.
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Affiliation(s)
- Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryo Furukawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yumi Hoshino
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
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3
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Mahajan VK, Sharma V, Sharma N, Rani R. Kikuchi-Fujimoto disease: A comprehensive review. World J Clin Cases 2023; 11:3664-3679. [PMID: 37383134 PMCID: PMC10294163 DOI: 10.12998/wjcc.v11.i16.3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/29/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
Kikuchi-Fujimoto disease, a rare form of necrotizing lymphadenitis, is an uncommon, benign, self-limiting disorder of obscure etiology. It affects mostly young adults of both genders. Clinically, it presents with fever and lymphadenopathy of a firm to rubbery consistency frequently involving cervical lymph nodes while weight loss, splenomegaly, leucopenia, and elevated erythrocyte sedimentation rate feature in severely affected patients. Cutaneous involvement occurs in about 30%-40% of cases as facial erythema and nonspecific erythematous papules, plaques, acneiform or morbilliform lesions of great histologic heterogeneity. Both Kikuchi-Fujimoto disease and systemic lupus erythematosus share an obscure and complex relationship as systemic lupus erythematosus may occasionally precede, develop subsequently, or sometimes be associated concurrently with Kikuchi-Fujimoto disease. It is often mistaken for non-Hodgkin lymphoma while lupus lymphadenitis, cat-scratch disease, Sweet’s syndrome, Still’s disease, drug eruptions, infectious mononucleosis, and viral or tubercular lymphadenitis are other common differentials. Fine needle aspiration cytology mostly has features of nonspecific reactive lymphadenitis and immunohistochemistry studies usually show variable features of uncertain diagnostic value. Since its diagnosis is exclusively from histopathology, it needs to be evaluated more carefully; an early lymph node biopsy will obviate the need for unnecessary investigations and therapeutic trials. Its treatment with systemic corticosteroids, hydroxychloroquine, or antimicrobial agents mostly remains empirical. The article reviews clinicoepidemiological, diagnostic, and management aspects of KFD from the perspective of practicing clinicians.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Neeraj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Ritu Rani
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
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4
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Qasim A, Itare V, Anwar MY, Arguello Perez E. A Rare Case of Kikuchi-Fujimoto Disease. Cureus 2023; 15:e39098. [PMID: 37332401 PMCID: PMC10270646 DOI: 10.7759/cureus.39098] [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: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is an autoimmune condition that is more common in females and occurs in the third decade of life. The condition is usually benign and self-resolving and is characterized by fever, cervical lymphadenopathy, night sweats, myalgia, and rashes. The disease can be misdiagnosed as reactive follicular hyperplasia, tuberculous lymphadenitis, systemic lupus erythematosus, and malignant lymphoma. The diagnosis of KFD involves the excision of the affected lymph node. Although there is no specific treatment for the disease, usually symptomatic and supportive measures are effective; however, steroids and immunosuppressive therapies are considered in more severe cases. The disease lasts for around one to four months. The neurological complications include cerebellar ataxia, meningoencephalitis, and aseptic meningitis. Here, we describe the case of a 36-year-old male who presented with complaints of fever, malaise chills, anorexia, and fatigue associated with a tender right axillary lymph node. The patient underwent a biopsy which confirmed KFD and responded well to supportive therapy.
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Affiliation(s)
- Abeer Qasim
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Vikram Itare
- Internal Medicine, BronxCare Health System, Bronx, USA
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5
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Harrison J, Sukumaran S, Vijayan V. Systemic Lupus Erythematosus Lymphadenopathy Presenting as Kikuchi-Fujimoto Disease in an Adolescent. Cureus 2023; 15:e35304. [PMID: 36968890 PMCID: PMC10038115 DOI: 10.7759/cureus.35304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Systemic lupus erythematosus is a multisystem autoimmune disorder with a highly heterogeneous clinical presentation. The clinical phenotype varies from mild cutaneous and musculoskeletal manifestations to neurological involvement. Lymphadenopathy is a frequent manifestation of SLE, but the association is often not recognized, as lymphadenopathy is not a criterion for diagnosis. An unusual and seldom reported mimicker of lupus lymphadenitis is Kikuchi-Fujimoto Disease. This is a rare self-limiting disease of young adult females that presents with lymphadenopathy, fever, and systemic symptoms. Lupus lymphadenitis and KFD share some common clinical and pathologic features; but distinguishing between those two diseases can be challenging. We describe a 16-year-old Hispanic female who presented with axillary lymphadenopathy and was initially diagnosed with KFD based on an excisional lymph node biopsy; but later met the criteria for the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria SLE. This case highlights the need for clinicians to be aware that patients with SLE may present with lymphadenopathy and to consider the association between Kikuchi disease and SLE to prevent misdiagnosis and allow for timely treatment to avoid complications.
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Li M, Hsu JY, Xie YX, Wu YL, Wei JCC. Ankylosing spondylitis with Kikuchi-Fujimoto disease: A case report with literature review. Int J Rheum Dis 2023; 26:383-385. [PMID: 36324224 DOI: 10.1111/1756-185x.14486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
We present the case of a patient diagnosed with ankylosing spondylitis (AS) along with Kikuchi-Fujimoto disease (KFD), possibly triggered by infection or autoimmunity. Both AS and KFD involved a similar immune pathway. Hence, clinicians should consider the possibility of KFD when lymphadenopathy is observed, especially in patients with infection or underlying autoimmune diseases.
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Affiliation(s)
- Man Li
- The Second Hospital of Longyan, Longyan, China
| | - Jhe-Yuan Hsu
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | | | - Yong-Lan Wu
- The Second Hospital of Longyan, Longyan, China
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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7
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Potapenko VG, Baykov VV, Markova АY, Mikhailova NB, Ter‑Grigoryan AS, Krivolapov YА. Kikuchi–Fujimoto disease: literature review and report of four cases. ONCOHEMATOLOGY 2022. [DOI: 10.17650/1818-8346-2022-17-4-48-59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Kikuchi–Fujimoto disease, or necrotizing histiocytic lymphadenitis, is one of the rare causes of benign lymphadeno-pathy. The diagnosis is based on histological and immunohistochemical analysis of the lymph node biopsy. The article presents four clinical cases of Kikuchi–Fujimoto disease. According to the results of the primary analysis of lymph node tissue three patients were misdiagnosed with lymphoma. due to the unusual for lymphoid malignancy course the primary material was reviewed. The diagnosis of Kikuchi–Fujimoto disease was put. In three patients the disease has a re-current course. during the observation period, the course of the disease in all the presented patients is benign with normal quality of life.
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Affiliation(s)
| | - V. V. Baykov
- Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | | | - N. B. Mikhailova
- Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - A. S. Ter‑Grigoryan
- Hematological Center named after professor R.O. Yeolyan, Ministry of Health of the Republic of Armenia
| | - Yu. А. Krivolapov
- I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia
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8
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Fadul A, Subahi EA, Ali EA, Awadalkareem H, Mohamed G, Elawad M, Sharaf Eldean M, Albozom A. Kikuchi-Fujimoto Disease: A Rare Cause of Pyrexia of Unknown Origin and Cervical Lymphadenopathy. Cureus 2022; 14:e30823. [DOI: 10.7759/cureus.30823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
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Bazkke B, Osman J, Shahrour M, Ziadeh M, Haji Mohamad A, Mouhandes MIE, Niazi A. A pregnant women with history of hashimoto's thyroiditis diagnosed with Kikuchi-Fujimoto disease: the first case report. Thyroid Res 2022; 15:16. [PMID: 36109799 PMCID: PMC9476254 DOI: 10.1186/s13044-022-00135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease (KFD) is a benign, self-limiting disorder characterized by regional lymphadenopathy. Clinical symptoms range from mild fever and tenderness to upper respiratory syndrome. A few cases have been observed during pregnancy or Hashimoto's disease. What we describe here is the first observed case of KFD in a pregnant woman with a history of Hashimoto's thyroiditis. CASE PRESENTATION A 36-year-old woman presented to Aleppo University Hospital during the 13th week of gestation with a painful cervical node on the right side of her neck. The patient's previous medical history confirmed Hashimoto's thyroiditis for several years. After histopathological examinations and radiological investigations, she was diagnosed with Kikuchi-Fujimoto disease and treated with corticosteroids. Although the patient did not adhere to the treatment very well due to her concerns for the fetus, the clinical picture improved after delivery. The patient now is on follow-up and continuing the current treatment with corticosteroids. CONCLUSIONS Further investigations need to be conducted to understand the possible autoimmune etiology of KFD when it is associated with Hashimoto's thyroiditis disease. It is also necessary to understand the relationship between this disease and pregnancy.
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Affiliation(s)
- Bashar Bazkke
- grid.42269.3b0000 0001 1203 7853Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Joli Osman
- grid.42269.3b0000 0001 1203 7853Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Mohammad Shahrour
- grid.42269.3b0000 0001 1203 7853Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Mohammad Ziadeh
- grid.42269.3b0000 0001 1203 7853Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | | | - Mohamed Imad Eddin Mouhandes
- grid.42269.3b0000 0001 1203 7853Department of Pathology, Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Ammar Niazi
- grid.42269.3b0000 0001 1203 7853Department of General Surgery, Faculty of Medicine, Aleppo University Hospital, Aleppo, Syria
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Yamamura Y, Furuichi K, Toyama T, Oshima M, Ogura H, Sato K, Nakagawa S, Miyagawa T, Kitajima S, Hara A, Iwata Y, Sakai N, Shimizu M, Ikeda H, Toma T, Takasawa K, Yachie A, Wada T. Repeated Necrotizing Lymphadenitis with MEFV Gene Mutations. Intern Med 2022; 61:1105-1110. [PMID: 34511567 PMCID: PMC9038464 DOI: 10.2169/internalmedicine.7882-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 36-year-old man with repeated necrotizing lymphadenitis due to MEFV gene mutations. The patient's chief complaints were a fever and painful cervical lymphadenopathy. We diagnosed him with necrotizing lymphadenitis based on the pathological findings of the lymph nodes and the exclusion of other differential diseases. The same episode recurred four times. We speculated the involvement of autoinflammatory backgrounds and detected MEFV gene mutations of E148Q (homo), P369S, and R408Q. Considering the elevation of interleukin-18, these mutations probably played roles in the repeated necrotizing lymphadenitis.
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Affiliation(s)
- Yuta Yamamura
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Kengo Furuichi
- Department of Nephrology, School of Medicine, Kanazawa Medical University, Japan
| | - Tadashi Toyama
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Megumi Oshima
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Hisayuki Ogura
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Koichi Sato
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Shiori Nakagawa
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Taro Miyagawa
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Shinji Kitajima
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Akinori Hara
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Yasunori Iwata
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Norihiko Sakai
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Miho Shimizu
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Hiroko Ikeda
- Department of Diagnostic Pathology, Kanazawa University Hospital, Japan
| | - Tomoko Toma
- Department of Pediatrics, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Kazuya Takasawa
- Department of Internal Medicine, Public Central Hospital of Matto Ishikawa, Japan
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
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James JF, Liles JE, Thakore MW. Lupus profundus and discoid lupus following a diagnosis of Kikuchi-Fujimoto disease. JAAD Case Rep 2021; 33:45-47. [PMID: 36852339 PMCID: PMC9958384 DOI: 10.1016/j.jdcr.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- JaBreia F. James
- Medical College of Georgia at Augusta University, Augusta, Georgia,Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia,Correspondence to: JaBreia F. James, BS, Augusta University, 1120 15th St, BA 2701, Augusta, GA 30912.
| | - Jenny E. Liles
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Morgan W. Thakore
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia
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Sato T, Kanda K, Kawamura Y, Takeuchi M. Sub internal limiting membrane hemorrhage followed by bilateral optic disc hemorrhage in Kikuchi-Fujimoto disease: a case report. BMC Ophthalmol 2021; 21:355. [PMID: 34620137 PMCID: PMC8499551 DOI: 10.1186/s12886-021-02106-y] [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] [Received: 06/22/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Kikuchi-Fujimoto disease (KFD) is a necrotizing lymphadenitis, and presents fever of unknown origin and cervical lymphadenopathy. Ocular complications are unusual in KFD. Here we report a case of sub internal limiting membrane (ILM) hemorrhage followed by bilateral optic disc hemorrhage in KFD. Case presentation A 16-year-old Japanese man perceived a sudden decrease of right vision 3 days after onset of fever with unknown origin and left cervical lymphadenopathy. At presentation, visual acuity (VA) of right eye was 0.05 in decimal chart (1.30: converted to logarithm of minimum angle of resolution: logMAR). Fundus photograph showed extensive sub-ILM hemorrhage in right eye, and optic disc hemorrhages in both eyes. Fluorescein angiography presented hypo- and hyperfluorescences in optic disc of right eye, and hyperfluorescence in the disc of left eye. To make a definitive diagnosis, cervical lymph node biopsy was performed, and KFD was diagnosed pathologically. Thereafter, fever, headache and the cervical lymphadenopathy disappeared spontaneously. The sub-ILM hemorrhage was drained into the vitreous cavity by neodymium:yttrium-aluminum-garnet laser (Nd: YAG) hyaloidotomy. VA recovered to 1.5 (− 0.18: logMAR VA) in right eye. Conclusion Sub-ILM hemorrhage and optic disc hemorrhage are a KFD-related ocular complication. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02106-y.
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Affiliation(s)
- Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Koji Kanda
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yusuke Kawamura
- Department of General Medicine, National Defense Medical College, Saitama, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
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Park S, Kim JY, Ryu YJ, Lee H. Kikuchi Cervical Lymphadenitis in Children: Ultrasound Differentiation From Common Infectious Lymphadenitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2069-2078. [PMID: 33263358 DOI: 10.1002/jum.15584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate ultrasound (US) features of enlarged cervical lymph nodes (LNs) to differentiate between Kikuchi disease (KD) and other common types of infectious lymphadenitis in an East Asian pediatric patient population. METHODS A total of 142 pediatric patients with KD and 45 patients with infectious lymphadenitis (suppurative lymphadenitis [n = 29], nontuberculous mycobacterial lymphadenitis [n = 9], and tuberculous lymphadenitis [n = 7]) were included. The clinical characteristics, laboratory results, and US features of LNs were reviewed. The area under the curve (AUC) from a receiver operating characteristic curve analysis was used as a diagnostic accuracy measure. RESULTS A multiple clustered adjacent pattern, bilaterality, an even size, posterior neck involvement, no enlargement, an elongated-to-ovoid shape, homogeneous hypoechogenicity, a well-defined margin, presence of an echogenic fatty hilum, no intranodal gross necrosis, increased perinodal fat echogenicity, and no increased echogenicity of the adjacent sternocleidomastoid muscle were significant US features of the affected LNs to discriminate KD from infectious lymphadenitis (P < .05). Homogeneous hypoechogenicity in KD showed the highest AUC (0.930) as a single variable (95% confidence interval, 0.88-0.96). The AUCs were increased in 3 combination models with 2 US features: homogeneous echogenicity and 1 of 3 other US features (increased perinodal fat echogenicity, 0.935; number of affected LNs, 0.947; and LN shape, 0.949). CONCLUSIONS Homogeneous hypoechogenicity of LNs was a significant US feature with the highest diagnostic accuracy in differentiating KD from common infectious lymphadenitis on a univariate analysis. In the combination model, US features of an elongated-to-ovoid shape and homogeneous hypoechogenicity showed the highest diagnostic accuracy.
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Affiliation(s)
- Sunyoung Park
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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14
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Anuntakarun S, Larbcharoensub N, Payungporn S, Reamtong O. Identification of genes associated with Kikuchi-Fujimoto disease using RNA and exome sequencing. Mol Cell Probes 2021; 57:101728. [PMID: 33819568 DOI: 10.1016/j.mcp.2021.101728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is an extremely rare disease, and although it is reported to have a worldwide distribution, young Asian women are most likely to be affected. Although this disease is generally benign and self-limiting, distinguishing it from other diseases that cause lymphadenopathy (e.g., leukemia, lymphoma, and infectious diseases) is challenging. A lymph node biopsy is a definitive diagnostic technique for KFD and only requires skillful pathologists. There are no specific symptoms or laboratory tests for KFD, and more than 50% of KFD patients have suffered from being misdiagnosed with lymphoma, which leads to improper treatment. In this study, lymph node tissue samples from KFD patients were used to reveal their exomes and transcriptomes using a high-throughput nucleotide sequencer. Fourteen single nucleotide polymorphisms (SNPs) were identified as candidate KFD markers and were compared with a healthy lymph node exome dataset. The mutation of these genes caused disruptive impact in the proteins. Several SNPs associated with KFD involve genes related to human cancers, olfaction, and osteoblast differentiation. According to the transcriptome data, there were 238 up-regulated and 1,519 down-regulated genes. RANBP2-like and ribosomal protein L13 were the most up-regulated and down-regulated genes in KFD patients, respectively. The altered gene expression involved in the human immune system, chromatin remodeling, and gene transcription. A comparison of KFD and healthy datasets of exomes and transcriptomes may allow further insights into the KFD phenotype. The results may also facilitate future KFD diagnosis and treatment.
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Affiliation(s)
- Songtham Anuntakarun
- Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sunchai Payungporn
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand; Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Onrapak Reamtong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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15
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Nelson ND, Meng W, Rosenfeld AM, Bullman S, Sekhar Pedamallu C, Nomburg JL, Wertheim GB, Paessler ME, Pinkus G, Hornick JL, Meyerson M, Luning Prak ET, Pillai V. Characterization of Plasmacytoid Dendritic Cells, Microbial Sequences, and Identification of a Candidate Public T-Cell Clone in Kikuchi-Fujimoto Disease. Pediatr Dev Pathol 2021; 24:193-205. [PMID: 33530869 DOI: 10.1177/1093526620987961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Kikuchi-Fujimoto disease (KFD) is a self-limited lymphadenitis of unclear etiology. We aimed to further characterize this disease in pediatric patients, including evaluation of the CD123 immunohistochemical (IHC) staining and investigation of potential immunologic and infectious causes. METHODS Seventeen KFD cases and 12 controls were retrospectively identified, and the histologic and clinical features were evaluated. CD123 IHC staining was quantified by digital image analysis. Next generation sequencing was employed for comparative microbial analysis via RNAseq (5 KFD cases) and to evaluate the immune repertoire (9 KFD cases). RESULTS In cases of lymphadenitis with necrosis, >0.85% CD123+ cells by IHC was found to be six times more likely in cases with a final diagnosis of KFD (sensitivity 75%, specificity 87.5%). RNAseq based comparative microbial analysis did not detect novel or known pathogen sequences in KFD. A shared complementarity determining region 3 (CDR3) sequence and use of the same T-cell receptor beta variable region family was identified in KFD LNs but not controls, and was not identified in available databases. CONCLUSIONS Digital quantification of CD123 IHC can distinguish KFD from other necrotizing lymphadenitides. The presence of a unique shared CDR3 sequence suggests that a shared antigen underlies KFD pathogenesis.
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Affiliation(s)
- Nya D Nelson
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wenzhao Meng
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aaron M Rosenfeld
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Bullman
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology and Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chandra Sekhar Pedamallu
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology and Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason L Nomburg
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology and Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gerald B Wertheim
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michele E Paessler
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Geraldine Pinkus
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Meyerson
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology and Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eline T Luning Prak
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vinodh Pillai
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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16
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Müller CSL, Vogt T, Becker SL. Kikuchi-Fujimoto Disease Triggered by Systemic Lupus Erythematosus and Mycoplasma pneumoniae Infection-A Report of a Case and a Review of the Literature. Am J Dermatopathol 2021; 43:202-208. [PMID: 32809980 DOI: 10.1097/dad.0000000000001764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT Kikuchi-Fujimoto disease (KFD) is a necrotizing histiocytic lymphadenitis that was described for the first time in 1972 in Japan. Its etiology is still not fully understood. It has been reported in association with many different agents, diseases, and triggering factors without any conclusive result. To the best of our knowledge, we report for the first time a case of KFD with systemic lupus erythematosus in a child in association with a polymerase chain reaction (PCR)-positive throat swab for Mycoplasma pneumoniae. Although difficult to prove, the acute M. pneumoniae infection might have served as a triggering event for the development of KFD in our case. We encourage further studies to investigate a potential relationship between KFD and M. pneumoniae, which should also use PCR-based testing for this pathogen in patients with KFD.
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Affiliation(s)
- Cornelia S L Müller
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg/Saar, Germany
- Swiss Tropical and Public Health Institute, Basel, Switzerland; and
- University of Basel, Basel, Switzerland
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17
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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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18
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Kikuchi-Fujimoto disease associated with primary Sjögren's syndrome - literature review based on a case report. Reumatologia 2020; 58:251-256. [PMID: 32921833 PMCID: PMC7477469 DOI: 10.5114/reum.2020.98438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/04/2020] [Indexed: 12/17/2022] Open
Abstract
Primary Sjögren’s syndrome (pSS) is a chronic, autoimmune disease predominantly involving exocrine glands. Lymphadenopathy is one of the possible symptoms of pSS. It may also suggest development of non-Hodgkin lymphoma (NHL), the most severe complication of pSS, or be a symptom of less common diseases, such as Kikuchi-Fujimoto disease (KFD), presented in this paper. Kikuchi-Fujimoto disease is an extremely rare, benign and self-limiting disorder, characterized by regional lymphadenopathy. This paper presents a case of previously unreported association of pSS, KFD and renal cancer in a patient with recurrent cervical lymphadenopathy, as well as a discussion on the coexistence of these diseases based on available literature searching for PubMed, Scopus and Google Scholar databases, particularly in this subject. These three clinical entities may manifest lymphadenopathy each, causing a diagnostic dilemma. The treatment is also challenging under such circumstances. In this particular situation, it was a combination of immunosuppressive therapy and surgery.
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19
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Goh Y, Yeo L, Quek A, Teng GG, Tan C, Wang S, Lim A. Kikuchi-Fujimoto disease associated with intracranial large-vessel vasculitis and recurrent cranial neuropathies. Scand J Rheumatol 2020; 50:80-82. [PMID: 32878510 DOI: 10.1080/03009742.2020.1771764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Y Goh
- Division of Neurology, University Medicine Cluster, National University Health System , Singapore, Singapore
| | - Lll Yeo
- Division of Neurology, University Medicine Cluster, National University Health System , Singapore, Singapore
| | - Aml Quek
- Division of Neurology, University Medicine Cluster, National University Health System , Singapore, Singapore
| | - G G Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System , Singapore, Singapore
| | - Cwt Tan
- Department of Ophthalmology, National University Hospital, National University Health System , Singapore, Singapore
| | - S Wang
- Department of Pathology, National University Hospital, National University Health System , Singapore, Singapore
| | - Ayn Lim
- Division of Rheumatology, University Medicine Cluster, National University Health System , Singapore, Singapore
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20
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Mohamad AA, Zahid M, Khan AA, Alani B, Khalil M, Saeed A, Elzouki AN. Kikuchi-Fujimoto Disease: Review of 11 Cases Diagnosed Over 10 Years at a Tertiary Care Hospital in Doha, Qatar. Eur J Case Rep Intern Med 2020; 7:001598. [PMID: 32523919 PMCID: PMC7279917 DOI: 10.12890/2020_001598] [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: 03/25/2020] [Accepted: 03/11/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction Kikuchi-Fujimoto (KF) disease is a rare and self-limiting disorder of unknown aetiology characterized by cervical lymphadenopathy (CLN) and fever. The pathophysiology remains unclear and may be triggered by an infectious agent leading to a self-limiting autoimmune process. There are no confirmatory laboratory tests and lymph node biopsy is required to differentiate KF disease from other serious conditions. Materials and methods We report 11 cases of KF disease diagnosed at Hamad General Hospital, Qatar, between 2006 to 2016. The diagnosis is based on clinical presentation, investigations and histopathological examination of lymph nodes. Results All patients had painful neck swelling (average duration of 2.9 weeks) and 10 had fever (average duration of 3.2 weeks). Five patients developed mild leucopenia which resolved completely. HIV and tuberculosis (TB) screening including sputum for AFB, a PPD skin test and chest x-ray was done for all patients and came back negative. Autoimmune screening was done for all patients and excluded any rheumatological disease. Ultrasound and CT of the neck confirmed cervical lymphadenopathy. Except for hepatomegaly in one patient, CT scans of the chest and abdomen were negative for any lymphadenopathy or organomegaly (performed in seven patients). Diagnosis was confirmed on lymph node excision biopsy. Histopathological examination showed findings consistent with the diagnosis of histiocytic necrotizing lymphadenitis (KF disease). Conclusion KF disease should be kept in mind for patients presenting with fever and CLN. Lymphoma, TB and autoimmune diseases like systemic lupus erythematosus should be excluded in such patients.
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Affiliation(s)
- Ahmed A Mohamad
- Department of Internal Medicine, Hamad General Hospital and Weil Cornell Medical College, Doha, Qatar
| | - Muhammad Zahid
- Department of Internal Medicine, Hamad General Hospital and Weil Cornell Medical College, Doha, Qatar
| | - Adeel Ahmad Khan
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Belal Alani
- Department of Maxillofacial Surgery, Hamad General Hospital, Doha, Qatar
| | - Mustafa Khalil
- Department of Maxillofacial Surgery, Hamad General Hospital, Doha, Qatar
| | - Abazar Saeed
- Department of Internal Medicine, Hamad General Hospital and Weil Cornell Medical College, Doha, Qatar
| | - Abdel-Naser Elzouki
- Department of Internal Medicine, Hamad General Hospital and Weil Cornell Medical College, Doha, Qatar
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21
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Ramachandran D, Venkitakrishnan R, Augustine J, Cleetus M. Spontaneous resolution of persistent lymphadenitis: a case of Kikuchi–Fujimoto disease. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_26_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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23
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Fernandez-Flores A. La biopsia cutánea en el contexto de la enfermedad sistémica. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:710-727. [DOI: 10.1016/j.ad.2019.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 02/07/2023] Open
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24
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Is recurrent Kikuchi-Fujimoto disease a precursor to systemic lupus erythematosus? ACTA ACUST UNITED AC 2019; 57:72-77. [PMID: 30375354 DOI: 10.2478/rjim-2018-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Indexed: 11/20/2022]
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign, self-limiting disease characterized by cervical lymphadenopathy and fever. Since KFD was first reported in 1972, the validity of this clinical entity has been controversial and its aetiology remains unknown. Herein, we report a case of a patient with KFD, which was believed to be associated with systemic lupus erythematosus.
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25
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Moyer A, Hanafi MZ, Scordino T, Bronze M. Kikuchi-Fujimoto Disease: An Atypical Presentation of a Rare Disease. Cureus 2019; 11:e3999. [PMID: 30989008 PMCID: PMC6445562 DOI: 10.7759/cureus.3999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/01/2019] [Indexed: 12/20/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD), or necrotizing histiocytic lymphadenitis, is a rare cause of lymphadenopathy and fever. Although the clinical course is usually benign, KFD is often mistaken for malignancy or infection. Recognition of typical and atypical cases of KFD is necessary to avoid unnecessary interventions. Here we report an atypical presentation of KFD with diffuse lymphadenopathy and leukocytosis associated with high levels of circulating Epstein-Barr viral DNA.
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Affiliation(s)
- Amanda Moyer
- Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Muhammad Z Hanafi
- Gastroenterology, University of Oklahoma Health Science Center, Oklahoma City, USA
| | - Teresa Scordino
- Pathology, University of Oklahoma Health Sciences Center, Oklahoma City , USA
| | - Michael Bronze
- Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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26
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Altinel Açoğlu E, Sari E, Şahin G, Oğuz MM, Akçaboy M, Zorlu P, Senel S. Kikuchi-Fujimoto disease triggered by Salmonella enteritidis in a child with concurrent auto-immune thyroiditis and papilloedema. Paediatr Int Child Health 2018; 38:298-301. [PMID: 29307273 DOI: 10.1080/20469047.2017.1420523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a histiocytic necrotising lymphadenitis characterised by painful cervical lymphadenopathy, fever, malaise and weight loss. Infections, auto-immune pathogenesis and a genetic association have been implicated. A 12-year-old boy presented with a 1-month history of fever, abdominal pain, constipation and weight loss, and a painful lymph node was detected in the right axilla. Chest CT demonstrated multiple lymph nodes, especially in the left mediastinum. Salmonella enteritidis group D was detected in a blood culture and he was treated with ceftriaxone, followed by meropenem. An axillary lymph node biopsy demonstrated necrotising histiocytic lymphadenitis and KFD was diagnosed. He was discharged 35 days after admission. He was re-admitted 3 weeks later with recurrence of symptoms and headache and was found to have papilloedema of the left eye and auto-immune thyroiditis. Intravenous immunoglobulin (IVIG) 400 mg/kg/day was administered for 5 days. The fever and papilloedema slowly resolved and, subsequently, the thyroiditis, and he has remained well on follow-up. This is the first report of an association of S. enteritidis infection and papilloedema with KFD. IVIG may be required in prolonged or recurrent cases and in those with an auto-immune association.
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Affiliation(s)
- Esma Altinel Açoğlu
- a Departments of Pediatrics , Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Eyup Sari
- a Departments of Pediatrics , Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Gürses Şahin
- b Departments of Pediatric Oncology , Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Melahat Melek Oğuz
- a Departments of Pediatrics , Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Meltem Akçaboy
- a Departments of Pediatrics , Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Pelin Zorlu
- a Departments of Pediatrics , Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Saliha Senel
- a Departments of Pediatrics , Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
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27
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Lelii M, Senatore L, Amodeo I, Pinzani R, Torretta S, Fiori S, Marchisio P, Bosis S. Kikuchi-Fujimoto disease in children: two case reports and a review of the literature. Ital J Pediatr 2018; 44:83. [PMID: 30021595 PMCID: PMC6052688 DOI: 10.1186/s13052-018-0522-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease is a rare, idiopathic and generally self-limiting cause of lymphadenitis of unknow etiology with a low recurrence rate. The typical clinical signs are cervical lymphadenopathy, fever, and symptoms of respiratory infection, and less frequently chills, night sweats, arthralgia, rash, and weight loss. CASE PRESENTATION Here we describe two case reports of Kikuchi Fujimoto disease presenting in Milan within the space of a few months. The first involved the recurrence of KFD in a young boy from Sri Lanka; the second was a rare case of severe KFD complicated by HLH. CONCLUSIONS Pediatricians must consider KFD in the differential diagnosis of fever of unknown origin in children, even in western countries. Although rare, recurrence and severe complications are possible. Where symptoms suggest KFD, a systematic diagnostic approach is key. Since no guidelines on the management of KFD are available, further studies should be conducted to investigate the therapeutic options and long term outcome in children.
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Affiliation(s)
- Mara Lelii
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Senatore
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pinzani
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Fiori
- Division of Pathology, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Lee EJ, Lee HS, Park JE, Hwang JS. Association Kikuchi disease with Hashimoto thyroiditis: a case report and literature review. Ann Pediatr Endocrinol Metab 2018; 23:99-102. [PMID: 29969882 PMCID: PMC6057018 DOI: 10.6065/apem.2018.23.2.99] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/10/2017] [Indexed: 11/20/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign and self-limited disease characterized by fever and lymphadenopathy. The etiology of KFD is unknown, but an autoimmune cause has been suggested. Hashimoto thyroiditis is the most common autoimmune thyroid disorder in children and is known to be associated with other autoimmune diseases. Only a few cases of Hashimoto thyroiditis associated with KFD have been documented. We report a case of a 16-year-old girl who was first diagnosed with KFD and developed Hashimoto thyroiditis 2 years and 6 months later during her follow-up period. Physicians of patients with KFD should consider the possibility of autoimmune diseases like Hashimoto's thyroiditis.
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Affiliation(s)
| | - Hae Sang Lee
- Address for correspondence: Hae Sang Lee, MD, PhD Department of Pediatrics, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-4454 Fax: +82-31-219-5169 E-mail:
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Characteristic Distribution Pattern of CD30-positive Cytotoxic T Cells Aids Diagnosis of Kikuchi-Fujimoto Disease. Appl Immunohistochem Mol Morphol 2018; 26:274-282. [DOI: 10.1097/pai.0000000000000411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Kikuchi-Fujimoto Disease in an Old Italian Woman: Case Report and Review of the Literature. Case Rep Med 2018; 2017:7257902. [PMID: 29387087 PMCID: PMC5745701 DOI: 10.1155/2017/7257902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/14/2017] [Indexed: 11/18/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare, benign, generally self-limiting disease that has higher prevalence in Asian people with a few cases reported in European countries. It generally affects young subjects under 40 years of age and is characterized by regional lymphadenopathy. Here, we present a case of a 66-year-old Italian woman who was extensively examined for right unilateral laterocervical lymph nodes associated with fever, night sweats, fatigue, and weight loss. She was diagnosed as having the KFD only after an excision biopsy of the largest laterocervical lymph node and was then managed symptomatically with NSAIDs. We also made a review of the literature for better awareness of the disease among physicians especially in those countries, like Italy, where the disease is not prevalent and may be frequently misdiagnosed. In fact, to our best knowledge, only seven Italian cases of KFD have been published in the last 15 years with patients being younger than 40 years. We finally highlight that it is noteworthy to consider KFD as differential diagnosis of lymphadenopathy even in old patients, and, since a misdiagnosis of lymphoma is actually feasible, an early biopsy has to be taken into account for confirming diagnosis and helping in the timely and appropriate management.
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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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Lin YC, Huang HH, Nong BR, Liu PY, Chen YY, Huang YF, Chiou YH, Lee HS. Pediatric Kikuchi-Fujimoto disease: A clinicopathologic study and the therapeutic effects of hydroxychloroquine. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 52:395-401. [PMID: 29050748 DOI: 10.1016/j.jmii.2017.08.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/07/2017] [Accepted: 08/31/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND To investigate the clinical features of Kikuchi-Fujimoto disease (KFD) in children, and place an emphasis on the therapeutic effects of hydroxychloroquine as monotherapy. METHODS We retrospectively reviewed the medical records of all children diagnosed with KFD during the period January 1992 to September 2016 at a tertiary medical center in Taiwan. RESULTS 40 patients were histopathologically confirmed as KFD, and the mean age of the patients was 13.9 ± 3.1 years. The male to female ratio was 1:1. The lymph node involvements were often cervical (95%) with features of unilateral predisposition (75%), polyadenopathy (84.4%) and tenderness (56.3%). Fever, cough, rhinorrhea, and tonsillitis were other common presentations. Laboratory findings included leukopenia (56.5%), monocytosis (63.6%), with positive results of EB-VCA IgG (88.9%), EB-VCA IgM (22.2%), EBEA IgG (22.2%) and EBNA IgG (88.9%). The univariate analyses of prolonged fever with lymphopenia, monocytosis, thrombocytopenia and necrotizing type in histopathology were disclosed as statistically significant (P < 0.05). Corticosteroids and hydroxychloroquine were administered in 15.6% of patients respectively, along with symptomatic treatments for the rest. Recurrence occurred in 13.0% of patients without corticosteroids or hydroxychloroquine treatment. There were neither recurrences nor relevant major adverse effects in all the five KFD cases treated with hydroxychloroquine. CONCLUSION KFD should be suspected in children with febrile cervical lymphadenopathy, especially when concomitant with leukopenia and monocytosis. Lymphopenia, monocytosis, thrombocytopenia and necrotizing type in histopathology are reliable predictors for prolonged fever. Hydroxychloroquine may be an alternative choice to corticosteroids for its favorable effects and safety.
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Affiliation(s)
- Yung-Chih Lin
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Hsiu-Hui Huang
- Department of Pathology and Laboratory, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Bao-Ren Nong
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Yen Liu
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ying-Yao Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yung-Feng Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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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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Choi MR, Yoo SB, Kim JH. Sporadic medullary microcarcinoma in a male patient with concurrent Hashimoto's hypothyroidism and Kikuchi disease. Korean J Intern Med 2016; 31:1184-1186. [PMID: 26813569 PMCID: PMC5094917 DOI: 10.3904/kjim.2014.395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/02/2015] [Accepted: 05/19/2015] [Indexed: 12/03/2022] Open
Affiliation(s)
- Mi-Rim Choi
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Seol-Bong Yoo
- Department of Pathology, Presbyterian Medical Center, Jeonju, Korea
| | - Ji Hye Kim
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
- Correspondence to Ji Hye Kim, M.D. Department of Internal Medicine, Presbyterian Medical Center, 365 Seowon-ro, Wansan-gu, Jeonju 54987, Korea Tel: +82-63-230-1372 Fax: +82-63-230-1309 E-mail:
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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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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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Abstract
Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenopathy, most often cervical. It has been mainly described in Asia. There are few data available on this disease in Europe. We conducted this retrospective, observational, multicenter study to describe KFD in France and to determine the characteristics of severe forms of the disease and forms associated with systemic lupus erythematosus (SLE). We included 91 cases of KFD, diagnosed between January 1989 and January 2011 in 13 French hospital centers (median age, 30 ± 10.4 yr; 77% female). The ethnic origins of the patients were European (33%), Afro-Caribbean (32%), North African (15.4%), and Asian (13%). Eighteen patients had a history of systemic disease, including 11 with SLE. Lymph node involvement was cervical (90%), often in the context of polyadenopathy (52%), and it was associated with hepatomegaly and splenomegaly in 14.8% of cases. Deeper sites of involvement were noted in 18% of cases. Constitutional signs consisted mainly of fever (67%), asthenia (74.4%), and weight loss (51.2%). Other manifestations included skin rash (32.9%), arthromyalgia (34.1%), 2 cases of aseptic meningitis, and 3 cases of hemophagocytic lymphohistiocytosis. Biological signs included lymphocytopenia (63.8%) and increase of acute phase reactants (56.4%). Antinuclear antibodies (ANAs) and anti-DNA antibodies were present in 45.2% and 18% of the patients sampled, respectively. Concomitant viral infection was detected in 8 patients (8.8%). Systemic corticosteroids were prescribed in 32% of cases, hydroxychloroquine in 17.6%, and intravenous immunoglobulin in 3 patients. The disease course was always favorable. Recurrence was observed in 21% of cases. In the 33 patients with ANA at diagnosis, SLE was known in 11 patients, diagnosed concomitantly in 10 cases and in the year following diagnosis in 2 cases; 6 patients did not have SLE, and 4 patients were lost to follow-up (median follow-up, 19 mo; range, 3-39 mo). The presence of weight loss, arthralgia, skin lesions, and ANA was associated with the development of SLE (p < 0.05). Male sex and lymphopenia were associated with severe forms of KFD (p < 0.05). KFD can occur in all populations, irrespective of ethnic origin. Deep forms are common. An association with SLE should be investigated. A prospective study is required to determine the risk factors for the development 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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Dumas G, Prendki V, Haroche J, Amoura Z, Cacoub P, Galicier L, Meyer O, Rapp C, Deligny C, Godeau B, Aslangul E, Lambotte O, Papo T, Pouchot J, Hamidou M, Bachmeyer C, Hachulla E, Carmoi T, Dhote R, Gerin M, Mekinian A, Stirnemann J, Charlotte F, Farge D, Molina T, Fain O. Kikuchi-Fujimoto disease: retrospective study of 91 cases and review of the literature. Medicine (Baltimore) 2014; 93:372-382. [PMID: 25500707 PMCID: PMC4602439 DOI: 10.1097/md.0000000000000220] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenopathy, most often cervical. It has been mainly described in Asia. There are few data available on this disease in Europe. We conducted this retrospective, observational, multicenter study to describe KFD in France and to determine the characteristics of severe forms of the disease and forms associated with systemic lupus erythematosus (SLE). We included 91 cases of KFD, diagnosed between January 1989 and January 2011 in 13 French hospital centers (median age, 30 ± 10.4 yr; 77% female). The ethnic origins of the patients were European (33%), Afro-Caribbean (32%), North African (15.4%), and Asian (13%). Eighteen patients had a history of systemic disease, including 11 with SLE. Lymph node involvement was cervical (90%), often in the context of polyadenopathy (52%), and it was associated with hepatomegaly and splenomegaly in 14.8% of cases. Deeper sites of involvement were noted in 18% of cases. Constitutional signs consisted mainly of fever (67%), asthenia (74.4%), and weight loss (51.2%). Other manifestations included skin rash (32.9%), arthromyalgia (34.1%), 2 cases of aseptic meningitis, and 3 cases of hemophagocytic lymphohistiocytosis. Biological signs included lymphocytopenia (63.8%) and increase of acute phase reactants (56.4%). Antinuclear antibodies (ANAs) and anti-DNA antibodies were present in 45.2% and 18% of the patients sampled, respectively. Concomitant viral infection was detected in 8 patients (8.8%). Systemic corticosteroids were prescribed in 32% of cases, hydroxychloroquine in 17.6%, and intravenous immunoglobulin in 3 patients. The disease course was always favorable. Recurrence was observed in 21% of cases. In the 33 patients with ANA at diagnosis, SLE was known in 11 patients, diagnosed concomitantly in 10 cases and in the year following diagnosis in 2 cases; 6 patients did not have SLE, and 4 patients were lost to follow-up (median follow-up, 19 mo; range, 3-39 mo). The presence of weight loss, arthralgia, skin lesions, and ANA was associated with the development of SLE (p < 0.05). Male sex and lymphopenia were associated with severe forms of KFD (p < 0.05). KFD can occur in all populations, irrespective of ethnic origin. Deep forms are common. An association with SLE should be investigated. A prospective study is required to determine the risk factors for the development of SLE.
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Affiliation(s)
- Guillaume Dumas
- From the Department of Internal Medicine (GD, CR), Hôpital d'Instruction des Armées Bégin, Saint-Mandé; Department of Internal Medicine 2 (JH, ZA), Pitié-Salpêtrière University Hospital, Paris; Department of Internal Medicine (PC), Pitié-Salpêtrière University Hospital, Paris; Department of Clinical Immunology (LG), Saint-Louis University Hospital, Paris; Department of Rheumatology (OM), Bichat University Hospital, Paris; Department of Internal Medicine (CD), Martinique University Hospital, Fort-de-France; Department of Internal Medicine (BG), Mondor University Hospital, Créteil; Department of Internal Medicine (EA), Cochin University Hospital, Paris; Department of Internal Medicine (OL), Bicêtre University Hospital, Le Kremlin-Bicêtre; Department of Internal Medicine (TP), Bichat University Hospital, Paris; Hôpital Européen Georges Pompidou (JP), Paris; Department of Internal Medicine (MH), Hôtel-Dieu University Hospital, Nantes; Department of Internal Medicine (CB), Tenon University Hospital, Paris; Department of Internal Medicine (EH), Huriez University Hospital, Lille; Department of Internal Medicine (TC), Hôpital d'Instruction des Armées du Val de Grace, Paris; Department of Internal Medicine (RD), Avicenne University Hospital, Bobigny; Department of Internal Medicine (MG, AM, OF), Jean Verdier University Hospital, Bondy; Department of Pathology (FC), Pitié-Salpêtrière University Hospital, Paris; Department of Internal Medicine (DF), Saint-Louis University Hospital, Paris; Department of Pathology (TM), Necker University Hospital, Paris; France; and Department of Internal Medicine (VP), Hôpital des Trois-Chêne, Hôpitaux Universitaires de Genève, Genève; and Department of Internal Medicine (JS), Hôpitaux Universitaires de Genève, Genève, Switzerland. Drs. Prendki and Fain contributed equally
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Yoo IH, Na H, Bae EY, Han SB, Lee SY, Jeong DC, Kang JH. Recurrent lymphadenopathy in children with Kikuchi-Fujimoto disease. Eur J Pediatr 2014; 173:1193-9. [PMID: 24714877 DOI: 10.1007/s00431-014-2306-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 03/24/2014] [Indexed: 11/25/2022]
Abstract
UNLABELLED Kikuchi-Fujimoto disease (KFD) is characterized by self-limiting regional lymphadenopathy with prolonged fever. Although the reported recurrence rate of KFD is known to be 3-4 %, this rate appears to be higher in our clinical experience, and rates up to 38.5 % have been previously reported. In this retrospective study, we reviewed medical records of children with pathologically confirmed KFD to investigate the factors associated with recurrent KFD. Enrolled children were divided into two groups according to the recurrence of KFD, and clinical and laboratory factors were compared between the two groups. The recurrence of KFD was determined based not on repeated pathologic confirmation but on the presence of clinical febrile lymphadenopathy. A total of 33 children with KFD, 26 boys (78.8 %) and 7 girls (21.2 %), with a median age of 12 years (9 months to 19 years), were enrolled. Thirty-one children (93.9 %) complained of fever, and most of the children (90.9 %) complained of cervical lymphadenopathy. Neutropenia (<1,500/μL) or lymphopenia (<1,500/μL) was observed in 51.5 %. Lactate dehydrogenase level, erythrocyte sedimentation rate, and C-reactive protein level were elevated in 90.9, 96.9, and 54.5 % of children, respectively. Fourteen children (42.4 %) experienced recurrent KFD, including ten children after biopsy and four children before and after biopsy. In a multivariate analysis, a past history of other systemic illnesses (p = 0.013) and a higher absolute lymphocyte count (p = 0.023) were significantly associated with recurrent KFD. These systemic illnesses were chronic idiopathic thrombocytopenic purpura, autoimmune thyroiditis, nephrotic syndrome, perinatal cytomegalovirus infection, and hemophagocytic lymphohistiocytosis. CONCLUSION Our results suggest that recurrent KFD is more frequent than reported, and recurrent KFD should be considered in children with a history of other systemic illnesses such as immune disorders.
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Affiliation(s)
- In Hyuk Yoo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
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Thomson-Glover R, Lawton M, Menon G. Kikuchi-Fujimoto Disease: part of the differential diagnosis of cervical lymphadenopathy in an HIV-positive patient. Int J STD AIDS 2014; 26:602-4. [PMID: 25080288 DOI: 10.1177/0956462414545793] [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] [Received: 03/23/2014] [Accepted: 07/07/2014] [Indexed: 11/16/2022]
Abstract
A 38-year-old HIV-positive Nigerian woman presented with a three-week history of cervical lymphadenopathy, night sweats, weight loss and fever. Provisional diagnoses of tuberculosis and lymphoma were considered; however, a histological diagnosis of Kikuchi-Fujimoto Disease was reached. This rare benign disease has presenting features that mimic more serious conditions commonly occurring in HIV-positive patients. This case report emphasises the importance of Kikuchi-Fujimoto Disease in the differential diagnosis of cervical lymphadenopathy in HIV-positive patients.
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Affiliation(s)
- R Thomson-Glover
- Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
| | - M Lawton
- Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
| | - G Menon
- Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
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Kanno K, Minami-Hori M, Ishida-Yamamoto A, Komura K, Oikawa K, Miyokawa N, Iizuka H. Cutaneous lesions of Kikuchi's disease: Evolution of histopathological findings. J Dermatol 2014; 41:736-8. [DOI: 10.1111/1346-8138.12557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Kyoko Kanno
- Department of Dermatology; Asahikawa Medical University; Asahikawa Japan
| | - Masako Minami-Hori
- Department of Dermatology; Asahikawa Medical University; Asahikawa Japan
| | | | - Keiji Komura
- Department of Internal Medicine; Asahikawa Medical University; Asahikawa Japan
| | - Kensuke Oikawa
- Department of Pathology; Asahikawa Medical University; Asahikawa Japan
| | - Naoyuki Miyokawa
- Department of Pathology; Asahikawa Medical University; Asahikawa Japan
| | - Hajime Iizuka
- Department of Dermatology; Asahikawa Medical University; Asahikawa Japan
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Characteristics of Kikuchi-Fujimoto disease in children compared with adults. Eur J Pediatr 2014; 173:111-6. [PMID: 23955486 DOI: 10.1007/s00431-013-2131-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign, self-limiting disease characterized by cervical lymphadenopathy. Although it was primarily thought to be a disease of young adults, it has been increasingly recognized in children. To define the characteristics of KFD in children, we reviewed the medical records of patients younger than 18 years of age who were diagnosed with KFD from 2001 to 2012 at Korea University Medical Center, as well as worldwide published reports of KFD. A total of 140 pediatric patients and 733 patients of all ages was analyzed. Compared to the female predominance found in adults (2:1), young boys were more commonly affected than young girls (1.4:1). Cervical lymphadenopathy was the most common clinical finding in children, as it was in adults. Lymphadenopathy was more likely to be tender (69 vs. 44 %, p < 0.001) but less generalized (1 vs. 8 %, p < 0.05) in children compared to adults. Fever (82 vs. 35 %, p < 0.001) and rash (10 vs. 4 %, p < 0.05) were observed in children more commonly than in adults. Leukopenia was observed in 50 and 38 % of children and adults, respectively. Rates of recurrence and association with autoimmune diseases in children were comparable to those of adults. Cervical lymphadenopathy was the most common clinical manifestation of KFD in all ages. While fever and rash were more common in children with KFD compared to adults, generalized lymphadenopathy was rarer.
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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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Go EJ, Jung YJ, Han SB, Suh BK, Kang JH. A case of Kikuchi-Fujimoto disease with autoimmune thyroiditis. KOREAN JOURNAL OF PEDIATRICS 2012; 55:445-8. [PMID: 23227065 PMCID: PMC3510275 DOI: 10.3345/kjp.2012.55.11.445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/19/2012] [Accepted: 07/23/2012] [Indexed: 11/27/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign self-limiting disease characterized by fever and lymphadenitis. The etiology and pathogenesis of KFD is unclear. However, two hypotheses have been suggested: a viral infection hypothesis and an autoimmune hypothesis. Several KFD patients with various types of autoimmune diseases have been reported, and these reports support the hypothesis for autoimmune pathogenesis of KFD. Here, we report the case of a 17-year-old female patient diagnosed with KFD and autoimmune thyroiditis. This case serves as additional evidence that the etiology of KFD is autoimmune origin.
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Affiliation(s)
- Eun Ji Go
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
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Hashimoto's Thyroiditis and Kikuchi's Disease: Presentation of a Case and Review of the Literature. Case Rep Otolaryngol 2012; 2012:267595. [PMID: 23227401 PMCID: PMC3514797 DOI: 10.1155/2012/267595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/05/2012] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 19-year-old woman with a history of Hashimoto's thyroiditis who presented with tender right anterior cervical lymphadenopathy and fever. Workup for infectious, autoimmune, and malignant causes was unremarkable. Surgical removal of cervical lymph nodes after detailed magnetic resonance (MR) imaging disclosed necrotizing lymphadenitis, also known as Kikuchi's disease (KD). The patient was treated with a short-term course of steroids, due to the onset of pancytopenia and borderline antiphospholipid antibodies combined with increased anti-thyroglobulin (anti-TG) titers. Despite being a diagnosis of exclusion, KD should be included in the differential of such patients, particularly in cases of previous or concurrent autoimmune diseases such as Hashimoto's thyroiditis, which necessitate a long-term follow-up.
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Bogusz AM, Bhargava P. Recurrent histiocytic necrotizing lymphadenitis with a long latency in a patient with autoimmunity: a case report and review of literature. Int J Surg Pathol 2012. [PMID: 23204033 DOI: 10.1177/1066896912467369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Kikuchi-Fujimoto disease (KFD), a histiocytic necrotizing lymphadenitis (HNL), characteristically presents as cervical lymphadenopathy in young Asian women. Most resolve spontaneously with rare recurrences described. We report a patient with biopsy-proven recurrence of KFD-like HNL after almost 8 years and analyze 65 additional published cases with recurrences. While those with recurrences similarly affect young (average age = 27 years), Asian (80%) women (76%), 73% had multiple sites of involvement and 32% of those tested had underlying autoimmune conditions. Our case is unusual with respect to the following: (a) Age: 50 years, the oldest among the reported patients with recurrences. (b) Race: African descent, with only 3 others reported with recurrent HNL. Of these 4 cases, 2 had underlying autoimmunity. (c) Underlying condition: Her clinical and laboratory features were best felt to represent Sjögren's syndrome (SjS). Only 2 other cases of SjS-associated HNL have been reported; in 2 recently reported cases SjS developed subsequently.
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Affiliation(s)
- Agata M Bogusz
- Department of Pathology, Division of Hematopathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, USA
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