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Apandi A, Wan Mansor WN, Musa Z, Mohd Ali NA. Multiple Painless Cervical Lymphadenopathies Misleading the Diagnosis of Kikuchi's Disease. Cureus 2024; 16:e58151. [PMID: 38741836 PMCID: PMC11089079 DOI: 10.7759/cureus.58151] [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: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Kikuchi's disease is an unusual and self-limited disease. It manifests as a painful cervical lymphadenopathy and is associated with a low-grade fever and night sweats. Recently, this disease has been reported worldwide, compared to its initial high prevalence among the Japanese population. The etiologies of Kikuchi's disease are still unknown, but it has been proposed to have either infectious or immunological causes. We report the atypical presentation of a young male with Kikuchi's disease. A 22-year-old male presented with a prolonged fever for a week, which was associated with bilateral neck swelling that was painless and gradually increased in size. In our case, histopathological examination of the left cervical lymph node revealed histiocytic necrotizing lymphadenitis in favor of Kikuchi's disease. This case report will highlight the atypical clinical presentation of this patient, thereby increasing awareness of the disease's future manifestation.
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Affiliation(s)
- Afena Apandi
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Otorhinolaryngology, Head & Neck Surgery, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, MYS
| | - Wan Nabila Wan Mansor
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Otorhinolaryngology, Head & Neck Surgery, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, MYS
| | - Zalilah Musa
- Department of Otorhinolaryngology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, MYS
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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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Jung HJ, Lee IJ, Yoon SH. Risk Assessment of Recurrence and Autoimmune Disorders in Kikuchi Disease. Risk Manag Healthc Policy 2020; 13:1687-1693. [PMID: 33061702 PMCID: PMC7519817 DOI: 10.2147/rmhp.s271283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Kikuchi disease (KD) is typically a benign disease. Recent studies reporting recurrence or serious cases suggest a possible association of KD with systemic autoimmune disorders. We performed a long-term analysis of the characteristics of KD in patients of all ages and assessed KD recurrence or progress to systemic autoimmune disorders. Patients and Methods Electronic medical records of patients diagnosed with KD between April 1995 and May 2017 were reviewed for clinical and laboratory manifestations. Results In total, 480 patients were confirmed to have KD based on histopathology findings. The mean age at KD diagnosis was 24.4 years. Recurrence occurred in 11.3% of patients; 2.7% developed autoimmune diseases after KD diagnosis. Patients who experienced recurrence had more extranodal symptoms, lymphopenia, and a longer lymphopenia-recovery duration. Patients who developed autoimmune diseases after KD were more likely to have extranodal symptoms, KD recurrence, and anti-nuclear antibody positivity. Conclusion KD patients with risk factors need to be followed-up for KD recurrence and the development of systemic autoimmune diseases.
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Affiliation(s)
- Hyun Joo Jung
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, South Korea
| | - Il Jae Lee
- Department of Plastic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, South Korea
| | - Seung-Hyun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, South Korea
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Kim L, Tatarina-Numlan O, Yin YD, John M, Sundaram R. A Case of Kikuchi-Fujimoto Disease in a 7-Year-Old African American Patient: A Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922784. [PMID: 32830793 PMCID: PMC7476743 DOI: 10.12659/ajcr.922784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Patient: Female, 7-year-old Final Diagnosis: Kikuchi-Fujimoto lymphadenitis Symptoms: Lymphadenopathy Medication:— Clinical Procedure: Biopsy Specialty: Immunology • Rheumatology
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Affiliation(s)
- Liyoung Kim
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Oksana Tatarina-Numlan
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Yongmei D Yin
- Department of Pathology and Laboratory Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Minnie John
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Revathy Sundaram
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Hwang JH, Yoo WH, An AR, Choi YJ. Coexistence of systemic lupus erythematosus with Kikuchi-Fujimoto disease involving the salivary gland, initially disguised as lymphoma. Rheumatology (Oxford) 2019; 58:550-553. [PMID: 30521051 DOI: 10.1093/rheumatology/key353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jeong-Hwan Hwang
- Division of Infectious Disease, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Wan-Hee Yoo
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Ae-Ri An
- Department of Pathology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yun-Jung Choi
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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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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Maruyama T, Nishihara K, Saio M, Nakasone T, Nimura F, Matayoshi A, Goto T, Yoshimi N, Arasaki A. Kikuchi-Fujimoto disease in the regional lymph nodes with node metastasis in a patient with tongue cancer: A case report and literature review. Oncol Lett 2017; 14:257-263. [PMID: 28693162 PMCID: PMC5494837 DOI: 10.3892/ol.2017.6139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 03/09/2017] [Indexed: 02/05/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare self-limiting disorder typically affecting the cervical lymph nodes (LNs), which is often misdiagnosed as other LN-associated diseases. KFD frequently presents with necrotic lesions and recurrences, which are also features of metastatic LNs. Clinicians may thus suspect LN metastasis when they encounter ipsilateral cervical lymphadenopathy in a patient with head and neck cancer. The present study reports the case of a 48-year-old man with tongue cancer and KFD affecting the right edge of his tongue and ipsilateral cervical LNs. LN metastasis was initially suspected, but pathological examination of the dissected LNs revealed one necrotic metastatic lesion and two necrotic KFD lesions. Ipsilateral cervical lymphadenopathy recurred 6 years after the initial surgery, and it was not possible to differentiate clinically between a second primary tumor and recurrent KFD prior to treatment. To the best of our knowledge, this is the first reported case of simultaneous tongue cancer, regional LN metastasis and KFD. This highlights the requirement to consider KFD in the event of LNs with necrotic lesions but no cancerous cells. A combination of clinical and pathological approaches may aid in the diagnosis of KFD, in addition to ruling out LN metastasis in initial and recurrent lymphadenopathies. The present study indicate that a diagnosis of KFD should be considered in patients with head and neck cancer that exhibit necrotic LNs lacking cancerous cells. This is important, as misdiagnosis of KFD as LN metastasis may lead to unnecessary adjuvant therapy.
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Affiliation(s)
- Tessho Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, Ryukyu University Hospital, Nishihara, Okinawa 903-0215, Japan
| | - Kazuhide Nishihara
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, Ryukyu University Hospital, Nishihara, Okinawa 903-0215, Japan
| | - Masanao Saio
- Department of Pathology, Ryukyu University Hospital, Nishihara, Okinawa 903-0215, Japan
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, Ryukyu University Hospital, Nishihara, Okinawa 903-0215, Japan
| | - Fumikazu Nimura
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Matayoshi
- Department of Oral and Maxillofacial Surgery, Ryukyu University Hospital, Nishihara, Okinawa 903-0215, Japan
| | - Takahiro Goto
- Department of Oral and Maxillofacial Surgery, Ryukyu University Hospital, Nishihara, Okinawa 903-0215, Japan
| | - Naoki Yoshimi
- Department of Pathology, Ryukyu University Hospital, Nishihara, Okinawa 903-0215, Japan
| | - Akira Arasaki
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, Ryukyu University Hospital, Nishihara, Okinawa 903-0215, Japan
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Jung IY, Ann HW, Kim JJ, Lee SJ, Kim J, Seong H, Oh DH, Kim YC, Kim EJ, Jeong SJ, Ku NS, Choi JY, Song YG, Kim JM. The incidence and clinical characteristics by gender differences in patients with Kikuchi-Fujimoto disease. Medicine (Baltimore) 2017; 96:e6332. [PMID: 28296758 PMCID: PMC5369913 DOI: 10.1097/md.0000000000006332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting disorder that typically affects the cervical lymph nodes (LNs). Although initially described in young women, KFD also occurs in men. There are no reports on the clinical manifestations and characteristics of male KFD patients. Therefore, this study was conducted to assess the incidence of KFD among males, as well as the most frequent clinical characteristics of these patients. A retrospective, cross-sectional study was performed at a tertiary hospital of patients pathologically confirmed as having KFD from LN biopsy specimens. Clinical and laboratory data, and treatment outcomes of the enrolled patients, were analyzed by gender. A total of 254 patients diagnosed with KFD were enrolled. There were 189 females and 65 males (2.9:1). The mean age was 32.6 ± 11.3 years. Compared to the female patients, the males had more frequent manifestations of fever (48% vs 67%, P = 0.008), headache (9% vs 20%, P = 0.013), bilateral lymphadenopathy (31% vs 46%, P = 0.029), thrombocytopenia (14% vs 29%, P = 0.014), elevated C-reactive protein (CRP) (35% vs 78.4%, P < 0.001), elevated liver enzymes (15% vs 41%, P < 0.001), and elevated lactate dehydrogenase (LDH) (61% vs 80%, P = 0.021). Male patients had fewer autoimmune features (9% vs 2%, P = 0.043) and fewer positive antinuclear antibodies (32% vs 10%, P = 0.006). In this study, 25.6% of the enrolled patients were male, with a 2.9:1 female-to-male sex ratio. Male patients showed a distinctive profile characterized by a higher frequency of fever, headache, bilateral lymphadenopathy, and thrombocytopenia, as well as elevated liver enzymes, CRP, and LDH.
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Affiliation(s)
- In Young Jung
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hea Won Ann
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Ju Kim
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Ju Lee
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinnam Kim
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Seong
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Oh
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Chan Kim
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Jin Kim
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Jeong
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Su Ku
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Yong Choi
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Goo Song
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - June Myung Kim
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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DOENÇA DE KIKUCHI‐FUJIMOTO REFRATÁRIA: RELATO DE CASO. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Aneja A, Maheswari K U, H J GD, Sheikh S. A rare case of multifocal lymphadenopathy in a young male. Oxf Med Case Reports 2015; 2014:141-4. [PMID: 25988059 PMCID: PMC4369995 DOI: 10.1093/omcr/omu054] [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: 07/31/2014] [Revised: 10/08/2014] [Accepted: 10/19/2014] [Indexed: 11/12/2022] Open
Abstract
Lymphadenopathy can be caused by localized and systemic diseases. While viral and bacterial infections commonly cause lymphadenitis in young adults, tuberculosis (TB) is a common cause for lymphadenopathy in endemic areas. Besides, lymphadenopathy may be a presenting manifestation of malignancy, systemic disorders and some rare diseases. Thus, relevant evaluation and exclusion of commoner causes is important to clinch the diagnosis. Histopathological examination is mandatory in such patients. We hereby report the case of a young adult male who presented with low-grade fever and abdominal pain with cervical and mesenteric lymphadenopathy in a TB endemic region, but was proved to have atypical presentation of Kikuchi–Fujimoto disease, which is a rare but benign cause of lymphadenopathy.
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Affiliation(s)
- Anshum Aneja
- Department of Respiratory Medicine , M.S. Ramaiah Medical College , Bangalore, Karnataka , India
| | - Uma Maheswari K
- Department of Respiratory Medicine , M.S. Ramaiah Medical College , Bangalore, Karnataka , India
| | - Gayathri Devi H J
- Department of Respiratory Medicine , M.S. Ramaiah Medical College , Bangalore, Karnataka , India
| | - Shamim Sheikh
- Department of Pathology , M.S. Ramaiah Medical College , Bangalore, Karnataka , India
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