1
|
Ichikawa G, Negishi Y, Chishima F, Suzuki S. Kikuchi-Fujimoto disease during early pregnancy. J Obstet Gynaecol Res 2024; 50:1056-1060. [PMID: 38511280 DOI: 10.1111/jog.15928] [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: 08/06/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Kikuchi-Fujimoto disease (KFD) is rare during pregnancy. It is characterized by necrotizing lymphadenitis and often occurs in young Asian women. We report a case of KFD during pregnancy, which was difficult to diagnose. A 37-year-old pregnant female (gestational week [GW] 7+5) was admitted to our hospital because of hyperemesis gravidarum. On the eighth day of hospitalization (GW 8+6), she suddenly developed a fever (38.0°C) with skin rash and posterior pharynx redness. Blood tests showed pancytopenia and abnormal liver function. The patient was misdiagnosed with severe Epstein-Barr virus infection and administered with prednisolone. Subsequently, cervical lymphadenopathy was observed, and biopsy results led to the diagnosis of KFD. Thereafter, her symptoms improved, and she was discharged at GW 13+4. KFD must be included as a differential diagnosis for patients with fever, abnormal liver function, and pancytopenia during pregnancy.
Collapse
Affiliation(s)
- Go Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
- Department of Obstetrics and Gynecology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Yasuyuki Negishi
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan
| | - Fumihisa Chishima
- Department of Obstetrics and Gynecology, Kawaguchi Municipal Medical Center, Saitama, Japan
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
2
|
Nga ME. Pitfalls in Lymph Node Fine Needle Aspiration Cytology. Acta Cytol 2023; 68:260-280. [PMID: 38118434 PMCID: PMC11305520 DOI: 10.1159/000535906] [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: 08/28/2023] [Accepted: 12/16/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is an accurate, minimally invasive, and cost-effective biopsy method for enlarged lymph nodes. While the role of lymph node FNAC in the diagnosis of infectious or reactive conditions and metastatic malignancy is unquestioned, differing views still exist on its role in the diagnosis of lymphoma. Nevertheless, regardless of the practice setting, pitfalls and potential for error exist, and it is incumbent upon the pathologist to be aware of these pitfalls, as this is the first line of defence against errors. SUMMARY This discussion will focus on potential interpretational errors, specifically highlighting scenarios leading to false-negative and false-positive diagnosis and errors in tumour classification, with an emphasis on cytomorphology. Potential entities that may fly below the radar of the pathologist - so-called off-radar entities - are also discussed, as a reminder to consider broad differentials in cases with unusual morphologic features. Some reasons for false-negative diagnoses include low-grade lymphomas that mimic a mixed, polymorphous reactive lymphoid population or aspirates with a paucity of lesional cells, through either sampling error or the intrinsic nature of the entity, e.g., nodular lymphocyte predominant Hodgkin lymphoma. Some of the potential causes of false-positive diagnoses that are discussed include viral-associated lymphadenopathy, Kikuchi-Fujimoto lymphadenitis, or benign adnexal lesions mimicking metastatic malignancy. Errors in tumour classification covered include metastatic carcinoma, sarcoma, melanoma, and lymphoma mimicking each other, and Hodgkin lymphoma and its mimics. Finally, less common entities such as follicular dendritic cell sarcoma and others are briefly mentioned, to remind us of conditions that may slip under our diagnostic radar. KEY MESSAGES A systematic review of diagnostic pitfalls and traps is elucidated here, with some tips to avoid these traps. The triple approach to the diagnostic workup is emphasised, which includes rigorous clinicopathologic correlation, attention to cytomorphology, and judicious application of ancillary tests.
Collapse
Affiliation(s)
- Min En Nga
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Chisholm KM, Bohling SD, Tsuchiya KD, Paulson VA. A Malignant Mimicker: Features of Kikuchi-Fujimoto Disease in the Pediatric Population. Pediatr Dev Pathol 2022; 25:538-547. [PMID: 35583198 DOI: 10.1177/10935266221103882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Kikuchi-Fujimoto disease (KFD) is a rare, benign, and self-limited disease that presents with cervical lymphadenopathy and systemic symptoms. Histologic evaluation is often necessary to differentiate KFD from other entities. METHODS Electronic medical records and diagnostic material were reviewed for 14 children diagnosed with KFD and 6 children diagnosed with infectious mononucleosis (IM) from 2013-2021. Four cases of KFD were further characterized using targeted DNA-based next-generation sequencing. RESULTS Systemic symptoms were present in 86% (n = 12/14) of KFD patients, the most common being fever. Laboratory values worrisome for malignancy included cytopenia(s) (n = 9/12), elevated ESR and/or CRP (n = 9/12), elevated ferritin (n = 7/7), and elevated LDH (n = 7/10). Histologically, lymph nodes showed characteristic necrotic foci without neutrophils surrounded by MPO+ "crescentic" histiocytes. Immunoblasts and CD123+ plasmacytoid dendritic cells (pDCs) were also increased surrounding the necrosis. IM lymph nodes showed similar features when necrosis was present but increases in pDCs were patchy and rare neutrophils were seen in the necrotic foci. Molecular analysis of 4 KFD cases did not identify pathogenic variants. CONCLUSION While the signs/symptoms of KFD are worrisome, there are pathologic features that help differentiate it from potential mimics. We did not identify characteristic molecular features to aid in the work-up of these cases.
Collapse
Affiliation(s)
- Karen M Chisholm
- Department of Laboratories, 7274Seattle Children's Hospital, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Sandra D Bohling
- Department of Laboratories, 7274Seattle Children's Hospital, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Karen D Tsuchiya
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Vera A Paulson
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| |
Collapse
|
6
|
Goel S, Gupta A, Sen K, Swami P. Kikuchi Necrotising Lymphadenitis in a Child: A Rare Case Report. DUBAI MEDICAL JOURNAL 2020. [DOI: 10.1159/000509835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Kikuchi-Fujimoto disease (KFD) is a rare benign disease with a self-limiting course. Patients usually present with clinical features of tender cervical lymphadenopathy (LAP), fever, malaise, weight loss, and night sweats. The disease may mimic infective LAP or lymphoma on clinical and histopathological examination (HPE). <b><i>Case Report:</i></b> We report a case of 3-year-old male child who presented to us with bilateral cervical LAP not responding to conservative management. Excision biopsy was done and HPE revealed KFD. <b><i>Conclusion:</i></b> Clinicians should have high index of suspicion for diagnosis of KFD in patients with cervical LAP not responding to conservative management. Excision biopsy is important for accurate diagnosis and to avoid aggressive interventions like chemotherapy.
Collapse
|
7
|
Sukswai N, Jung HR, Amr SS, Ng SB, Sheikh SS, Lyapichev K, El Hussein S, Loghavi S, Agbay RLMC, Miranda RN, Medeiros LJ, Khoury JD. Immunopathology of Kikuchi-Fujimoto disease: A reappraisal using novel immunohistochemistry markers. Histopathology 2020; 77:262-274. [PMID: 31854007 DOI: 10.1111/his.14050] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
AIMS Kikuchi-Fujimoto disease (KFD) is a self-limited disease characterised by destruction of the lymph node parenchyma. Few studies have assessed the immunohistological features of KFD, and most employed limited antibody panels that lacked many of the novel immunohistochemistry markers currently available. METHODS AND RESULTS We used immunohistochemistry to reappraise the microanatomical distribution of plasmacytoid dendritic cells (pDCs), follicular helper T cells and cytotoxic T cells, B cells, follicular dendritic cell (FDC) meshworks, and histiocytes in lymph nodes involved by KFD. The study group consisted of 138 KFD patients (89 women; 64.5%) with a median age of 27 years (range, 3-50 years). Cervical lymph nodes were most commonly involved, in 108 (78.3%) patients. The numbers of pDCs were increased, predominantly around and within apoptotic areas and the paracortex, and tapering off within xanthomatous areas. pDCs formed sizeable tight clusters, most notably around apoptotic/necrotic areas. T cells consisted mostly of CD8-positive cells with predominant expression of T-cell receptor-β. There were notable increases in the numbers of CD8-positive T cells within lymphoid follicles, and their numbers correlated with alterations in FDC meshworks (P < 0.001). The number of follicular helper T cells was decreased within distorted FDC meshworks. CD21 highlighted frequent distortion of FDC meshworks, even in lymph node tissue that was distant from apoptotic/necrotic areas. Distorted FDC meshworks spanned all morphological patterns, and FDC meshwork characteristics (intact; distorted; remnant/nearly absent) correlated with morphological patterns (P < 0.01). CONCLUSIONS The immunohistological landscape of KFD is complex and characterised by increased numbers of pDCs that frequently cluster around apoptotic/necrotic foci, increased numbers of cytotoxic T cells, and substantial distortion of FDC meshworks.
Collapse
Affiliation(s)
- Narittee Sukswai
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TV, USA
- Department of Pathology, Chulalongkorn University, Bangkok, Thailand
| | - Hye Ra Jung
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TV, USA
- Department of Pathology, Keimyung University, Dongsan Medical Center, Seoul, South Korea
| | - Samir S Amr
- Department of Pathology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Siok Bian Ng
- Department of Pathology, National University Hospital, Singapore
| | - Salwa S Sheikh
- Department of Pathology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Kirill Lyapichev
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TV, USA
| | - Siba El Hussein
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TV, USA
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TV, USA
| | - Rose Lou Marie C Agbay
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TV, USA
- Department of Pathology, The Medical City Hospital, Manila, Philippines
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TV, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TV, USA
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TV, USA
| |
Collapse
|
8
|
Xu S, Sun W, Liu J. Kikuchi-Fujimoto disease: a case report and the evaluation of diagnostic procedures. BMC Oral Health 2019; 19:223. [PMID: 31638953 PMCID: PMC6805530 DOI: 10.1186/s12903-019-0920-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease, known as histiocytic necrotizing lymphadenitis, is a benign, self-limiting and systemic disorder involving lymph nodes with unknown aetiology. First reported in Japan, there has been an increase in its incidence globally. Because of its non-specific clinical features, the disease can be easily mistaken for other forms of lymphadenitis with a high rate of misdiagnosis and mistreatment, posing a considerable challenge. CASE PRESENTATION A case of young Chinese woman with fever and cervical lymphadenopathy is presented. Physical examinations and imaging techniques were used to rule out common forms of lymphadenitis (e.g. cat-scratch disease and tuberculous lymphadenitis). Laboratory tests were then conducted to exclude others such as systemic lupus erythematosus and non-Hodgkin lymphoma. After Kikuchi-Fujimoto disease was identified, the patient was managed with symptomatic treatments. Our case was compared with relevant cases in the literature. A diagnostic flow chart was proposed to facilitate the diagnosis and treatment. CONCLUSIONS With its shared clinical features, Kikuchi-Fujimoto disease can be mistaken for other forms of lymphadenitis. A combined use of medical imaging and laboratory tests is the effective way to avoid misdiagnosis.
Collapse
Affiliation(s)
- Shenjie Xu
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, People's Republic of China.
| | - Weilian Sun
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, People's Republic of China
| | - Jiamei Liu
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, People's Republic of China
| |
Collapse
|
9
|
Chen LC, Wang CJ, Chang YC, Shie SS, Lin TY, Hsieh YC, Arthur Huang KY, Kuo CY, Chiu CH, Huang YC, Chen CJ. Distribution of lymphadenopathy in patients with Kikuchi disease. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 54:299-304. [PMID: 31615722 DOI: 10.1016/j.jmii.2019.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/17/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cervical lymphadenopathy is among the cardinal manifestations of Kikuchi disease (KD). The incidences and locations of extra-cervical lymph nodes (LNs) involvement in KD have not been comprehensively reported. METHODS From 2003 to 2016, 60 patients with pathologically confirmed KD and with computed tomography and/or whole-body inflammation scans at diagnosis were retrospectively identified. The locations, sizes and characteristics of all affected LNs were analyzed by extensive review of the image studies. The clinical and laboratory parameters were abstracted from medical records and the associations with extra-cervical LNs involvement were identified. RESULTS Female accounted for 35 (58.3%) patients and the median age of all patients was 21.3 years (ranges, 3-64 years). Of 59 patients with evaluable neck images, 42 (71.2%) and 16 (27.1%) patients presented with unilateral and bilateral nodal involvement, respectively, with the most common locations at level II, III and IV by Som's classification. The largest LNs appeared most commonly in level II. The incidences of extra-cervical lymphadenopathy in abdomen, pelvis, inguina, axilla and mediastinum with available images were respectively 52.9% (9/17), 47.1% (8/17), 41.2% (7/17), 30.6% (11/36) and 14.3% (8/56). When compared to cases with solitary cervical lymphadenopathy, the cases with extra-cervical lymphadenopathy had significantly greater incidences of bilateral cervical lymphadenopathy (P = .0379) and leukopenia (P = .0173). CONCLUSION Unilateral cervical lymphadenopathy was the most frequent form of LNs involvement of KD. Extra-cervical lymphadenopathy was not uncommon and was associated with the appearance of bilateral distribution of cervical LNs and leukopenia.
Collapse
Affiliation(s)
- Lung-Chiung Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; Department of Pediatrics, Taoyuan Armed Forces General Hospital, 325 Taoyuan, Taiwan
| | - Chao-Jan Wang
- Department of Radiology, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan
| | - Yu-Chuan Chang
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, Chang Gung University, 333 Taoyuan, Taiwan
| | - Shian-Sen Shie
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Tzou-Yien Lin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Yu-Chia Hsieh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Kuan-Ying Arthur Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Chen-Yen Kuo
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan.
| |
Collapse
|
10
|
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare entity characterized by subacute necrotizing lymphadenopathy and frequently associated with fever. Young adults of Asian ancestry are most commonly affected, but it has been reported worldwide. Despite many studies in the literature, the cause of KFD remains uncertain. Histologically, KFD is characterized by paracortical lymph node expansion with patchy, well-circumscribed areas of necrosis showing abundant karyorrhectic nuclear debris and absence of neutrophils and eosinophils. Three evolving histologic patterns-proliferative, necrotizing, and xanthomatous-have been recognized. By immunohistochemistry, histiocytes in KFD are positive for myeloperoxidase. There is a marked predominance of T cells in the lesions (with mostly CD8-positive cells) with very few B cells. The differential diagnosis of KFD includes infectious lymphadenitis, autoimmune lymphadenopathy (primarily systemic lupus erythematosus), and lymphoma. Clinicians and pathologists are poorly familiar with this entity, which frequently causes significant diagnostic challenges.
Collapse
Affiliation(s)
| | - Sarah M Choi
- From the Section of Hematopathology, Department of Pathology, University of Michigan, Ann Arbor
| |
Collapse
|
11
|
Salamat S, Chan J, Jolly K, Powell G, Harrison K, Ahanger S, Hari C. Kikuchi-Fujimoto Disease and Prognostic Implications. Head Neck Pathol 2019; 14:272-275. [PMID: 30888636 PMCID: PMC7021859 DOI: 10.1007/s12105-019-01026-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/02/2019] [Indexed: 12/19/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenitis seen mostly in Asian populations (Kikuchi in Nippon Ketsueki Gakkai Zasshi 35:379-80, 1972). First described in 1972, KFD is a benign and self-limiting disease characterised by lymphadenopathy, mild fever, fatigue, and leukopenia (Fujimoto in Naika 30:920-7, 1972; Lin et al. in Otolaryngol Head Neck Surg 128(5): 650-3, 2003). We present a case of a 38-year-old woman with a 6-week history of cervical lymphadenopathy. Her ultrasound scan and fine needle aspiration cytology results were inconclusive. Excisional biopsy of the lymph node confirmed presence of KFD. The aetiology of KFD is unknown; however, there is strong association with systemic lupus erythematosus (SLE). Kucukardali reported 9% of European KFD patients and 28% of East Asian patients had concomitant SLE (Kucukardali et al. in Clin Rheumatol 26(1):50-4, 2007). We describe a follow-up algorithm for newly diagnosed KFD cases, based on the current literature. KFD is a rare cause of cervical lymphadenopathy. It is associated with increased risk of developing SLE, therefore early diagnosis and long-term follow-up are recommended.
Collapse
Affiliation(s)
- Sebastian Salamat
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
| | - Jacquline Chan
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
| | - Karan Jolly
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
| | - George Powell
- Department of Pathology, Shrewsbury and Telford NHS Trust, Telford, Shropshire UK
| | - Katherine Harrison
- Department of Pathology, Shrewsbury and Telford NHS Trust, Telford, Shropshire UK
| | - Sajad Ahanger
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
| | - Churunal Hari
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
| |
Collapse
|
12
|
Joean O, Thiele T, Raap M, Schmidt RE, Stoll M. Take a second look: it's Kikuchi's disease! A case report and review of literature. Clin Pract 2018; 8:1095. [PMID: 30631410 PMCID: PMC6297864 DOI: 10.4081/cp.2018.1095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 12/05/2018] [Indexed: 12/02/2022] Open
Abstract
Generalized lymphadenopathy is a common cause of concern for both patients and clinicians. Possible etiologies include infections, malignancies and autoimmune diseases. Kikuchi Fujimoto disease (KFD) is a hyperergic condition that presents with fever, lymphadenopathy and can include systemic involvement, thus being easily mistaken for the above-mentioned entities. We report the case of a previously healthy 18- year old male who presented with a selflimiting generalized lymphadenopathy, high fevers, skin vasculitis and polyserositis. The lymph-node biopsy revealed a histiocytotic necrotizing lymphadenitis, suggestive of Kikuchi’s disease. This case emphasizes the importance of KFD in the differential diagnosis of lymphadenopathy, especially in young adults.
Collapse
Affiliation(s)
- Oana Joean
- Department of Immunology and Rheumatology
| | | | - Mieke Raap
- Department of Pathology, Hannover Medical University, Hannover, Germany
| | | | | |
Collapse
|
13
|
Zuckerman R, Damiani L, Ayyad HA, Alpert DR. Persistent cervical lymphadenitis in a patient with prior thyroid cancer attributed to Kikuchi-Fujimoto disease. BMJ Case Rep 2018; 2018:bcr-2018-226457. [PMID: 30344150 DOI: 10.1136/bcr-2018-226457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We describe a 50-year-old woman with a history of thyroid cancer who presented with bilateral cervical and submandibular lymphadenopathy, low-grade fevers, and increasing fatigue. The patient underwent lymph node fine-needle aspiration, which showed no evidence of metastatic or lymphoproliferative disease. This procedure was complicated by a parapharyngeal abscess and cellulitis. She was treated unsuccessfully with various courses of antibiotics, but briefly responded to short courses of steroids. As her cervical lymphadenopathy returned, she underwent an excisional lymph node biopsy, which demonstrated caseating granulomatous lymphadenitis. Extensive review of systems, physical examination, laboratory and imaging studies demonstrated no evidence of malignancy, infection or systemic lupus erythematosus . Our patient was clinically diagnosed with Kikuchi-Fujimoto disease and successfully treated with prednisone tapered over 3 months. She remains in clinical remission.
Collapse
Affiliation(s)
- Roman Zuckerman
- Rheumatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Louise Damiani
- Medicine/Oncology, Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Hashem A Ayyad
- Pathology, Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Deborah R Alpert
- Medicine/Rheumatology, Jersey Shore University Medical Center, Neptune, New Jersey, USA
| |
Collapse
|
14
|
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]
|
15
|
Mathew LM, Kapila R, Schwartz RA. Kikuchi-Fujimoto disease: a diagnostic dilemma. Int J Dermatol 2016; 55:1069-75. [PMID: 27207311 DOI: 10.1111/ijd.13314] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/08/2015] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
Abstract
Kikuchi-Fujimoto disease is a benign, self-limiting condition characterized by lymphadenopathy and fever. Its diagnosis can be challenging, as the disease must be differentiated from lymphoma and systemic lupus erythematosus. Patients can present with nonspecific cutaneous lesions. Adequate clinical and histopathologic correlation can aid in the timely diagnosis of Kikuchi's disease, thus preventing the use of unnecessary diagnostic procedures and inappropriate treatments.
Collapse
Affiliation(s)
- Laju M Mathew
- Dermatology, Rutgers New Jersey Medical School and Rutgers University School of Public Affairs and Administration, Newark, NJ, USA
| | - Rajendra Kapila
- Infectious Diseases, Rutgers New Jersey Medical School and Rutgers University School of Public Affairs and Administration, Newark, NJ, USA.,Medicine, Rutgers New Jersey Medical School and Rutgers University School of Public Affairs and Administration, Newark, NJ, USA
| | - Robert A Schwartz
- Dermatology, Rutgers New Jersey Medical School and Rutgers University School of Public Affairs and Administration, Newark, NJ, USA. .,Medicine, Rutgers New Jersey Medical School and Rutgers University School of Public Affairs and Administration, Newark, NJ, USA. .,Pathology, Rutgers New Jersey Medical School and Rutgers University School of Public Affairs and Administration, Newark, NJ, USA. .,Pediatrics, Rutgers New Jersey Medical School and Rutgers University School of Public Affairs and Administration, Newark, NJ, USA. .,Rutgers New Jersey Medical School and Rutgers University School of Public Affairs and Administration, Newark, NJ, USA.
| |
Collapse
|
16
|
|
17
|
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: 64] [Impact Index Per Article: 7.1] [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.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
The kikuchi-fujimoto disease in Nigeria: a case report and literature review. Case Rep Med 2014; 2014:171029. [PMID: 24872816 PMCID: PMC4020498 DOI: 10.1155/2014/171029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 02/20/2014] [Indexed: 11/17/2022] Open
Abstract
The Kikuchi-Fujimoto is a rare, self-limiting disease, which is characterized by regional lymphadenopathy. It occurs worldwide with a higher prevalence among Asians and women below the age of forty years. We present 41-year-old Nigerian woman who was investigated extensively for unilateral left cervical lymphadenopathy. She was eventually diagnosed as having the Kikuchi-Fujimoto disease and was managed conservatively thereafter. We describe a case report and review of literature for better awareness of the disease amongst medical practitioners and pathologists in Africa.
Collapse
|
20
|
Kikuchi-fujimoto disease: a study of 24 cases. Indian J Otolaryngol Head Neck Surg 2014; 66:69-73. [PMID: 24605305 DOI: 10.1007/s12070-013-0672-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare benign disorder predominantly affecting young adults and has a site predilection for cervical lymph nodes. The objective of this study is to analyze the clinicopathological features of KFD. A retrospective study of 24 cases of KFD presenting at a tertiary care hospital in southern India over a 4 year period is presented here. Clinical findings, histopathological findings and follow up data were reviewed. Of the 24 cases encountered, 17 were females and 7 were males. Painless cervical lymphadenopathy was the most common presenting feature. All cases showed typical morphology of KFD with necrosis, karyorrhectic debris and presence of the typical cell types namely crescentic histiocytes and plasmacytoid monocytes. Of the 19 cases with follow up, all resolved within 1 month. The pathologist should be aware of the typical presentation and morphology of KFD in order to distinguish it from the more common causes of cervical lymphadenopathy like tuberculosis (especially in countries like India) as well lymphomas.
Collapse
|
21
|
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.
Collapse
|
22
|
Ray A, Muse VV, Boyer DF. Case records of the Massachusetts General Hospital. Case 38-2013. A 30-year-old man with fever and lymphadenopathy. N Engl J Med 2013; 369:2333-43. [PMID: 24328468 DOI: 10.1056/nejmcpc1310002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
23
|
Lee SK, Bahn YE, Kim DE. Features of Sequential CT and US-guided Biopsy in Recurrent Kikuchi Disease of the Neck: A Case Report. EAR, NOSE & THROAT JOURNAL 2013. [DOI: 10.1177/014556131309200909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 26-year-old woman presented with recurrent Kikuchi disease 7 years after her initial episode. Computed tomography (CT) and ultrasonography demonstrated enlarged lymph nodes with extensive necrosis at the same site as the initial episode. Cytologic and histologic examinations were not conclusive. CT performed 1 month later demonstrated a complete resolution of the lymphadenopathy, which confirmed the diagnosis of recurrent Kikuchi disease. Care must be taken to avoid misdiagnosis of recurrent Kikuchi disease as tuberculous lymphadenitis.
Collapse
Affiliation(s)
- Sang Kwon Lee
- Department of Radiology Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Young Eun Bahn
- Department of Radiology Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Dong Eun Kim
- Department of Otolaryngology Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| |
Collapse
|
24
|
Guadarrama MBR, Guzmán-Aguilar OD, López-Ugalde AC, Navarro JSA, Cruz-Ortíz H. Kikuchi-Fujimoto Disease Associated to the Epstein-Barr Virus. A Type of Rare Necrotizing Lymphadenitis and Its Differential Diagnosis. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojpathology.2013.34034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
25
|
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.
Collapse
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
| | | |
Collapse
|
26
|
Mahajan T, Merriman RC, Stone MJ. Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis): report of a case with other autoimmune manifestations. Proc (Bayl Univ Med Cent) 2011; 20:149-51. [PMID: 17431451 PMCID: PMC1849878 DOI: 10.1080/08998280.2007.11928275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign and self-limited disease that mainly affects young women. Patients present with localized lymphadenopathy, fever, and leukopenia in up to half of the cases. KFD can occur in association with systemic lupus erythematosus. We present the case of a patient with KFD and systemic lupus erythematosus, as well as relapsing polychondritis. This patient had persistently low C4 complement levels, so she was evaluated for a genetic defect in complement production and was found to have two "null" C4 alleles. We believe that this may have contributed to the development of her diseases.
Collapse
Affiliation(s)
- Tina Mahajan
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
| | | | | |
Collapse
|
27
|
Das DK, Mallik MK, Dashti HAHMGH, Sathar SA, Jaragh M, Junaid TA. Kikuchi-fujimoto disease in fine-needle aspiration smears: A clinico-cytologic study of 76 cases of KFD and 684 cases of reactive hyperplasia of the lymph node. Diagn Cytopathol 2011; 41:288-95. [DOI: 10.1002/dc.21810] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 07/14/2011] [Indexed: 11/11/2022]
|
28
|
Han KM, Go JH, Myong NH, Lee W. Fine Needle Aspiration Cytology of Kikuchi's Lymphadenitis: with Emphasis on Differential Diagnosis with Tuberculosis. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.6.626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kang Min Han
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Jai Hyang Go
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Na Hye Myong
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Wonae Lee
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
29
|
Zhang MJ, Xiao L, Zhu YH, Jiang JJ, Jiang MS, He W. Lymph Node Uptake of 18F-Fluorodeoxyglucose Detected With Positron Emission Tomography/Computed Tomography Mimicking Malignant Lymphoma in a Patient With Kikuchi Disease. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2010; 10:477-9. [DOI: 10.3816/clml.2010.n.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
30
|
Lymphomatoid gastropathy: a distinct clinicopathologic entity of self-limited pseudomalignant NK-cell proliferation. Blood 2010; 116:5631-7. [PMID: 20829373 DOI: 10.1182/blood-2010-06-290650] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Diagnostic errors in distinguishing between malignant and reactive processes can cause serious clinical consequences. We report 10 cases of unrecognized self-limited natural killer-cell proliferation in the stomach, designated as lymphomatoid gastropathy (LyGa). This study included 5 men and 5 women (age, 46-75 years) without any gastric symptoms. Gastroscopy showed elevated lesion(s) (diameter, ∼ 1 cm). Histologically, medium-sized to large atypical cells diffusely infiltrated the lamina propria and, occasionally, the glandular epithelium. The cells were CD2(+/-), sCD3(-), cCD3(+), CD4(-), CD5(-), CD7(+), CD8(-), CD16(-), CD20(-), CD45(+), CD56(+), CD117(-), CD158a(-), CD161(-), T cell-restricted intracellular antigen-1(+), granzyme B(+), perforin(+), Epstein-Barr early RNA(-), T-cell receptor αβ(-), and T-cell receptor γδ(-). Analysis of the 16 specimens biopsied from 10 patients led to a diagnosis of lymphoma or suspected lymphoma in 11 specimens, gastritis for 1 specimen, adenocarcinoma for 1 specimen, and LyGa or suspected LyGa for 3 specimens. Most lesions underwent self-regression. Three cases relapsed, but none of the patients died. According to conventional histopathologic criteria, LyGa is probably diagnosed as lymphoma, especially as extranodal natural killer/T-cell lymphoma, nasal type. However, LyGa is recognized as a pseudomalignant process because of its clinical characteristics. The concept of LyGa should be well recognized.
Collapse
|
31
|
Astudillo L. [Kikuchi-Fujimoto disease]. Rev Med Interne 2010; 31:757-65. [PMID: 20605287 DOI: 10.1016/j.revmed.2010.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 11/07/2009] [Accepted: 01/01/2010] [Indexed: 01/30/2023]
Abstract
Kikuchi-Fujimoto disease is a necrotizing lymphadenitis, involving young patients, predominantly females. Lymphadenopathy is usually localized, particularly in the cervical area, mostly unilateral and tender. Fever is present in one third of cases. Associated skin lesions, arthralgia, myalgia, splenomegaly or hepatomegaly are rare. Laboratory evaluation shows a slight increase of erythrocyte sedimentation rate and leukopenia. Kikuchi-Fujimoto has been reported in association with other diseases, including systemic lupus, Still's disease, hemophagocytosis, pregnancy, other autoimmune diseases, and cancer. A viral or bacterial origin has been suspected but not confirmed. Lymph node biopsy allows the diagnosis and shows necrotizing lymphadenitis with acidophil necrosis, CD68+ histiocyte infiltrate, presence of plasmacytoid monocytes, multiple apoptotic cells (CD8+ T cell) with nuclear dust, immunoblastic reaction and the absence of neutrophils or eosinophils. The disease course is usually spontaneously favourable in few weeks or months, requiring corticosteroids only occasionally.
Collapse
Affiliation(s)
- L Astudillo
- Service de médecine interne, CHU Purpan, Toulouse cedex, France.
| |
Collapse
|
32
|
Hua F, Zhu L. Kikuchi Fujimoto disease associated with cryptogenic organizing pneumonia: case report and literature review. BMC Infect Dis 2010; 10:64. [PMID: 20222953 PMCID: PMC2842275 DOI: 10.1186/1471-2334-10-64] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 03/11/2010] [Indexed: 11/13/2022] Open
Abstract
Background The association of Kikuchi Fujimoto disease (KFD) with cryptogenic organizing pneumonia (COP) is extremely rare. We report a case of simultaneous diagnosis of KFD and COP. Case Presentation A 33-year-old male presented with a 1-month cough illness and fever lasting for 5 days. The chest radiograph revealed double lower lobe infiltrate, which was unresponsive to antibiotics. A cervical lymph node was first found in the development of this disease. Bronchoscopy, bronchoalveolar lavage and lung biopsy established the diagnosis of COP, while a lymph node biopsy was consistent with KFD. The patient improved on steroids. Conclusions KFD and COP are possible part of a disease continuum, rather than separate entities.
Collapse
Affiliation(s)
- Feng Hua
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032, PR China.
| | | |
Collapse
|
33
|
Abstract
Kikuchi-Fujimoto disease, or histiocytic necrotizing lymphadenitis, is a self-limited condition, characterized by benign lymphadenopathy with associated fevers and systemic symptoms. It most commonly affects adults younger than 40 years of age and of Asian descent. Involved lymph nodes demonstrate paracortical areas of apoptotic necrosis with abundant karyorrhectic debris and a proliferation of histiocytes, plasmacytoid dendritic cells, and CD8(+) T cells in the absence of neutrophils. Kikuchi-Fujimoto disease is thought to have 3 evolving phases: proliferative, necrotizing, and xanthomatous. The etiology is unknown, although viruses and autoimmune mechanisms have been proposed. No specific laboratory tests contribute to the diagnosis. Diagnosis requires histopathologic examination and exclusion of other factors by ancillary studies. Non-Hodgkin lymphoma and systemic lupus erythematosus should be ruled out before diagnosis of Kikuchi-Fujimoto disease, given the overlapped clinical and histologic features as well as the different therapeutic approaches. Treatment involves supportive measures, and the symptoms usually resolve spontaneously within 4 months.
Collapse
Affiliation(s)
- Charles Blake Hutchinson
- Department of Pathology, Duke University Medical Center, 1 Trent Dr, Box 3712, Durham, NC 27710, USA.
| | | |
Collapse
|
34
|
Kikuchi-fujimoto disease in a 30-year-old caucasian female. Int J Otolaryngol 2009; 2009:901537. [PMID: 20111755 PMCID: PMC2811397 DOI: 10.1155/2009/901537] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Accepted: 10/05/2009] [Indexed: 11/18/2022] Open
Abstract
Kikuchi-Fujimoto disease is a rare, self-limited, histiocytic, necrotizing lymphadenitis first described in Japan in 1972. Necrosis of lymph node tissue is caused by apoptosis and may be virally induced. It commonly presents with cervical lymphadenitis and fever. Despite its low incidence, Kikuchi-Fujimoto disease should be considered in patients with persistent lymphadenopathy. Originally thought to occur only in young Asian women, it is now recognized in other geographic regions. We report a 30-year-old white woman with Kikuchi-Fujimoto disease. We discuss the clinical features, differential diagnosis, radiography, pathology, and outcome.
Collapse
|
35
|
Cramer J, Schmiedel S, Alegre NG, Schäfer H, Burchard GD, Merz H. Necrotizing lymphadenitis: Kikuchi--Fujimoto disease alias lupus lymphadenitis? Lupus 2009; 19:89-92. [PMID: 19933723 DOI: 10.1177/0961203309345793] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Differentiation between lymphadenopathy in potentially life-threatening systemic lupus erythematosus (SLE) and self-limiting necrotizing lymphadenitis, also called Kikuchi- Fujimoto disease (KFD), is difficult. In the past, co-occurrence of SLE and KFD has been described repeatedly in case reports. Here, we report a case of necrotizing lymphadenitis, describe the clinical and histopathologic features in detail and discuss the current literature. KFD may in fact be a histopathologic characteristic of SLE supporting the hypothesis that KFD is a rare manifestation of SLE. To clarify whether KFD is the same entity as lupus lymphadenitis, more cases with SLE and lymphadenopathy should be examined in detail.
Collapse
Affiliation(s)
- Jp Cramer
- Section for Tropical Medicine, I, Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
| | | | | | | | | | | |
Collapse
|
36
|
Disseminated Kikuchi-Fujimoto disease mimicking malignant lymphoma on positron emission tomography in a child. J Pediatr Hematol Oncol 2009; 31:687-9. [PMID: 19684524 DOI: 10.1097/mph.0b013e31819a5d77] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kikuchi-Fujimoto disease is a rare and benign disease, characterized by regional cervical lymphadenopathy with fever of unknown origin, affecting mainly young women. This self-limiting disease of unknown etiology has rarely been reported in children, so it has been frequently confused with malignancies. We describe a case of a child who was initially mistaken for malignant lymphoma because of multiple lymph nodes with 18-fluorodeoxyglucose uptake on positron emission tomography and was finally diagnosed with Kikuchi-Fujimoto disease by excisional biopsy of the affected lymph node.
Collapse
|
37
|
Affiliation(s)
- Jessica Kulak
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Fla
| | - Lee P. Smith
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Fla
| | - Behram C. Acar
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Fla
| | - Donald T. Weed
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Fla
| |
Collapse
|
38
|
Osborn M, Aqel N, Levine TS. The fine needle aspiration appearances of Kikuchi’s lymphadenitis. Cytopathology 2009; 20:36-43. [DOI: 10.1111/j.1365-2303.2007.00491.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
39
|
Xavier RG, Silva DR, Keiserman MW, Lopes MFT. Doença de Kikuchi-Fujimoto. J Bras Pneumol 2008; 34:1074-8. [DOI: 10.1590/s1806-37132008001200014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 04/15/2008] [Indexed: 01/08/2023] Open
Abstract
A doença de Kikuchi-Fujimoto é caracterizada por febre e linfadenopatia, geralmente cervical. Esta doença acomete principalmente mulheres jovens. Pode ser confundida com linfoma, metástase de adenocarcinoma e tuberculose. Relatamos dois casos da doença de Kikuchi-Fujimoto. No primeiro caso, uma paciente de 28 anos havia tratado tuberculose há um ano e apresentava quadro clínico e histológico compatível com a doença de Kikuchi-Fujimoto. A segunda paciente, de 58 anos, recebeu tratamento inicialmente para granulomatose de Wegener e, posteriormente, para tuberculose. O exame histopatológico com estudo imunohistoquímico permitiu estabelecer o diagnóstico da doença de Kikuchi-Fujimoto nos dois casos. Após o diagnóstico definitivo, ambas foram tratadas sintomaticamente e melhoraram clinicamente dentro de um mês. Posteriormente, a segunda paciente desenvolveu lúpus eritematoso sistêmico.
Collapse
|
40
|
Paradela S, Lorenzo J, Martínez-Gómez W, Yebra-Pimentel T, Valbuena L, Fonseca E. Interface dermatitis in skin lesions of Kikuchi–Fujimoto’s disease: a histopathological marker of evolution into systemic lupus erythematosus? Lupus 2008; 17:1127-35. [DOI: 10.1177/0961203308092161] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Kikuchi’s disease (KD) is a self-limiting histiocytic necrotizing lymphadenitis (HNL). Cutaneous manifestations are frequent and usually show histopathological findings similar to those observed in the involved lymph nodes. HNL with superposed histological features to KD has been described in patients with lupus erythematosus (LE), and a group of healthy patients previously reported as having HNL may evolve into LE after several months. Up to date, features to predict which HNL patients will have a self-limiting disease and which could develop LE have been not identified. In order to clarify the characteristics of skin lesions associated with KD, we report a case of HNL with evolution into systemic lupus erythematosus (SLE) and a review of previous reports of KD with cutaneous manifestations. A 17-year-old woman presented with a 4-month history of fever and generalised lymphadenopathy. A diagnosis of HNL was established based on a lymph node biopsy. One month later, she developed an erythematoedematous rash on her upper body, with histopathological findings of interface dermatitis. After 8 months, anti-nuclear antibodies (ANA) at titre of 1/320, anti-DNA-ds antibodies and marked decrease of complement levels were detected. During the following 2 years, she developed diagnostic criteria for SLE, with arthralgias, pleuritis, aseptic meningitis, haemolytic anaemia and lupus nephritis. To our knowledge, 27 cases of nodal and cutaneous KD have been reported, 9 of which later developed LE. In all these patients, the skin biopsy revealed interface dermatitis. Skin biopsy revealed a pattern of interface dermatitis in all reviewed KD cases, which evolved into LE. Even this histopathological finding was not previously considered significant; it might be a marker of evolution into LE.
Collapse
Affiliation(s)
- S Paradela
- Department of Dermatology, Hospital Juan Canalejo, La Coruña, Spain
| | - J Lorenzo
- Department of Internal Medicine, Hospital Juan Canalejo, La Coruña, Spain
| | - W Martínez-Gómez
- Department of Dermatology, Hospital Juan Canalejo, La Coruña, Spain
| | - T Yebra-Pimentel
- Department of Pathology, Hospital Juan Canalejo, La Coruña, Spain
| | - L Valbuena
- Department of Pathology, Hospital Juan Canalejo, La Coruña, Spain
| | - E Fonseca
- Department of Dermatology, Hospital Juan Canalejo, La Coruña, Spain
| |
Collapse
|
41
|
Alijotas-Reig J, Suy-Franch A, Casellas-Caro M, Vilardell-Tarres M, Cabero-Roura L. Recurrent Kikuchi-Fujimoto necrotizing lymphadenitis during pregnancy. Eur J Obstet Gynecol Reprod Biol 2008; 140:144-5. [DOI: 10.1016/j.ejogrb.2007.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 09/20/2007] [Accepted: 10/31/2007] [Indexed: 10/22/2022]
|
42
|
Glaser M, Borin P, Kavalar R, Skalicky M. Necrotizing cervical lymphadenopathy: Kikuchi-Fujimoto disease in a young male. Wien Klin Wochenschr 2008; 120:360-5. [DOI: 10.1007/s00508-008-0990-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 11/29/2007] [Indexed: 11/30/2022]
|
43
|
|
44
|
Zhang WP, Wang JH, Wang WQ, Chen XQ, Wang Z, Li YF, Hu PZ, Zhang W, Wang L, Wang D, Huang GS. An association between parvovirus B19 and Kikuchi-Fujimoto disease. Viral Immunol 2007; 20:421-8. [PMID: 17931112 DOI: 10.1089/vim.2006.0098] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although Kikuchi-Fujimoto disease (KFD) has a higher prevalence among Asian countries, it is a well-defined entity throughout the world. However, its etiology and pathogenesis remain undetermined. To study whether B19 infection is associated with idiopathic KFD (iKFD), we examined the presence of the viral genome and proteins in paraffin-embedded tissues of lymph nodes retrospectively from 33 iKFD patients and 16 age- and sex-matched control subjects by nested PCR (nPCR), in situ hybridization (ISH), and immunohistochemistry (IHC). B19 was detected in 87.1, 69.7, and 57.6% of iKFD specimens by nPCR, ISH, and IHC, respectively, whereas the virus was positive in only 56.3, 31.3, and 25.0% of control tissues by the respective methods (nPCR: p = 0.029; ISH: p = 0.011; IHC: p = 0.032). The IHC-ISH double-staining assay demonstrated that B19-infected cells were mainly lymphocytes and a small number of histiocytes. These results showed for the first time a high frequency of localized persistence of B19 in lymph nodes from iKFD patients, suggesting that B19 might play an important role in the pathogenesis of iKFD.
Collapse
Affiliation(s)
- Wei-Ping Zhang
- Department of Pathology and State Key Laboratory of Cancer Biology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Viallard JF, Parrens M, Lazaro E, Caubet O, Pellegrin JL. Lymphadénite histiocytaire nécrosante ou maladie de Kikuchi-Fujimoto. Presse Med 2007; 36:1683-93. [PMID: 17611068 DOI: 10.1016/j.lpm.2007.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD), first described independently by Kikuchi and Fujimoto in 1972, is a subacute necrotizing lymphadenitis of unknown cause. Although most frequent in young Asian women, KFD has a worldwide distribution. Clinically, KFD is characterized by lymphadenitis of one or more lymph nodes, predominantly in the posterior cervical region, fever, and leukopenia in up to 50% of cases. Extranodal manifestations can occur, especially skin lesions and aseptic meningitides. Diagnosis is usually confirmed by analysis of samples from an excisional biopsy of the affected nodes. Histologically, the lesions affect the cortical and paracortical areas of the node. Characteristic features include focal necrosis predominantly in the paracortical region with abundant karyorrhectic debris and atypical mononuclear cells around the necrotic zone (crescent-shaped histiocytes, plasmacytoid monocytes, and small lymphocytes and immunoblasts, mostly CD3(+)/CD8(+)), most often with an intact lymph node capsule, an absence of neutrophils, and a paucity of plasma cells. KFD has been classified into three histological subtypes and is thought to progress from the proliferative type (> 50%) to the necrotizing type (30%) and finally resolve into the xanthomatous type (< 20%). Differential diagnoses should include malignant lymphoma, infectious diseases such as toxoplasmatic lymphadenitis, tuberculous lymphadenitis and cat scratch disease, and systemic lupus erythematosus (SLE). The cause of KFD is unknown: a viral infection has been suggested, but not demonstrated, possibly involving human herpes virus 8 or Epstein-Barr virus. Apoptotic cell death plays a role: proliferating CD8(+) T-lymphocytes act as both killers and victims in the apoptotic process via Fas and perforin pathways. The course is usually benign with resolution in a few months with the use of antiinflammatory drugs. Regular follow-up is required because SLE may develop several years after the onset of Kikuchi-Fujimoto disease.
Collapse
|
46
|
Phelan E, Lang E, Gormley P, Lang J. Kikuchi-Fujimoto Disease: A Report of 3 Cases. EAR, NOSE & THROAT JOURNAL 2007. [DOI: 10.1177/014556130708600720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cervical lymphadenopathy has many underlying etiologies. One of its rare causes is Kikuchi-Fujimoto disease (Kikuchi's disease, histiocytic necrotizing lymphadenitis). We discovered such a cause in a 37-year-old woman who had presented with malaise, night sweats, and weight loss in addition to cervical lymphadenopathy. We based our diagnosis on excisional lymph node biopsy. We also review 2 other cases of Kikuchi's disease that were diagnosed by others at our institution. Clinically and histologically, Kikuchi's disease is very similar to lymphoma, and distinguishing the two is difficult. However, despite the fact that Kikuchi's disease is benign, an accurate diagnosis is important because misdiagnosis might lead to unnecessary surgery and/or chemotherapy.
Collapse
Affiliation(s)
- Eimear Phelan
- Department of Otolaryngology, Galway University Hospital, Galway, Ireland
| | - Emer Lang
- Department of Otolaryngology, Galway University Hospital, Galway, Ireland
| | - Peter Gormley
- Department of Otolaryngology, Galway University Hospital, Galway, Ireland
| | - John Lang
- Department of Otolaryngology, Galway University Hospital, Galway, Ireland
| |
Collapse
|
47
|
Liatsos GD, Pirounaki M, Skounakis M, Moulakakis A. Novel presentation of Kikuchi-Fujimoto disease with chronic, febrile diarrhoea, mimicking inflammatory bowel disease. Ann Hematol 2007; 86:773-5. [PMID: 17516065 DOI: 10.1007/s00277-007-0315-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Accepted: 05/07/2007] [Indexed: 10/23/2022]
|
48
|
Robertson KE, Forsyth PD, Batstone PJ, Levison DA, Goodlad JR. Kikuchi's disease displaying a t(2:16) chromosomal translocation. J Clin Pathol 2007; 60:433-5. [PMID: 17405981 PMCID: PMC2001119 DOI: 10.1136/jcp.2006.038646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Kikuchi's disease is a rare self-limiting lymphoproliferative condition of unknown aetiology, characterised by acute or subacute necrotising lymphadenitis. It is a benign condition that can mimic malignant lymphoma. In this report, a case of Kikuchi's disease associated with a chromosomal abnormality is described. This is the first report in the literature of such a case and it highlights an important learning point; benign lymphoproliferative conditions can be associated with chromosomal abnormalities that are more typically associated with malignant lymphoproliferative conditions such as malignant lymphoma. The report illustrates the necessity for interpreting cytogenetic data in the relevant clinical and histopathological context in a multidisciplinary setting to avoid misdiagnosis and inappropriate treatment.
Collapse
Affiliation(s)
- Katherine E Robertson
- Division of Pathology and Neuroscience, Ninewells Hospital and Medical School University of Dundee, Dundee, UK.
| | | | | | | | | |
Collapse
|
49
|
Sah SK, Pant R, Piper K, Chowdhury TA, Crean SJ. Recurrent Kikuchi–Fujimoto disease: Case report. Br J Oral Maxillofac Surg 2007; 45:231-3. [PMID: 16356607 DOI: 10.1016/j.bjoms.2005.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 07/29/2005] [Indexed: 11/15/2022]
Abstract
Kikuchi-Fujimoto disease, also known as histiocytic necrotising lymphadenitis, is a self-limiting condition of uncertain aetiology characterised by lymphadenopathy, pyrexia, and neutropenia. Some reported cases have been associated with systemic lupus erythematosus and there have been suggestions that Kikuchi's disease could represent a mild form of lupus but without definite evidence. We describe an unusual case of histiocytic necrotising lymphadenitis in an Asian woman who had recurrent episodes for five years before a diagnosis was made.
Collapse
Affiliation(s)
- Sunil K Sah
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, Whitechapel, London E1 1BB, UK
| | | | | | | | | |
Collapse
|
50
|
Abstract
PURPOSE Report a case of oculomotor palsy with papillary edema in a child showing signs of Kikuchi's disease and review the literature. MATERIALS AND METHODS A 10-year-old girl presented with diplopia with right ptosis, right exophthalmia, headache, generalized weakness, and fever. The assessment consisted of an ocular and neurological examination, imagery by cerebral magnetic resonance, a biological and immunological assessment, and a biopsy. RESULTS The ophthalmologic examination found right exophthalmia with absence of right abduction and adduction, and right ptosis. The ocular fundus showed a bilateral papillary edema. Magnetic resonance revealed a bilateral intraconic attack of the orbital apex. The biopsy of cervical adenopathy showed a histiocytic necrotizing lymphadenitis. Infection assessment was negative and immunologic tests were normal. DISCUSSION Kikuchi's disease, or histiocytic necrotizing lymphadenitis, is a rare disease in young patients that is characterized by adenopathy, fever, and neutropenia. The diagnosis was confirmed histologically. The etiology of Kikuchi's disease remains unknown, although a viral or autoimmune hypothesis has been suggested. The course of the disease is spontaneously favorable and recurrence is rare. Association with systemic lupus erythematous had been described. The differential diagnosis of Kikuchi's disease includes infectious necrotizing lymphadenitis, systemic lupus erythematous, and lymphoma. Ocular manifestation is exceptionally described (uveitis). CONCLUSION Kikuchi's disease should be considered in children revealing ocular manifestations with lymphadenopathy and fever of unknown origin.
Collapse
Affiliation(s)
- F Rocher
- Service d'Ophtalmologie, Hôpital d'Enfants Armand Trousseau, 26, rue du Dr Arnold Netter, 75785 Paris cedex 12.
| | | | | | | |
Collapse
|