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Fahmy LM, Schreidah CM, Lapolla BA, Magro CM, Geskin LJ. VEXAS syndrome presenting as refractory cutaneous Kikuchi disease-like inflammatory pattern responding to tofacitinib. JAAD Case Rep 2023; 38:136-140. [PMID: 37521198 PMCID: PMC10382838 DOI: 10.1016/j.jdcr.2023.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Affiliation(s)
- Lauren M. Fahmy
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Celine M. Schreidah
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Brigit A. Lapolla
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Cynthia M. Magro
- Division of Dermatopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Larisa J. Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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Alkhyeli F, Bahaeddin A. Kikuchi-Fujimoto Disease in a 25-Year-Old Female: A Case Report. Cureus 2023; 15:e44007. [PMID: 37746448 PMCID: PMC10517180 DOI: 10.7759/cureus.44007] [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: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a rare benign disease that presents as cervical lymphadenopathy and fever. CASE PRESENTATION A 25-year-old South Asian female dentist, recently married, presented to our emergency department due to two weeks of fever, sore throat, swollen neck, and cough. The patient initially presented to a private clinic and was prescribed antibiotics on two visits. On physical examination, her neck was swollen with palpable and tender right posterior and submandibular lymph nodes. Oropharyngeal examination revealed pharyngeal hyperemia without tonsillar enlargement, exudates, or mucocutaneous ulcers. Ultrasound imaging revealed enlarged neck and thoracic and abdominal lymph nodes. CBC showed leukopenia and anemia of chronic disease. B2 microglobulin, lactate dehydrogenase, and kappa light chains were elevated. Anti-ANA, anti-dsDNA, HIV polymerase chain reaction (PCR), Quantiferon-tuberculosis (TB), and rapid plasma reagin were all negative. A lymph node biopsy confirmed the diagnosis of Kikuchi-Fujimoto disease. CONCLUSION We believe this is the second case to be reported in the United Arab Emirates (UAE). Kikuchi-Fujimoto disease has a non-specific presentation that overlaps with several conditions including autoimmune, infectious, and malignant. Therefore, a thorough clinical approach and a high grade of clinical suspicion is required to rule out other possible differential diagnosis. Finally, Although Kikuchi-Fujimoto disease is mostly benign, clinicians should be careful as some patients might develop systemic lupus erythematosus (SLE), Still disease, or B cell lymphoma in the future.
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Affiliation(s)
- Fatima Alkhyeli
- Internal Medicine, Sheikh Khalifa Medical City, Abu Dhabi, ARE
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Mahajan VK, Sharma V, Sharma N, Rani R. Kikuchi-Fujimoto disease: A comprehensive review. World J Clin Cases 2023; 11:3664-3679. [PMID: 37383134 PMCID: PMC10294163 DOI: 10.12998/wjcc.v11.i16.3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/29/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
Kikuchi-Fujimoto disease, a rare form of necrotizing lymphadenitis, is an uncommon, benign, self-limiting disorder of obscure etiology. It affects mostly young adults of both genders. Clinically, it presents with fever and lymphadenopathy of a firm to rubbery consistency frequently involving cervical lymph nodes while weight loss, splenomegaly, leucopenia, and elevated erythrocyte sedimentation rate feature in severely affected patients. Cutaneous involvement occurs in about 30%-40% of cases as facial erythema and nonspecific erythematous papules, plaques, acneiform or morbilliform lesions of great histologic heterogeneity. Both Kikuchi-Fujimoto disease and systemic lupus erythematosus share an obscure and complex relationship as systemic lupus erythematosus may occasionally precede, develop subsequently, or sometimes be associated concurrently with Kikuchi-Fujimoto disease. It is often mistaken for non-Hodgkin lymphoma while lupus lymphadenitis, cat-scratch disease, Sweet’s syndrome, Still’s disease, drug eruptions, infectious mononucleosis, and viral or tubercular lymphadenitis are other common differentials. Fine needle aspiration cytology mostly has features of nonspecific reactive lymphadenitis and immunohistochemistry studies usually show variable features of uncertain diagnostic value. Since its diagnosis is exclusively from histopathology, it needs to be evaluated more carefully; an early lymph node biopsy will obviate the need for unnecessary investigations and therapeutic trials. Its treatment with systemic corticosteroids, hydroxychloroquine, or antimicrobial agents mostly remains empirical. The article reviews clinicoepidemiological, diagnostic, and management aspects of KFD from the perspective of practicing clinicians.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Neeraj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Ritu Rani
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
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Lalevée S, Moguelet P, Hurabielle C, Senet P, Pha M, Rivière S, Barbaud A, Amoura Z, Francès C, Chasset F. Cutaneous Kikuchi disease-like inflammatory pattern without lymph node involvement is associated with systemic disease and severe features in lupus erythematous: A case-control study. Lupus 2020; 30:473-477. [PMID: 33292039 DOI: 10.1177/0961203320978519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Kikuchi-Fujimoto disease (KFD) is a self-limited histiocytic necrotizing lymphadenitis sometimes affecting the skin. "Kikuchi disease-like inflammatory pattern" (KLIP) has been described in cutaneous lesions as similar pathological features in patients without lymph node involvement and as a potential clue for the diagnosis of lupus. We aimed to describe KLIP-associated clinical and immunological features in lupus patients with a retrospective case-control study. METHODS Thirteen cases of KLIP were included as well as thirty-nine age- and sex-matched control lupus patients without KLIP. At the time of KLIP diagnosis, 4/13 patients (31%) had isolated cutaneous lupus erythematosus (CLE) and 9/13 had (69%) systemic lupus erythematosus (SLE) including 6 (46%) with severe haematological, lung, cardiac or renal disease. KLIP features were observed in skin biopsies of different clinical presentations. RESULTS Compared with our control group, KLIP patients more frequently had SLE 9/13 (69%) versus 8/39 (21%) (OR 12.9; IC95% [2.86-58.2]; p = 0.0004) and more frequently severe SLE. Two out of four CLE exhibiting KLIP lesions (50%) developed severe SLE with cardiac or renal involvement after 12 and 24 months, respectively.Treatment with thalidomide 100 mg/day allowed rapid and complete clearance of cutaneous lesions in 6/6 KLIP patients. The need to use thalidomide tended to be more frequent in KLIP patients than in controls. CONCLUSION Our study suggests that KLIP features in lupus skin lesions are associated with SLE and severe systemic features. Despite a limited number of isolated CLE patients with KLIP features in the skin, this observation may warrant closer follow-up on patients with a higher risk of developing SLE.
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Affiliation(s)
- Sophie Lalevée
- Service d'anatomopathologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Moguelet
- Service d'anatomopathologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Patricia Senet
- Sorbonne Université, Medecine, Service de dermatologie et allergologie, APHP, Hôpital Tenon, Paris, France
| | - Micheline Pha
- Service de Medecine Interne 2, Centre National de Reference du lupus systemique, Hôpital Pitie-Salpêtriere, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sebastien Rivière
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Médecine Interne, Hôpital Saint-Antoine, Paris, France
| | - Annick Barbaud
- Sorbonne Université, Medecine, Service de dermatologie et allergologie, APHP, Hôpital Tenon, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Médecine Sorbonne Université, Paris, France
| | - Zahir Amoura
- Service de Medecine Interne 2, Centre National de Reference du lupus systemique, Hôpital Pitie-Salpêtriere, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Camille Francès
- Sorbonne Université, Medecine, Service de dermatologie et allergologie, APHP, Hôpital Tenon, Paris, France
| | - Francois Chasset
- Sorbonne Université, Medecine, Service de dermatologie et allergologie, APHP, Hôpital Tenon, Paris, France
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Deschaine MA, Lehman JS. The interface reaction pattern in the skin: an integrated review of clinical and pathological features. Hum Pathol 2019; 91:86-113. [DOI: 10.1016/j.humpath.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 12/14/2022]
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Delplanque M, Chasset F, Hirsch P, Malard F, Ditchi Y, Fain O, Mekinian A. Cutaneous lupus with Kikuchi disease-like inflammatory pattern associated with myelodysplastic syndrome. Rheumatology (Oxford) 2019; 58:554-556. [PMID: 30590766 DOI: 10.1093/rheumatology/key413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Marion Delplanque
- Department of Internal Medicine, APHP, Saint Antoine Hospital, Sorbonne Université, France
| | - François Chasset
- Department of Dermatology, APHP, Tenon Hospital, Sorbonne Université, France
| | - Pierre Hirsch
- Department of Haematology, APHP, Saint Antoine Hospital, Sorbonne Université, France
| | - Florent Malard
- Department of Clinical Haematology, APHP, Saint Antoine Hospital, Sorbonne Université, France
| | - Yoan Ditchi
- Department of Anatopopathology, APHP, Tenon Hospital, Sorbonne Université, France
| | - Olivier Fain
- Department of Internal Medicine, APHP, Saint Antoine Hospital, Sorbonne Université, France
| | - Arsene Mekinian
- Department of Internal Medicine, APHP, Saint Antoine Hospital, Sorbonne Université, France
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Delplanque M, Chasset F, Hirsh P, Malard F, Ditchi Y, Fain O, Mekinian A. Lupus cutané érythémateux et histologie compatible avec une maladie de Kikuchi-Fujimoto associés à un syndrome myélodysplasique. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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