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Sekiguchi S, Yamamoto Y, Hatakeyama S, Matsumura M. Recurrent Aseptic Meningitis Associated with Kikuchi's Disease (Histiocytic Necrotizing Lymphadenitis): A Case Report and Literature Review. Intern Med 2021; 60:1779-1784. [PMID: 33431735 PMCID: PMC8222115 DOI: 10.2169/internalmedicine.6494-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We herein report a 31-year-old man with recurrent aseptic meningitis associated with Kikuchi's disease. Although aseptic meningitis is the most common neurological complication of Kikuchi's disease, its characteristics remain unclear, especially in recurrent cases. A literature review revealed that aseptic meningitis associated with Kikuchi's disease was more likely to occur in men and was associated with a low cerebrospinal fluid (CSF)/serum glucose ratio. Lymphadenopathy tended to occur simultaneously or after the onset of meningitis. When encountering a patient with aseptic meningitis of unknown etiology, it may be worthwhile to focus on the CSF/serum glucose ratio and lymphadenopathy with a careful examination.
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Affiliation(s)
- Shiori Sekiguchi
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Shuji Hatakeyama
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Masami Matsumura
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
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Song Y, Liu S, Song L, Chen H, Bai M, Yan J, Luo T, Liu K, Sun L, Zhao Y. Case Report: Histiocytic Necrotizing Lymphadenitis (Kikuchi-Fujimoto Disease) Concurrent With Aseptic Meningitis. Front Neurol 2021; 12:565387. [PMID: 33959084 PMCID: PMC8093430 DOI: 10.3389/fneur.2021.565387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
Kikuchi–Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign, self-limiting disease characterized by local lymphadenopathy. Central nervous system involvement in KFD is extremely rare and remains a diagnostic challenge. Only 41 cases of aseptic meningitis associated with KFD have been reported worldwide, with just four cases (including our case) of KFD with meningitis as the first symptom. We report a case of KFD accompanied by aseptic meningitis with severely high intracranial pressure (400 mmH2O), increased white blood cell count (56 × 106/L), and moderately elevated protein level (0.52 g/L). This case is unique in the delayed appearance of lymphadenopathy. After 1 month of treatment with steroids, fever, headache, and lymphadenopathy gradually disappeared, and the result of cerebrospinal fluid examination gradually became normal. In conclusion, based on our case findings and our literature review on KFD with aseptic meningitis, a diagnosis of KFD should be considered when delayed appearance of lymphadenopathy is observed in patients with aseptic meningitis.
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Affiliation(s)
- Yanna Song
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Shan Liu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Lei Song
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Huaqiu Chen
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Miaoshui Bai
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Jinhua Yan
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Tianfei Luo
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Kangding Liu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Li Sun
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Yang Zhao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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Kaito S, Goto M, Iguchi M, Okuno Y, Moriyoshi K, Koyama H. Methotrexate-associated lymphoproliferative disorder with histopathological features of histiocytic necrotizing lymphadenitis. Mod Rheumatol Case Rep 2020; 5:141-144. [PMID: 33269654 DOI: 10.1080/24725625.2020.1775991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An 84-year-old Japanese woman suffering from rheumatoid arthritis (RA), who had been treated with methotrexate (MTX) for 15 years, was admitted to our hospital for generalised lymphadenopathy, thrombocytopenia, anaemia, elevated aminotransferases, and elevated CRP levels. Pathological findings of cervical lymph node biopsy were compatible with histiocytic necrotising lymphadenitis (HNL). Small lymphocytes positive for Epstein-Barr virus (EBV)-encoded small RNA were detected in the tissue. We suspected a MTX-associated lymphoproliferative disorder (MTX-LPD), withdrew MTX and administered leucovorin (folic acid). The patient's symptoms gradually resolved following discontinuation of MTX. We considered that this patient developed HNL as an MTX-LPD when EBV was reactivated. This is the first case of HNL associated with MTX treatment for RA, which we report here along with clinical course.
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Affiliation(s)
- Shuko Kaito
- Department of General Internal Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masashi Goto
- Department of General Internal Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mikiko Iguchi
- Department of Rheumatology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yoshiaki Okuno
- Department of Hematology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroshi Koyama
- Department of General Internal Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Wong YK, Khan M. Kikuchi-Fujimoto disease: a rare cause of cervical lymphadenopathy and fever. BMJ Case Rep 2018; 2018:bcr-2018-225210. [PMID: 30097545 DOI: 10.1136/bcr-2018-225210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 28-year-old Pakistani man with previously treated latent tuberculosis (TB) presented with a 3-month history of productive cough, fever, drenching night sweats, anorexia, sore throat and tender left cervical lymphadenopathy. Extensive biochemical and microbiological tests, and imaging studies were all inconclusive. Lymph node biopsy revealed the diagnosis of Kikuchi-Fujimoto disease (KFD). He had persistent fever and anorexia during admission despite supportive measures which resolved quickly on starting prednisolone. He remained well after being weaned off steroids on 18 weeks' follow-up. KFD is a rare, self-limiting disease which can mimic several serious conditions such as TB and lymphoma. Prompt diagnosis with lymph node biopsy is paramount in addressing diagnostic uncertainty and avoids starting potentially toxic treatment on these patients.
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Affiliation(s)
- Yu Kwong Wong
- General Medicine, Queen's Medical Centre, Nottingham, UK
| | - Marium Khan
- Department of Histopathology, Queen's Medical Centre, Nottingham, UK
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McKenna C, Whitfield T, Patel N, Bonington A. TB or not to be? Kikuchi-Fujimoto disease: a rare but important differential for TB. BMJ Case Rep 2017; 2017:bcr-2016-217500. [PMID: 28052948 DOI: 10.1136/bcr-2016-217500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 29-year-old British Pakistani woman presented with a 2-month history of drenching fevers, night sweats, lethargy and tender cervical and axillary lymphadenopathy. Initial investigations, bloods and imaging were unremarkable. Fever persisted during her admission, and treatment for tuberculosis (TB) lymphadenitis was started postbiopsy until histology confirmed a diagnosis of Kikuchi-Fujimoto's disease (KFD). KFD has a non-specific presentation of fever, night sweats and lymphadenopathy and commonly raises a clinical suspicion of a number of other serious conditions such as TB, lymphoma, HIV, systemic lupus erythematous, toxoplasmosis and infectious mononucleosis. Although rare, KFD should be considered to be a differential diagnosis for fever of unknown origin and tender lymphadenopathy in otherwise well individuals. This case demonstrates the importance of a timely histological biopsy diagnosis to prevent an incorrect diagnosis and administration of unnecessary medications.
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Affiliation(s)
- C McKenna
- North West Regional Centre for Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - T Whitfield
- North West Regional Centre for Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - N Patel
- North West Regional Centre for Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - A Bonington
- North West Regional Centre for Infectious Diseases, North Manchester General Hospital, Manchester, UK.,The University of Manchester, Manchester Academic Health Science Centre, North Manchester General Hospital, Manchester, UK
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Naito N, Shinohara T, Machida H, Hino H, Naruse K, Ogushi F. Kikuchi-Fujimoto disease associated with community acquired pneumonia showing intrathoratic lymphadenopathy without cervical lesions. SPRINGERPLUS 2015; 4:693. [PMID: 26587361 PMCID: PMC4642454 DOI: 10.1186/s40064-015-1500-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/02/2015] [Indexed: 01/23/2023]
Abstract
Introduction Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a rare entity of unknown etiology in young adults that is typically characterized by cervical lymphadenopathy and persistent fever. The pathogenesis of KFD has been suggested to be an abnormal immune response, and infections or autoimmune diseases are considered to be involved in KFD. However, KFD associated with community acquired pneumonia (CAP) has not been reported. Case description A 35-year-old male was admitted due to high fever, diffuse air-space consolidation in the right lung with ipsilateral pleural effusion and massive mediastinal and hilar lymphadenopathy without cervical lesions. On clinical suspicion of malignant lymphoma complicated with pneumonia, we performed a video-assisted thoracoscopic lymph node biopsy, and the diagnosis of KFD was established. Complete cure of the intrathoratic lesions was observed by administration of β-lactam antibiotics alone without steroid therapy. Discussion and evaluation Previous large case series have identified no pathogenic relationship between KFD and pneumonia. The hilar adenopathy could have caused airway compression leading to pneumonia. Conclusions KFD should be considered in the differential diagnosis of massive mediastinal and hilar lymphadenopathy, even when there are no superficial lesions. In addition, we need to bear in mind that unexpected disorders occasionally coexist with common diseases.
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Affiliation(s)
- Nobuhito Naito
- Division of Pulmonary Medicine, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077 Japan
| | - Tsutomu Shinohara
- Department of Clinical Investigation, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077 Japan
| | - Hisanori Machida
- Division of Pulmonary Medicine, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077 Japan
| | - Hiroyuki Hino
- Division of Thoracic Surgery, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077 Japan
| | - Keishi Naruse
- Division of Pathology, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077 Japan
| | - Fumitaka Ogushi
- Division of Pulmonary Medicine, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077 Japan
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Co-occurrence of Kikuchi-Fujimoto's disease and Still's disease: case report and review of previously reported cases. Clin Rheumatol 2014; 34:2147-53. [PMID: 25098416 DOI: 10.1007/s10067-014-2755-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 07/05/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022]
Abstract
Kikuchi-Fujimoto's disease (KFD) and adult-onset Still's disease (AOSD) are rare inflammatory conditions with some overlapping features. We encountered a 22-year-old male patient who presented with daily fevers, neck discomfort, and sore throat and subsequently developed rash, arthritis, and cervical lymphadenopathy. Biopsy of the skin rash was consistent with KFD skin involvement. Given that the patient also met criteria for AOSD, a final diagnosis of KFD/AOSD co-occurrence was made. Anti-IL-1β therapy with anakinra resulted in rapid resolution of all symptoms. A literature search identified eight more cases of KFD/AOSD. Fever, rash, arthritis, and lymphadenopathy were present in all patients. No case report demonstrated an association of rash eruption clearly associated with fever spikes. Duration of symptoms ranged from 3 weeks to 10 years. Seven patients had leukocytosis, six had anemia, and five demonstrated elevated ferritin and/or decreased glycosylated ferritin. Seven patients had elevated erythrocyte sedimentation rate (ESR), and seven had transaminitis. Eight of nine patients had no evidence of infectious disease. Autoantibodies were absent from all patients. KFD and AOSD are very rare diseases, yet they may overlap. The two conditions not only share several clinical and laboratory characteristics but also differ in characteristic ways. Given the rapid response observed with anakinra in the index patient, IL-1β likely plays a role in both diseases.
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Santos MV, Gallo P, Roked F, Nicklaus-Wollenteit I, Rodrigues D. Unusual presentation of Kikuchi-Fujimoto disease. J Neurosurg Pediatr 2013; 12:266-9. [PMID: 23889353 DOI: 10.3171/2013.6.peds13118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The authors report the case of a 13-year-old girl with Kikuchi-Fujimoto disease who presented with features of raised intracranial pressure due to subdural effusions. A biopsy revealed dural involvement in the disease process. The authors review the medical literature of this rare disease and highlight the paucity of documented cases with CNS involvement.
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Affiliation(s)
- Marcelo Volpon Santos
- Department of Paediatric Neurosurgery, Birmingham Children’s Hospital, Birmingham, United Kingdom
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Komagamine T, Nagashima T, Kojima M, Kokubun N, Nakamura T, Hashimoto K, Kimoto K, Hirata K. Recurrent aseptic meningitis in association with Kikuchi-Fujimoto disease: case report and literature review. BMC Neurol 2012; 12:112. [PMID: 23020225 PMCID: PMC3570427 DOI: 10.1186/1471-2377-12-112] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/26/2012] [Indexed: 12/30/2022] Open
Abstract
Background Kikuchi Fujimoto disease (KFD), or histiocytic necrotising lymphadenitis, is a benign and self-limiting condition characterised by primarily affecting the cervical lymph nodes. Recurrent aseptic meningitis in association with KFD is extremely rare and remains a diagnostic challenge. Case presentation We report a 28-year-old man who presented 7 episodes of aseptic meningitis associated with KFD over the course of 7 years. Histopathological findings of enlarged lymph nodes led to the diagnosis of KFD. The patient’s headache and lymphadenopathy spontaneously resolved without any sequelae. Conclusions A diagnosis of KFD should be considered when enlarged cervical lymph nodes are observed in patients with recurrent aseptic meningitis. A long-term prognosis remains uncertain, and careful follow-up is preferred.
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Affiliation(s)
- Tomoko Komagamine
- Department of Neurology, Dokkyo Medical University, Shimotsuga, Tochigi, Japan.
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Kurahara Y, Tachibana K, Tezuka K, Shimizu S, Kitaichi M, Hayashi S, Suzuki K. Kikuchi-Fujimoto disease mimicking tuberculous lymphadenitis. Intern Med 2012; 51:1927-30. [PMID: 22821115 DOI: 10.2169/internalmedicine.51.7574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 28-year-old woman was referred to our hospital for treatment of tuberculous lymphadenitis, after presenting with fever, left cervical lymphadenopathy, and a positive interferon-gamma release assay (QuantiFERON®-TB Gold In-Tube; QFT) result. Surprisingly, biopsy specimens of the cervical lymph nodes showed necrotic lesions with prominent nuclear debris and a proliferation of histiocytes, consistent with Kikuchi-Fujimoto disease (KFD). A diagnosis was made of KFD complicated by latent tuberculosis infection (LTBI), and all symptoms had resolved completely two months post-diagnosis. KFD may be misdiagnosed as tuberculous lymphadenitis, and antibiotics unnecessarily prescribed. Careful attention should therefore be paid when diagnosing cervical lymphadenopathy.
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Affiliation(s)
- Yu Kurahara
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
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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]
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