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Fujita Y, Kurasawa K, Kuwashima S, Yoshihara S. Polyarthritis Associated with Kikuchi-Fujimoto Disease in a Child. Indian J Pediatr 2023; 90:199. [PMID: 36480129 DOI: 10.1007/s12098-022-04425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Kazuhiro Kurasawa
- Department of Rheumatology, Dokkyo Medical University, Tochigi, Japan
| | | | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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Sato T, Kanda K, Kawamura Y, Takeuchi M. Sub internal limiting membrane hemorrhage followed by bilateral optic disc hemorrhage in Kikuchi-Fujimoto disease: a case report. BMC Ophthalmol 2021; 21:355. [PMID: 34620137 PMCID: PMC8499551 DOI: 10.1186/s12886-021-02106-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Kikuchi-Fujimoto disease (KFD) is a necrotizing lymphadenitis, and presents fever of unknown origin and cervical lymphadenopathy. Ocular complications are unusual in KFD. Here we report a case of sub internal limiting membrane (ILM) hemorrhage followed by bilateral optic disc hemorrhage in KFD. Case presentation A 16-year-old Japanese man perceived a sudden decrease of right vision 3 days after onset of fever with unknown origin and left cervical lymphadenopathy. At presentation, visual acuity (VA) of right eye was 0.05 in decimal chart (1.30: converted to logarithm of minimum angle of resolution: logMAR). Fundus photograph showed extensive sub-ILM hemorrhage in right eye, and optic disc hemorrhages in both eyes. Fluorescein angiography presented hypo- and hyperfluorescences in optic disc of right eye, and hyperfluorescence in the disc of left eye. To make a definitive diagnosis, cervical lymph node biopsy was performed, and KFD was diagnosed pathologically. Thereafter, fever, headache and the cervical lymphadenopathy disappeared spontaneously. The sub-ILM hemorrhage was drained into the vitreous cavity by neodymium:yttrium-aluminum-garnet laser (Nd: YAG) hyaloidotomy. VA recovered to 1.5 (− 0.18: logMAR VA) in right eye. Conclusion Sub-ILM hemorrhage and optic disc hemorrhage are a KFD-related ocular complication. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02106-y.
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Affiliation(s)
- Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Koji Kanda
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yusuke Kawamura
- Department of General Medicine, National Defense Medical College, Saitama, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
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Zhang R, Liang L, Li D, Bai Y, Li X. Analysis of the clinical manifestations and 18F-FDG PET-CT findings in 40 patients with histiocytic necrotizing lymphadenitis. Medicine (Baltimore) 2021; 100:e27189. [PMID: 34477179 PMCID: PMC8415950 DOI: 10.1097/md.0000000000027189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/19/2021] [Indexed: 01/05/2023] Open
Abstract
Histiocytic necrotizing lymphadenitis (HNL) is a rare, benign, and self-limiting inflammatory disease that mainly involves the lymph nodes. There is a lack of large sample studies concerning the clinical manifestations and imaging features of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) of HNL.The clinical symptoms, laboratory examination results, 18F-FDG PET/CT imaging features, and treatment outcome were investigated in this retrospective study.A total of 40 HNL patients were recruited. The onset age was between 14 and 65 years, with a median of 25 years. The white blood cell count was 3.9 (2.9, 7.1) × 109/L, C-reactive protein level was 20.2 (6.6, 63.8) mg/L, erythrocyte sedimentation rate was 29.0 (18.0,45.0) mm/h, and ferritin was 616.5 (205.6, 2118.1) ng/mL. An abnormal liver function was observed in 23 patients. 18F-FDG PET-CT showed that an abnormal lymph node metabolism was observed in 38 patients, among which the highest 18F-FDG maximal standard uptake value (SUVmax) of the lymph nodes ranged between 3.4 and 41.9; the nodes were mainly distributed in the neck and axilla regions. Meanwhile, a total of 2502 lymph nodes (721 lymph nodes with a short axis greater than 10 mm) were found in the 38 patients, including 1837 lymph nodes with an 18F-FDG SUVmax ≥ 2.5. The 18F-FDG SUVmax of the spleen ranged from 2.5 to 9.2 in 20 patients, while that of central and peripheral bone marrow ranged from 2.7 to 36.0 in 30 patients. After follow-up for an average period of 1 month, the symptoms improved after prednisone treatment.HNL often occurs in adolescents. Scanning with 18F-FDG PET/CT showed that most patients had multiple involved lymph nodes that were hypermetabolic, and only few lymph nodes are enlarged. Besides, the spleen or central and peripheral bone marrow could sometimes be hypermetabolic. Glucocorticoid treatment for the HNL patients is effective.
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Affiliation(s)
- Rui Zhang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lidan Liang
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Daoming Li
- Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuling Bai
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangzhou Li
- Department of Nuclear Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Jain J, Banait S, Tiewsoh I, Choudhari M. Kikuchi's disease (histiocytic necrotizing lymphadenitis): A rare presentation with acute kidney injury, peripheral neuropathy, and aseptic meningitis with cutaneous involvement. INDIAN J PATHOL MICR 2018; 61:113-115. [PMID: 29567898 DOI: 10.4103/ijpm.ijpm_256_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kikuchi's disease (KD) also known as histiocytic necrotizing lymphadenitis is rare, idiopathic, generally self-limited cause of lymphadenitis. We present a case of twenty year young female who presented in critically ill state with fever, cervical and axillary lymphadenopathy, rash, vomiting and altered sensorium and found to have neurological, hepatic, renal and dermatological involvement. Kikuchi's disease should be considered in differential diagnosis of fever and lymphadenopathy and though benign can sometimes present with multi-organ involvement. It is because of rarity of this disease with unusual complications, present case is reported.
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Affiliation(s)
- Jyoti Jain
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Shashank Banait
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Iadarilang Tiewsoh
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Madhura Choudhari
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
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Dalugama C, Gawarammana IB. Fever with lymphadenopathy - Kikuchi Fujimoto disease, a great masquerader: a case report. J Med Case Rep 2017; 11:349. [PMID: 29246252 PMCID: PMC5732422 DOI: 10.1186/s13256-017-1521-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/20/2017] [Indexed: 12/05/2022] Open
Abstract
Background Kikuchi Fujimoto disease is an uncommon benign condition of necrotizing histiocytic lymphadenitis commonly seen in East Asian and Japanese populations. It commonly presents with fever, cervical lymphadenopathy, and elevated inflammatory markers. Diagnosis of Kikuchi Fujimoto disease is based on histopathological studies of the involved lymph nodes. The presentation of Kikuchi Fujimoto disease can mimic many sinister conditions including lymphoma. Treatment is mainly supportive provided that accurate diagnosis is made and sinister conditions like lymphoma ruled out. Case presentation We report the case of an 18-year-old Sri Lankan Moor woman who presented with fever and cervical lymphadenopathy for 1 month. She had elevated inflammatory markers with high lactate dehydrogenase and ferritin levels. She had an extensive work-up including an excision biopsy of an involved lymph node and bone marrow biopsy. Finally, a diagnosis of Kikuchi Fujimoto disease was based on histopathology of the lymph node and negative bone marrow biopsy. Conclusions Although Kikuchi Fujimoto disease is a self-limiting condition, it is a great masquerader which mimics the clinical features of many sinister conditions including tuberculosis, lymphoma, and adult-onset Still’s disease. Early recognition of the disease is of crucial importance in minimizing potentially harmful and unnecessary evaluations and treatments.
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Affiliation(s)
- Chamara Dalugama
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
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Ranabhat S, Tiwari M, Kshetri J, Maharjan S, Osti BP. An uncommon presentation of Kikuchi Fujimoto disease: a case report with literature review. BMC Res Notes 2015; 8:478. [PMID: 26409444 PMCID: PMC4583729 DOI: 10.1186/s13104-015-1460-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease is so named because Kikuchi and Fujimoto were the first scientists to describe it in Japan in 1972. Although the disease has been reported from all over the world and more so from Asia, it is rare. To date only eight cases have been reported from Nepal. Cervical lymphadenopathy, fever and raised Erythrocyte Sedimentation Rate are usual presenting features of this disease. We describe a case which presented with thrombocytopenia and axillary lymphadenopathy in addition to the usual features. Out of the total eight cases that have been reported from Nepal so far, no patients had thrombocytopenia and only one patient had axillary lymphadenopathy. CASE PRESENTATION A 24-year-old Nepali female presented with a 3-week history of low-grade fever, headache, and painful, discrete, unilateral left-sided cervical and axillary lymphadenopathy. Among the multitude of tests that were carried out, Erythrocyte Sedimentation Rate was raised and there was thrombocytopenia while other tests were normal. Painful lymphadenopathy pointed to bacterial lymphadenitis while chronic low-grade fever suggested tuberculosis. A cervical lymph node was excised for histopathological examination to reach an accurate diagnosis. On the basis of pathognomonic features viz., paracortical foci composed of various types of histiocytes including crescentic type in the background of abundant apoptotic karyorrhectic debris, a diagnosis of Kikuchi-Fujimoto disease was made. On follow-up evaluation after 6 weeks, the patient had no systemic symptoms, enlarged lymph nodes had regressed in size significantly, and Erythrocyte Sedimentation Rate and platelet count had become normal. CONCLUSION Kikuchi-Fujimoto disease should be kept in the differential diagnosis of lymphadenopathy in young patients, female or male even in tuberculosis-endemic countries and even in patients who have unusual features; for example thrombocytopenia and involvement of axillary lymph nodes in addition to cervical lymph nodes as in this case.
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Affiliation(s)
- Sabin Ranabhat
- Department of Pathology, Chitwan Medical College (CMC) Teaching Hospital, Bharatpur-10, Chitwan, Nepal.
| | - Mamta Tiwari
- Department of Pathology, Chitwan Medical College (CMC) Teaching Hospital, Bharatpur-10, Chitwan, Nepal.
| | - Jiwan Kshetri
- Department of Pathology, Chitwan Medical College (CMC) Teaching Hospital, Bharatpur-10, Chitwan, Nepal.
| | - Sushna Maharjan
- Department of Pathology, Chitwan Medical College (CMC) Teaching Hospital, Bharatpur-10, Chitwan, Nepal.
| | - Bidur Prasad Osti
- Department of Pathology, Chitwan Medical College (CMC) Teaching Hospital, Bharatpur-10, Chitwan, Nepal.
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Aneja A, Maheswari K U, H J GD, Sheikh S. A rare case of multifocal lymphadenopathy in a young male. Oxf Med Case Reports 2015; 2014:141-4. [PMID: 25988059 PMCID: PMC4369995 DOI: 10.1093/omcr/omu054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/08/2014] [Accepted: 10/19/2014] [Indexed: 11/12/2022] Open
Abstract
Lymphadenopathy can be caused by localized and systemic diseases. While viral and bacterial infections commonly cause lymphadenitis in young adults, tuberculosis (TB) is a common cause for lymphadenopathy in endemic areas. Besides, lymphadenopathy may be a presenting manifestation of malignancy, systemic disorders and some rare diseases. Thus, relevant evaluation and exclusion of commoner causes is important to clinch the diagnosis. Histopathological examination is mandatory in such patients. We hereby report the case of a young adult male who presented with low-grade fever and abdominal pain with cervical and mesenteric lymphadenopathy in a TB endemic region, but was proved to have atypical presentation of Kikuchi–Fujimoto disease, which is a rare but benign cause of lymphadenopathy.
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Affiliation(s)
- Anshum Aneja
- Department of Respiratory Medicine , M.S. Ramaiah Medical College , Bangalore, Karnataka , India
| | - Uma Maheswari K
- Department of Respiratory Medicine , M.S. Ramaiah Medical College , Bangalore, Karnataka , India
| | - Gayathri Devi H J
- Department of Respiratory Medicine , M.S. Ramaiah Medical College , Bangalore, Karnataka , India
| | - Shamim Sheikh
- Department of Pathology , M.S. Ramaiah Medical College , Bangalore, Karnataka , India
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8
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The enigmatic kikuchi-fujimoto disease: a case report and review. Case Rep Hematol 2014; 2014:648136. [PMID: 24649384 PMCID: PMC3932818 DOI: 10.1155/2014/648136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 12/29/2013] [Indexed: 01/16/2023] Open
Abstract
We report this case of a 33-year-old African American woman who presented to the clinic with preauricular and submandibular masses that she had noticed 6 weeks earlier. She gave a remote history of noticing bilateral cervical masses 3 years prior to this presentation that had not been investigated at the time and resolved spontaneously. Excisional biopsies of the cervical lymph nodes showed morphologic and immunophenotypic findings suggestive of Kikuchi Fujimoto disease (KFD). KFD is an uncommon, self-limited, and perhaps an underdiagnosed entity with an excellent prognosis. It mimics malignant lymphoma in presentation and therefore an accurate clinicopathological differentiation is crucial.
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Garcia-Zamalloa A, Taboada-Gomez J, Bernardo-Galán P, Magdalena FM, Zaldumbide-Dueñas L, Ugarte-Maiztegui M. Bilateral pleural effusion and interstitial lung disease as unusual manifestations of Kikuchi-Fujimoto disease: case report and literature review. BMC Pulm Med 2010; 10:54. [PMID: 21054856 PMCID: PMC2991292 DOI: 10.1186/1471-2466-10-54] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 11/05/2010] [Indexed: 11/10/2022] Open
Abstract
Background Kikuchi-Fujimoto's disease (KFD), also called histiocytic necrotizing lymphadenitis, is a rare, idiopathic and self-limited condition usually characterized by cervical lymphadenopathy and fever, most often affecting young patients. Aetiology is unknown. Differential diagnosis includes mainly malignant lymphoma, tuberculous lymphadenitis and systemic lupus erythematosus (SLE), so early diagnosis is crucial. Pleuropulmonary involvement due to isolated KFD has been seldom reported. Case Presentation a 32-year-old man, on treatment for iatrogenic hypothyroidism, was admitted due to high grade fever and painful cervical lymphadenopathies. KFD was diagnosed by lymph node biopsy. Some days after admission the patient got worse, he developed generalized lymphadenopathy, bilateral pleural effusion and interstitial lung disease. All of them resolved with prednisone and after two years of following up he remains asymptomatic and without evidence of any other associated disease. Conclusion Pleural effusion and interstitial lung disease are very uncommon manifestations of KFD. In our experience, treatment with oral prednisone was effective.
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Clinical Presentations, Laboratory Results and Outcomes of Patients with Kikuchi's Disease: Emphasis on the Association Between Recurrent Kikuchi's Disease and Autoimmune Diseases. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2010; 43:366-71. [DOI: 10.1016/s1684-1182(10)60058-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 06/30/2009] [Accepted: 08/20/2009] [Indexed: 11/23/2022]
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Kikuchi–Fujimoto and Kimura diseases: the selected, rare causes of neck lymphadenopathy. Eur Arch Otorhinolaryngol 2009; 267:5-11. [DOI: 10.1007/s00405-009-1120-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 09/30/2009] [Indexed: 11/28/2022]
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Cunha BA, Mickail N, Durie N, Pherez FM, Strollo S. Fever of unknown origin (FUO) caused by Kikuchi's disease mimicking lymphoma. Heart Lung 2009; 38:450-6. [DOI: 10.1016/j.hrtlng.2009.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
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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.
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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
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Singh YP, Agarwal V, Krishnani N, Misra R. Enthesitis-related arthritis in Kikuchi-Fujimoto disease. Mod Rheumatol 2008; 18:492-5. [PMID: 18470474 DOI: 10.1007/s10165-008-0076-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 03/19/2008] [Indexed: 11/26/2022]
Abstract
Histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease (KFD) is a rare, benign and self-limiting disorder that characteristically presents with fever and cervical lymphadenopathy. Articular manifestations in the form of arthralgias are common but frank arthritis is distinctly rare and dactylitis has not been reported yet. Herein, we describe a young boy who presented with arthritis and dactylitis as the initial manifestation of KFD. A 14-year-old boy presented with a two-week history of fever, generalized lymphadenopathy and asymmetric polyarthritis, enthesitis and dactylitis of the toes. Two years earlier he presented with arthritis of the knee and ankle joints, which lasted for 12 months. However, he had been asymptomatic for one year. Investigations revealed anemia, leukopenia and raised acute phase reactants. Work-up for infectious etiology, systemic lupus erythematosus and leukemia and lymphoma was negative. Excision biopsy of the cervical lymph node confirmed KFD. Fever, lymphadenopathy and leukopenia dissipated with nonsteroidal anti inflammatory drug therapy, but the arthritis persisted. A trial of methotrexate led to the resolution of the arthritis.
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Affiliation(s)
- Yogesh Preet Singh
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
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15
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Atwater AR, Longley BJ, Aughenbaugh WD. Kikuchi's disease: case report and systematic review of cutaneous and histopathologic presentations. J Am Acad Dermatol 2008; 59:130-6. [PMID: 18462833 DOI: 10.1016/j.jaad.2008.03.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 01/30/2008] [Accepted: 03/10/2008] [Indexed: 11/29/2022]
Abstract
Kikuchi's disease, also known as histiocytic necrotizing lymphadenitis, is a systemic illness with classic clinical findings of cervical lymphadenopathy and fever. Diagnosis is confirmed by lymph node histology, which reveals paracortical foci of necrosis and a histiocytic infiltrate. Kikuchi's disease has been associated with a number of infections, but no single source has been identified. Diverse, often nonspecific, cutaneous findings have been described in up to 40% of cases. Description of the histopathologic findings of skin lesions is limited to single case reports and one case series. We describe a 24-year-old woman with fevers, lymphadenopathy, hepatic and hematologic abnormalities, and a skin eruption involving the face, neck, trunk, and extremities with characteristic lymph node and cutaneous histopathologic findings. We completed a systematic review of the clinical presentations and histopathology of Kikuchi's disease.
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Affiliation(s)
- Amber Reck Atwater
- Department of Dermatology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin 53715, USA
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Lazzareschi I, Barone G, Ruggiero A, Liotti L, Maurizi P, Larocca LM, Riccardi R. Paediatric Kikuchi-Fujimoto disease: a benign cause of fever and lymphadenopathy. Pediatr Blood Cancer 2008; 50:119-23. [PMID: 16755552 DOI: 10.1002/pbc.20918] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare and benign disease that typically affects the cervical lymph nodes. Its aetiology is unknown and a role of the autoimmune system in the pathogenesis is hypothesized. This self-limiting disease is often confused with malignancies. No specific management is generally required but long-term follow-up should be planned despite the low risk of recurrence, as recurrences have been described many years after the first episode and there is a high risk of development of an autoimmune disease or even lymphoma. We review the clinical and histological features of KFD and report an unusual case presenting with cervical and supraclavicular lymphadenopathy, and persistent fever.
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Affiliation(s)
- Ilaria Lazzareschi
- Division of Paediatric Oncology, Department of Paediatric Sciences, Catholic University, Rome
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Altuntas F, Sari I, Canoz O, Yildiz O, Eser B, Cetin M, Unal A. Kikuchi-Fujimoto disease: a rare but important cause of fever and lymphadenopathy in pregnant women. Am J Hematol 2006; 81:118-20. [PMID: 16432868 DOI: 10.1002/ajh.20495] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a case of Kikuchi-Fujimoto disease (KFD) in a 28-year-old pregnant woman with prolonged fever and generalized lymphadenopathy. We evaluated the patient for etiology of the fever and adenopathy, which were unresponsive to antibiotic therapy. Cervical lymph node histology showed KFD. Currently, there is scant data available regarding the course and treatment of KFD during pregnancy. We administered steroid therapy (prednisone 1 mg/kg/day) to control severe systemic and constitutional symptoms. We observed a reduction in lymph node size as well as abatement of fever and other constitutional symptoms. The patient carried the fetus to full term with no apparent adverse effect. Our experience showed that steroid therapy may be used effectively to control KFD-related symptoms after the first 16 weeks without terminating the pregnancy.
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Affiliation(s)
- Fevzi Altuntas
- Department of Hematology-Oncology, Erciyes University, Faculty of Medicine, Dedeman Oncology Hospital, Kayseri, Turkey.
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Affiliation(s)
- Xavier Bosch
- Servicio de Medicina Interna, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain.
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Abstract
We reviewed 12 patients who had Kikuchi-Fujimoto disease (KFD) and presented with prolonged fever and lymphadenopathy. The clinical and laboratory aspects of the patients confirmed by excisional lymph node biopsy were analyzed. The mean age of the children was 11.0 +/- 3.0 years (range: 6-15 years). The male-to-female ratio was 1.4:1. The median duration of fever before admission and the total duration of fever was 13 days (range: 7-65 days) and 19.5 days (range: 9-75 days), respectively. One patient had supraclavicular lymphadenopathy, 10 had cervical involvement, and 1 had axillary lymphadenopathy. All of the histologic findings of the lymph node biopsies showed the characteristic findings consistent with KFD, such as paracortical necrosis with karyorrhexis and an increase in the number of phagocytic histiocytes and atypical lymphocytes. As for the laboratory findings, leukopenia (3600 +/- 900 per mm3), anemia (hemoglobin 11.4 +/- 1.2 g/dL), an elevated erythrocyte sedimentation rate (44 +/- 18 mm/hour), and a relatively low C-reactive protein level (1.3 +/- 1.1 mg/dL) were noted. Eight patients received conservative therapy with antipyretics, and 3 patients were treated with prednisolone. KFD is a rare disease yet should be considered in the differential diagnosis for older children with prolonged fever and lymphadenopathy.
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Affiliation(s)
- Kyung-Yil Lee
- Department of Pediatrics, Catholic University of Korea, Daejeon St Mary's Hospital, 520-2 Daeheung-dong, Jung-gu, Daejeon 301-723, Republic of Korea.
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Santana A, Lessa B, Galrão L, Lima I, Santiago M. Kikuchi-Fujimoto's disease associated with systemic lupus erythematosus: case report and review of the literature. Clin Rheumatol 2004; 24:60-3. [PMID: 15517448 DOI: 10.1007/s10067-004-0923-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 03/15/2004] [Indexed: 11/26/2022]
Abstract
Kikuchi-Fujimoto's disease (KFD) or histiocytic necrotising lymphadenitis is a benign and self-limited disease, of unknown aetiology, which affects mainly young women. It presents with localised lymphadenopathy, predominantly in the cervical region, accompanied by fever and leukopenia in up to 50% of the cases. KFD has been rarely described in association with systemic lupus erythematosus (SLE), and its diagnosis can precede, postdate or coincide with the diagnosis of SLE. We present a patient with the diagnosis of SLE characterised by arthritis, leukopenia, malar rash, photosensitivity and positive ANA, besides cervical lymphadenopathy whose biopsy was compatible with KFD, which improved after using prednisone. Although the presence of lymphadenopathy is not uncommon in SLE patients, particularly in the phases of disease activity, the concomitance with KFD has rarely been reported in the literature. Its recognition is necessary because one can avoid laborious investigation for infectious and lymphoproliferative diseases.
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Affiliation(s)
- Alex Santana
- Hospital Santa Izabel, Núcleo de Reumatologia da Bahia/Escola Bahiana de Medicina e Saúde Pública (EBMSP), Praça Almeida Couto, 500, CEP 40.000-000 Nazaré, Salvador, Bahia, Brazil
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21
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Cervical Lymphadenopathy, Fever and Leukopenia (Histiocytic-Necrotizing Lymphadenitis or Kikuchi Disease). AJSP-REVIEWS AND REPORTS 2004. [DOI: 10.1097/01.pcr.0000139780.01599.eb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parappil A, Rifaath AA, Doi SAR, Pathan E, Surrun SK. Pyrexia of unknown origin: Kikuchi-Fujimoto disease. Clin Infect Dis 2004; 39:138-43. [PMID: 15206067 DOI: 10.1086/421267] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2003] [Accepted: 02/07/2004] [Indexed: 01/04/2023] Open
Abstract
A case of Kikuchi-Fujimoto disease is presented in the context of pyrexia of unknown origin. Although no specific etiology has been identified, several reported cases are associated with a variety of viruses, toxoplasma, or systemic lupus erythematosus. We present a case and discuss the implications for management.
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Famularo G, Giustiniani MC, Marasco A, Minisola G, Nicotra GC, De Simone C. Kikuchi Fujimoto lymphadenitis: case report and literature review. Am J Hematol 2003; 74:60-3. [PMID: 12949892 DOI: 10.1002/ajh.10335] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe a young woman with two severe episodes of Kikuchi Fujimoto disease occurring 16 years apart. Both episodes were proven by biopsy, and on the second occasion the patient remained dependent on high-dose prednisone for more than 6 months in order to control inflammation and achieve a reduction in cervical lymph node size. The second lymph node biopsy showed leukocytoclastic vasculitis in addition to the typical features of Kikuchi Fujimoto disease, but, even though the clinical interpretation of this finding was unclear, we documented no clinical or laboratory evidence of the development of other serious systemic disease over 20 years of follow-up. Kikuchi Fujimoto disease is considered a disorder with a self-limited course and a favorable outcome. However, on the basis of our experience with this patient and data from peer-reviewed literature, we suggest that this generally accepted postulate should be revised.
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