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费 秀, 刘 斯, 汪 波, 董 爱. [Clinical characteristics and treatment in adults and children with histiocytic necroti-zing lymphadenitis]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2024; 56:533-540. [PMID: 38864141 PMCID: PMC11167557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To analyze the clinical data of histiocytic necrotizing lymphadenitis(HNL), comparing the similarities and differences between children and adults, to deepen the understanding of the disease by clinical physicians, and to improve diagnostic rate and reduce misdiagnosis and mistreatment. METHODS The clinical data of hospitalized patients with histiocytic necrotizing lymphadenitis diagnosed by biopsy from January 2010 to August 2023 in Peking University First Hospital were collec-ted, and the clinical features, laboratory examinations, pathological features, treatments with antibiotics and glucocorticoids, and prognosis of histiocytic necrotic lymphadenitis were analyzed. Grouped based on age, the differences of clinical characteristics, laboratory tests, treatment, and prognosis between the children group (< 16 years old) and the adult group (≥16 years old) were compared. RESULTS Among the 81 enrolled patients, there were 42 males and 39 females. The median age was 21(14, 29) years, the median duration of disease was 20.0(13.0, 30.0) days, and the median length of hospital stay was 13.0 (10.0, 15.0) days. The first symptoms were fever, lymphadenopathy, and both. All the patients had enlarged lymph nodes with different parts and sizes, 96.3% (78 of 81) of the patients had cervical lymphadenopathy, 50.6% (41 of 81) had bilateral cervical lymphadenopathy, 55.6% (45 of 81) had supraclavicular, axillary or inguinal lymphadenopathy, and the median lymph node diameter was 20.0(20.0, 30.0) mm. Only one patient had no fever, the other 80 patients had fever, the median peak body temperature was 39.0(38.0, 39.8) ℃. Accompanying symptoms: rash (8.6%, 7/81), fatigue (34.6%, 28/81), night sweating (8.6%, 7/81), chills (25.3%, 25/81), muscle soreness (13.6%, 11/81), and joint pain (6.2%, 5/81). There were 17 cases (21.0%, 17/81) of hepatosplenomegaly, of which 12 cases (70.6%, 12/17) were splenomegaly. 68.8%(55/80) of patients had a decrease in white blood cell (WBC) count, with 47.5%(38/80)increased in lymphocyte(LY)proportion, 53.4%(39/73) increased in high-sensitivity C-reactive protein(CRP), 79.2%(57/72) increased in erythrocyte sedimentation rate(ESR), 22.2%(18/81) increased in alanine transaminase(ALT), 27.2%(22/81) elevated in aspartate transaminase(AST), and 81.6%(62/76) elevated in lactate dehydrogenase(LDH). All the 81 patients underwent lymph node biopsy, and 77.8%(63/81) of the patients showed that most of the structures in the lymph nodes were destroyed or disappeared, and 16.0%(13/81) of the lymph nodes were still in existence, hyperplasia and normal lymph node were 1.2%(1/81) respectively, and 3.7%(3/81) had normal lymph node structures. Immunohistochemical staining was performed in 67 cases. The percentages of CD3+ and CD68(KP1)+ were respectively 97.0%(65/67), and MPO+ were 94.0%(63/67). In the study, 51 patients (63.0%, 51/81) were treated with glucocorticoid therapy after diagnosis. The median time for temperature to return to normal was 1.0(1.0, 4.0) days after glucocorticoid therapy. when the glucocorticoid treatment worked best, the body temperature could drop to normal on the same day. There were significant differences in length of stay, predisposing factors, chills, the rate of increase in high-sensitivity CRP, antibiotic and glucocorticoid treatment between the adults and children groups (P < 0.05). CONCLUSION In clinical practice, if there are cases with unexplained fever, superficial lymph node enlargement, and reduced white blood cells as clinical characteristics, and general antibiotics treatment is ineffective, histiocytic necrotic lymphadenitis should be considered. Lymph node biopsy should be performed as early as possible to clarify the diagnosis, reduce misdiagnosis and mistreatment, and symptomatic treatment should be the main treatment. Glucocorticoids therapy has a definite therapeutic effect.
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Affiliation(s)
- 秀文 费
- 北京大学第一医院急诊科,北京 100034Department of Emergency, Peking University First Hospital, Beijing 100034, China
| | - 斯 刘
- 北京大学第一医院急诊科,北京 100034Department of Emergency, Peking University First Hospital, Beijing 100034, China
| | - 波 汪
- 北京大学第一医院急诊科,北京 100034Department of Emergency, Peking University First Hospital, Beijing 100034, China
| | - 爱梅 董
- 北京大学第一医院全科医学科,北京 100034Department of General Practice, Peking University First Hospital, Beijing 100034, China
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Kularathna MDSV, Medagama A, Bandara R, Yasarathna D, Dilani MKI, Anuththara T. Kikuchi disease complicated with aseptic meningitis following COVID-19 Vaccination: a case report. J Med Case Rep 2024; 18:270. [PMID: 38840233 PMCID: PMC11155001 DOI: 10.1186/s13256-024-04541-z] [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: 03/13/2022] [Accepted: 04/10/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Kikuchi Fujimoto disease is a rare self-limiting disorder mainly affecting young Asian females. The typical presentation is unexplained fever with associated cervical lymphadenopathy. It can mimic many sinister diseases such as lymphoma, tuberculosis, and systemic lupus erythematosus. Aseptic meningitis due to Kikuchi disease is extremely rare, and majority were reported from Japan. There have been no published cases of aseptic meningitis due to Kikuchi disease in Sri Lanka. CASE PRESENTATION A 29 years old Sri Lankan female presented with a prolonged fever for three weeks with an associated headache for five days duration. She developed painful cervical lymphadenopathy during the hospital stay. She has been previously well and had been vaccinated against COVID-19 six weeks before. Her lumbar puncture showed lymphocytic pleocytosis with marginally elevated protein levels and reduced ratio of serum to CSF sugar. Lymph node biopsy was consistent with necrotizing lymphadenitis. She was subsequently diagnosed with Kikuchi disease complicated with aseptic meningitis. She responded to corticosteroids well and had an uneventful recovery. CONCLUSION Kikuchi disease is a rare self-limiting disorder that can be complicated with aseptic meningitis on infrequent occasions. Other conditions such as tuberculosis, lymphoma, systemic lupus erythematosus, and adult-onset Still's disease should be considered as differential diagnoses. Knowledge of Kikuchi disease and its complications will prevent unnecessary investigations which delay the early diagnosis and treatment.
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Wang N, Zhu Y, Zhang J, Pan S, Wang H. Clinical scoring approach for detection of histiocytic necrotising lymphadenitis in adults. Intern Med J 2023; 53:84-88. [PMID: 32896970 DOI: 10.1111/imj.15042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Histiocytic necrotising lymphadenitis (HNL) is rare and can be easily ignored. AIMS To summarise the characteristics of HNL and find a simple scoring approach to detect HNL in adult patients. METHODS Adult patients with lymphadenopathy diagnosed by lymph node biopsy were enrolled. Chi-squared test and t-test were used to determine the significant variables. The cut-off values and scores assigned to each factor were performed by receiver operating characteristic (ROC) curves and coefficients in the logistic regression respectively. The performance of the scoring system was evaluated by ROC curves. RESULTS There were 32 HNL cases and 1162 other cases in the present study. These features, including age, the frequency of presentations of fever, cervical and painful lymph nodes, decrease of white blood cells (WBC), ratio of neutrophil to WBC (N ratio) and elevated lactate dehydrogenase (LDH), were different between patients with HNL and other diseases. Based on the multivariate analysis, the scoring approach was defined as follows: score = 3 (fever) + 2 (cervical lymphadenopathy) + 2 (decreased WBC) + 1 (decreased N ratio) + 2 (elevated LDH). The cut-off was score 4. This approach performed will detect HNL with an area under the curve of 0.889. CONCLUSION The present study suggests that the novel scoring approach we put forward might be useful to detect HNL in adult patients though further studies are needed.
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Affiliation(s)
- Ning Wang
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingying Zhu
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiaojiao Zhang
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuming Pan
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hairong Wang
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Achappa B, Herath NC, Sebastian B, Dsouza NV, RAGHURAM PAVANMANIBETTU, Holla R, Chowta N, Kini JR. Kikuchi-Fujimoto disease in a tertiary care teaching hospital in Coastal South India: A 8-year retrospective study. F1000Res 2022; 11:492. [PMID: 35811790 PMCID: PMC9226704 DOI: 10.12688/f1000research.109832.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Kikuchi-Fujimoto disease (KFD) is a rare, benign condition of unknown etiology, presenting as cervical lymphadenitis. Lymphadenopathy is usually tender and maybe associated with systemic symptoms. Despite the extensive literature on this disease, it continues to be misdiagnosed owing to its misleading clinical presentation.
Methods:
A retrospective hospital-based descriptive cross-sectional study was conducted in tertiary care hospitals from 2011 to 2019. All patients with confirmed KFD diagnosis were included and after ethics committee approval the clinical details and histopathological data was retrieved from the medical records department and analyzed.
Results:
A total of 67 cases were included. The mean age was 26.9±11.3 years with a female: male ratio of 1.9:1. There were 50 patients with tender cervical lymphadenopathy which was the most common clinical presentation. The mean length and width of palpable lymph nodes were 2.3±1.0 cm and 2.2±0.7 cm respectively. Histology revealed proliferative stage in majority of patients (
n=40, 59.7%). Lymphadenopathy resolved in 83.6% within 2 months. There were 42 patients who had complete recovery with symptomatic treatment within a period of 9 months.
Conclusions:
KFD is prevalent in young, female patients of Asian descent and often presents as tender cervical lymphadenopathy. Early diagnosis with excisional lymph node biopsy is crucial to avoid unnecessary investigations and treatment. Treatment is symptomatic unless complicated, where steroid therapy is considered. KFD has an excellent prognosis with almost no risk of fatality.
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Affiliation(s)
- Basavaprabhu Achappa
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nipuni Chamathka Herath
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Bodhi Sebastian
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nikhil Victor Dsouza
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - PAVAN MANIBETTU RAGHURAM
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nithyananda Chowta
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Jyoti Ramanath Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Masiak A, Lass A, Kowalski J, Hajduk A, Zdrojewski Z. Self-limiting COVID-19-associated Kikuchi-Fujimoto disease with heart involvement: case-based review. Rheumatol Int 2022; 42:341-348. [PMID: 35024942 PMCID: PMC8757403 DOI: 10.1007/s00296-021-05088-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/30/2021] [Indexed: 12/17/2022]
Abstract
Background The association between COVID-19 infection and the development of autoimmune diseases is currently unknown, but there are already reports presenting induction of different autoantibodies by SARS-CoV-2 infection. Kikuchi-Fuimoto disease (KFD) as a form of histiocytic necrotizing lymphadenitis of unknown origin. Objective Here we present a rare case of KFD with heart involvement after COVID-19 infection. To our best knowledge only a few cases of COVID-19-associated KFD were published so far. Based on presented case, we summarize the clinical course of KFD and its association with autoimmune diseases, as well we discuss the potential causes of perimyocarditis in this case. Methods We reviewed the literature regarding cases of “Kikuchi-Fujimoto disease (KFD)” and “COVID-19” and then “KFD” and “heart” or “myocarditis” by searching medical journal databases written in English in PubMed and Google Scholar. Results Only two cases of KFD after COVID infection have been described so far. Conclusion SARS-CoV-2 infection can also be a new, potential causative agent of developing KFD.
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Affiliation(s)
- Anna Masiak
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, ul. Dębinki 7, 80-952, Gdańsk, Poland.
| | - Amanda Lass
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, ul. Dębinki 7, 80-952, Gdańsk, Poland
| | - Jacek Kowalski
- Department of Pathomorphology, Medical University of Gdansk, Gdańsk, Poland
| | - Adam Hajduk
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, ul. Dębinki 7, 80-952, Gdańsk, Poland
| | - Zbigniew Zdrojewski
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, ul. Dębinki 7, 80-952, Gdańsk, Poland
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Faria C, Fernandes M, Cunha R, Moreira H, Costa R. Kikuchi-Fujimoto Disease: Diagnosis in a Relapsing Case. Cureus 2021; 13:e19542. [PMID: 34934560 PMCID: PMC8668199 DOI: 10.7759/cureus.19542] [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] [Accepted: 11/13/2021] [Indexed: 11/20/2022] Open
Abstract
The differential diagnosis of cervical lymphadenopathy is varied. Different age groups require different approaches. Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a rare but important diagnosis to consider after excluding more common aetiologies. We present the case of a 21-year-old female with painful left cervical swelling, lasting over a week. Physical examination revealed multiple cervical lymphadenopathies, elastic, non-adherent to deep tissues which were tender to touch. Blood tests showed elevated acute phase proteins. Cytomegalovirus, Epstein-Barr, toxoplasmosis, and human immunodeficiency virus serologies were negative. Computed tomography of the neck revealed multiple cervical lymphadenopathies which were round-shaped, some with necrosis and with extracapsular extent. These features could be compatible with tuberculous lymphadenitis. However, interferon-gamma release assay was negative. Excisional biopsy was scheduled, but spontaneous regression did not allow it. Two weeks later she relapsed. Excisional biopsy revealed histiocytic necrotizing lymphadenitis. Kikuchi-Fujimoto’s diagnosis demands high clinical suspicion and histological documentation. This case represents a rare diagnosis of a relapsing disease.
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Affiliation(s)
- Catarina Faria
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, PRT
| | - Marco Fernandes
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, PRT
| | - Rui Cunha
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, PRT
| | - Hugo Moreira
- Internal Medicine Department, Hospital São Francisco Xavier, Lisboa, PRT
| | - Rui Costa
- Internal Medicine, Hospital da Luz, Lisboa, PRT
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Gahlot GS, Dubey R, Chatterjee T, Chopra M. Necrotizing lymphadenitis with generalized adenopathy: A diagnostic dilemma – Kikuchi–Fujimoto disease. JOURNAL OF MARINE MEDICAL SOCIETY 2021. [DOI: 10.4103/jmms.jmms_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rare Presentation of Self-Limiting Kikuchi-Fujimoto Disease in Relapsing Nature. Case Rep Med 2020; 2020:9785104. [PMID: 33014067 PMCID: PMC7525287 DOI: 10.1155/2020/9785104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background Kikuchi–Fujimoto disease (KFD) is a rare, benign, and self-limiting disease that is commonly associated with cervical lymphadenopathy and fever. The disease has a wide spectrum of clinical manifestations, and definitive diagnosis is based on the histological appearance in the excision biopsy of the lymph nodes. Recurrence of KFD is reported rarely. Case Presentation. A 56-year-old Iranian woman with a background history of thrombocytopenia presented with fever, malaise, loss of appetite, and weight loss with cervical lymphadenopathy. The excision biopsy of the cervical lymph nodes confirmed the diagnosis of KFD, and she made a full recovery with improvement of symptoms, regression of cervical lymph nodes, and normalization inflammatory markers. One year after remission, she presented with similar clinico-biochemical profile, and repeat biopsy confirmed KFD. Conclusion Although the rate of recurrence of the disease is very low, the treating physician should consider the possibility and confirm it histologically.
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Kodithuwakku GDE, Fonseka CL, Nanayakkara S, Herath HMM. Pulmonary Onset of Adult Onset Still's Disease Complicated with Kikuchi Lymphadenitis. Case Rep Rheumatol 2020; 2020:8327068. [PMID: 32148996 PMCID: PMC7053467 DOI: 10.1155/2020/8327068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/03/2020] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adult onset Still's disease (AOSD) is a rare inflammatory disorder with a variety of clinical presentations. Even though pneumonitis and pleurisy are known to occur in AOSD, pulmonary onset presentations are exceedingly rare. Case Presentation. We present a 40-year-old male, presenting with fever and bilateral alveolar shadows with pleural effusions mimicking community-acquired severe pneumonia. He was initially treated as severe pneumonia with poor response to broad spectrum antibiotics. Subsequently, he was managed as AOSD-induced pneumonitis, as he fulfilled Yamaguchi criteria. Few weeks later, he developed macular rash and arthralgia with generalized lymphadenopathy with lymph node histology, showing Kikuchi lymphadenitis. He responded well to steroids and had a complete recovery. CONCLUSION Non-infective causes of pneumonitis should be suspected in the setting of poorly resolving pneumonias, especially when microbiological and serological investigations does not support an infective etiology. Presence of systemic symptoms with arthralgia, rash, and disproportionately elevated ferritin level supports the diagnosis of AOSD. Kikuchi lymphadenitis is a reported association with AOSD, and there could be a causal link between the two disorders.
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Affiliation(s)
| | - C L Fonseka
- University Medical Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - S Nanayakkara
- University Medical Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - H M M Herath
- University Medical Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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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.
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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
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Baziboroun M, Bayani M, Kamrani G, Saeedi S, Sharbatdaran M. Kikuchi-Fujimoto Disease in an Iranian Woman; a Rare but Important Cause of Lymphadenopathy. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:e3. [PMID: 30847438 PMCID: PMC6377216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Kikuchi-Fujimoto Disease (KFD), is a rare and self-limited condition of histiocytic necrotizing lymphadenitis, which typically presents as fever and lymphadenopathy. We describe a case of KFD in an Iranian woman. Due to low incidence and high importance, awareness of this disease is necessary for clinicians for early diagnosis and appropriate treatment. A 26-year-old woman was admitted to our hospital with a 3-week history of fever and lymphadenopathy. On physical examination, she had three separate enlarged lymph nodes on the right side of her neck. In laboratory tests that were carried out, she had mild anemia and an increase in C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR) and lactate dehydrogenase (LDH) level, while other tests were normal. Ultasound (U/S) guided core needle lymph node biopsy was performed and based on the histological finding, diagnosis of Kikuchi-Fujimoto disease was made. The patient was managed supportively and with prednisolone. She symptomatically improved and was discharged with no follow up. Although the incidence of KFD is rare, it must be considered as a differential diagnosis of lymphadenopathy especially in tuberculosis-endemic areas like our country-Iran. Moreover, it is necessary that physicians are aware of this disease in order to minimize unnecessary evaluation and toxic treatment.
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Affiliation(s)
- Mana Baziboroun
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Masomeh Bayani
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran,Correspondening author: Masomeh Bayani; Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. . Tel: +989113112559
| | - Ghodsieh Kamrani
- Department of Pathology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Shahab Saeedi
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Majid Sharbatdaran
- Department of Pathology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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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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