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Honda F, Tsuboi H, Toko H, Ohyama A, Takahashi H, Abe S, Yokosawa M, Asashima H, Hagiwara S, Hirota T, Kondo Y, Matsumoto I, Sumida T. Recurrent Kikuchi-Fujimoto Disease Successfully Treated by the Concomitant Use of Hydroxychloroquine and Corticosteroids. Intern Med 2017; 56:3373-3377. [PMID: 29021444 PMCID: PMC5790731 DOI: 10.2169/internalmedicine.9205-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 04/24/2017] [Indexed: 11/06/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign disease of unknown etiology characterized by lymphadenopathy and a fever. For the majority of patients with KFD, the course is self-limited; however, the optimum method of managing recurrent cases has not yet been established. We herein report a case of a 42-year-old Japanese woman with KFD (confirmed by a lymph node biopsy). Although high-dose prednisolone (PSL) rapidly induced remission, she experienced four recurrences on treatment tapering. Concomitant use of hydroxychloroquine (HCQ) with low-dose PSL induced continuous remission. This is the first case to suggest the effectiveness of HCQ for recurrent KFD in a Japanese patient.
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Affiliation(s)
- Fumika Honda
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hirofumi Toko
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Ayako Ohyama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hidenori Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Saori Abe
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Masahiro Yokosawa
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiromitsu Asashima
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Shinya Hagiwara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Tomoya Hirota
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
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Clinical association between Kikuchi׳s disease and systemic lupus erythematosus: A systematic literature review. Semin Arthritis Rheum 2017; 47:46-52. [DOI: 10.1016/j.semarthrit.2017.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 01/21/2017] [Accepted: 01/23/2017] [Indexed: 12/17/2022]
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3
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Ruaro B, Sulli A, Alessandri E, Fraternali-Orcioni G, Cutolo M. Kikuchi-Fujimoto's disease associated with systemic lupus erythematous: difficult case report and literature review. Lupus 2014; 23:939-44. [PMID: 24739458 DOI: 10.1177/0961203314530794] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 03/11/2014] [Indexed: 11/16/2022]
Abstract
Kikuchi-Fujimoto's disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign and self-limiting disease of unknown aetiology. KFD tends to affect a young population under 30 years of age and predominantly females. KFD is a rare pathology and its association with systemic lupus erythematosus (SLE) is not frequent. Herein, we present the case of a male Italian patient with SLE in association with KFD with 5 years of follow-up, where a differential diagnosis from infection or lymphoproliferative disease was problematic.
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Affiliation(s)
- B Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - A Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - E Alessandri
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - G Fraternali-Orcioni
- Department of Pathology, Anatomic Pathology Division, San Martino University Hospital, Genova, Italy
| | - M Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
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Luijten RK, Fritsch-Stork RD, Bijlsma JW, Derksen RH. The use of glucocorticoids in Systemic Lupus Erythematosus. After 60years still more an art than science. Autoimmun Rev 2013; 12:617-28. [DOI: 10.1016/j.autrev.2012.12.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/02/2012] [Indexed: 01/18/2023]
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Mrówka-Kata K, Kata D, Kyrcz-Krzemień S, Sowa P. Kikuchi-Fujimoto disease as a rare cause of lymphadenopathy--two cases report and review of current literature. Otolaryngol Pol 2013; 67:1-5. [PMID: 23374656 DOI: 10.1016/j.otpol.2012.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 02/22/2012] [Accepted: 02/23/2012] [Indexed: 11/30/2022]
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a benign and self-limited disease, characterized typically by enlargement of regional lymph nodes accompanied by fever. KFD affects predominantly young adult females of Asian origin and is rarely seen in European countries, where it may cause diagnostic difficulties. Two cases of KFD in a 33 and 27-year-old woman with mild fever, malaise, lymphadenopathy initially misdiagnosed for indolent non-Hodgkin's lymphoma was presented. The definitive diagnosis was established on the basis of histopathological examination of totally excised cervical lymph nodes. The propriety diagnosis allowed us to avoid inappropriate chemotherapy. The disease course in our patient was uneventful during the 1.5 and 12-year follow-up period. The clinical presentations, complications as well as current concepts on pathogenesis, diagnosis and treatment of the Kikuchi-Fujimoto disease was briefly reviewed in this paper. The need of a long-term follow-up of patients with Kikuchi-Fujimoto disease was emphasized.
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Affiliation(s)
- Katarzyna Mrówka-Kata
- Katedra i Oddział Kliniczny Laryngologii w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach, ul. M. Skłodowskiej-Curie 10, 41-800 Zabrze, Poland.
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Bharadwaj A, Abdulla A. Kikuchi Fujimoto and connective tissue diseases – Uncommon association commonly missed. INDIAN JOURNAL OF RHEUMATOLOGY 2012. [DOI: 10.1016/j.injr.2012.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Mahajan T, Merriman RC, Stone MJ. Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis): report of a case with other autoimmune manifestations. Proc (Bayl Univ Med Cent) 2011; 20:149-51. [PMID: 17431451 PMCID: PMC1849878 DOI: 10.1080/08998280.2007.11928275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign and self-limited disease that mainly affects young women. Patients present with localized lymphadenopathy, fever, and leukopenia in up to half of the cases. KFD can occur in association with systemic lupus erythematosus. We present the case of a patient with KFD and systemic lupus erythematosus, as well as relapsing polychondritis. This patient had persistently low C4 complement levels, so she was evaluated for a genetic defect in complement production and was found to have two "null" C4 alleles. We believe that this may have contributed to the development of her diseases.
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Affiliation(s)
- Tina Mahajan
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
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Abstract
Kikuchi’s disease, a rare disorder which usually presents with fever painful lymphadenopathy, rash and arthritis, all of which are close mimickers of infective and immunological disorders. It is essentially a histopathological diagnosis and tests to rule out other connective tissue disorders or infective etiology must be undertaken. We present a series of two cases of kikuchi-fujimoto’s disease presenting primarily with lymphadenopathy and fever in all cases. The first is a case of generalized lymphadenopathy and the second case of kikuchi’s disease with SLE, a rare association. Lymph node excision biopsy and histopathology documented Kikuchi Fujimoto disease in above cases. All the cases improved on follow up and had no residual stigmata.
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Affiliation(s)
- Pankaj Singhania
- Department of Medicine, Medical College and Hospitals, Kolkata, India
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Kim SK, Kang MS, Yoon BY, Kim DY, Cho SK, Bae SC, Her MY. Histiocytic necrotizing lymphadenitis in the context of systemic lupus erythematosus (SLE): Is histiocytic necrotizing lymphadenitis in SLE associated with skin lesions? Lupus 2011; 20:809-19. [PMID: 21562017 DOI: 10.1177/0961203310397684] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Histiocytic necrotizing lymphadenitis (HNL), or Kikuchi's disease, is a benign and self-limiting lymphadenopathy that typically affects young Asian females. It presents with lymphadenopathy, usually cervical, accompanied by fever, chills and leukopenia. Although the association between systemic lupus erythematosus (SLE) and HNL is rare, the number of reports of HNL in SLE patients is increasing. We present nine cases of HNL in patients with SLE. Among the seven patients with diverse skin manifestations, three had skin manifestations that were histologically compatible with SLE. A review of previous reports in the literature showed that cutaneous involvement was commonly found in HNL in association with SLE. In the patients who had simultaneous onset of both diseases, lupus flare-ups were commonly observed. We suggest that HNL in SLE patients is associated with cutaneous manifestations. This report contributes to our understanding of the relationship between these diseases.
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Affiliation(s)
- S K Kim
- Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, South Korea
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Chen PH, Huang YF, Tang CW, Wann SR, Chang HT. Kikuchi-Fujimoto disease: an amazing response to hydroxychloroquine. Eur J Pediatr 2010; 169:1557-9. [PMID: 20645108 DOI: 10.1007/s00431-010-1256-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 07/06/2010] [Indexed: 11/29/2022]
Abstract
Kikuchi-Fujimoto disease is a benign and self-limited disorder. The common clinical features are fever and cervical lymphadenitis. A 9-year-old girl with fever and cervical lymphadenitis was admitted because of persistent symptoms. A cervical lymph node biopsy showed the characteristic features of Kikuchi-Fujimoto disease. Herein, we will discuss the clinical features, diagnosis, and treatment of Kikuchi-Fujimoto disease and highlight the dramatic response when a patient was treated with hydroxychloroquine.
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Affiliation(s)
- Po-Hung Chen
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st road, Kaohsiung City, Taiwan
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Astudillo L. [Kikuchi-Fujimoto disease]. Rev Med Interne 2010; 31:757-65. [PMID: 20605287 DOI: 10.1016/j.revmed.2010.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 11/07/2009] [Accepted: 01/01/2010] [Indexed: 01/30/2023]
Abstract
Kikuchi-Fujimoto disease is a necrotizing lymphadenitis, involving young patients, predominantly females. Lymphadenopathy is usually localized, particularly in the cervical area, mostly unilateral and tender. Fever is present in one third of cases. Associated skin lesions, arthralgia, myalgia, splenomegaly or hepatomegaly are rare. Laboratory evaluation shows a slight increase of erythrocyte sedimentation rate and leukopenia. Kikuchi-Fujimoto has been reported in association with other diseases, including systemic lupus, Still's disease, hemophagocytosis, pregnancy, other autoimmune diseases, and cancer. A viral or bacterial origin has been suspected but not confirmed. Lymph node biopsy allows the diagnosis and shows necrotizing lymphadenitis with acidophil necrosis, CD68+ histiocyte infiltrate, presence of plasmacytoid monocytes, multiple apoptotic cells (CD8+ T cell) with nuclear dust, immunoblastic reaction and the absence of neutrophils or eosinophils. The disease course is usually spontaneously favourable in few weeks or months, requiring corticosteroids only occasionally.
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Affiliation(s)
- L Astudillo
- Service de médecine interne, CHU Purpan, Toulouse cedex, France.
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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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Ponnusamy A, Woywodt A, Reeve R, Kondlapudi J, Lewis D. Kikuchi disease preceding systemic lupus erythematosus with membranous lupus nephritis. NDT Plus 2009; 2:370-2. [PMID: 25949346 PMCID: PMC4421372 DOI: 10.1093/ndtplus/sfp090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 06/25/2009] [Indexed: 11/14/2022] Open
Abstract
Kikuchi disease (KD) is a rare form of necrotizing lymphadenitis. KD usually presents with cervical lymphadenopathy and fever in young women. It tends to run a benign course and resolve spontaneously within months. The aetiology of the disease is still unclear although a variety of infectious agents have been postulated. There is also a documented but rare association with systemic lupus erythematosus (SLE). We present the case of a young woman with biopsy-proven KD who subsequently developed SLE with biopsy-proven lupus nephritis. Nephrologists should be aware of KD as it may precede the development of SLE and lupus nephritis.
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Affiliation(s)
| | - Alexander Woywodt
- Renal Unit , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire
| | - Roy Reeve
- Department of Pathology, Salford Royal NHS Foundation Trust, Salford , UK
| | - Jyothi Kondlapudi
- Renal Unit , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire
| | - David Lewis
- Renal Department, Salford Royal NHS Foundation Trust, Salford
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Vassilakopoulos TP, Pangalis GA, Siakantaris MP, Levidou G, Yiakoumis X, Floudas C, Gribabis D, Bouros S, Metaxas I, Dimitriadou EM, Pantazi L, Tsoukala C, Korkolopoulou P, Andreopoulos A, Vaiopoulos G. Kikuchi's lymphadenopathy: a relatively rare but important cause of lymphadenopathy in Greece, potentially associated with the antiphospholipid syndrome. Rheumatol Int 2009; 30:925-32. [PMID: 19693507 DOI: 10.1007/s00296-009-1077-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 07/17/2009] [Indexed: 11/30/2022]
Abstract
Kikuchi-Fujimoto disease is a form of reactive lymphadenopathy, which was firstly described in Japan, but is uncommon in the Western world. We retrospectively reviewed the medical records of nine cases of adult or adolescent Kikuchi's disease diagnosed in a single Haematology Unit in Athens, Greece between 1990 and 2006. The median age of the patients was 25 years (14-40) and 8/9 were females. All patients presented with cervical lymphadenopathy sparing the supraclavicular fossa; one had associated axillary lymphadenopathy, seven had fever and two were asymptomatic. The median duration of lymphadenopathy before presentation was 30 days (10-45). Just palpable splenomegaly was recorded in three patients. The median value of the maximal lymph node diameter was 2 cm (1-5) and only 1/9 had nodes >2 cm in their largest diameter. Lymphadenopathy was tender in two patients; hard nodes were observed in three patients. The median leukocyte count was 4.7 x 10(9)/l (2.2-4.9) with a normal differential in 7/9 patients. No infectious agent could be demonstrated. One patient had clinical and laboratory evidence of primary antiphospholipid syndrome (APLS). In conclusion, Kikuchi's disease represents a rare but important diagnostic possibility for patients presenting with lymphadenopathy in Greece and other western countries. In this setting, autoimmune disorders, mainly lupus and APLS, should be considered and excluded by the appropriate laboratory work-up.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- First Department of Internal Medicine and Department of Haematology, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Ag. Thoma street, Goudi, Athens, 11527, Greece
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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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Frikha F, Marzouk S, Frigui M, Jallouli M, Kechaou M, Kaddour N, Boudawara T, Jlidi R, Bahloul Z. [Kikuchi-Fujimoto's disease and connective tissue disease: a report of three cases]. Rev Med Interne 2007; 29:129-34. [PMID: 17981372 DOI: 10.1016/j.revmed.2007.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 06/05/2007] [Accepted: 07/26/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Kikuchi-Fujimoto's disease or histiocytic necrotizing lymphadenitis, clinicopathological entity of unknown aetiology, is a rare and benign cause of cervical lymphadenopathies. It can be associated with various auto-immune diseases especially systemic lupus erythematous (SLE) or with some infectious agents. EXEGESIS This report describes a survey of three patients who developed Kikuchi's lymphadenitis occurring concomitantly with connective tissue disease: LES in two cases and non determined connective tissue disease in the other case. Comparing the clinical, histopathological and evolutionary findings to the literature allows to identify the main features of this self-limiting disorder: occurrence in young women; clinical presentation with cervical lymphadenopathy in a context of fever and asthenia. The definite diagnosis is usually made through histopathological examination of a lymph node biopsy. Disease course is generally favourable with spontaneous resolution within few weeks. It may be improved with corticosteroid treatment in patients with systemic involvement. Prognosis is related to the associated disease. CONCLUSION Kikuchi-Fujimoto's disease is a rare and benign cause of cervical lymphadenopathy that could resemble lymphoma, tuberculosis and may be associated with a characterized systemic disease.
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Affiliation(s)
- F Frikha
- Service de médecine interne, CHU d'Hédi-Chaker, Sfax 3029, Tunisie.
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Chen HC, Lai JH, Huang GS, Gao HW, Chen CH, Kuo SY, Chang DM. Systemic lupus erythematosus with simultaneous onset of Kikuchi-Fujimoto's disease complicated with antiphospholipid antibody syndrome: a case report and review of the literature. Rheumatol Int 2005; 25:303-6. [PMID: 15645234 DOI: 10.1007/s00296-004-0507-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Accepted: 07/19/2004] [Indexed: 11/26/2022]
Abstract
Histiocytic necrotizing lymphadenitis, called Kikuchi-Fujimoto's disease (KFD), is an idiopathic, self-limited condition rarely associated with systemic lupus erythematosus (SLE). The cause of concomitant KFD and SLE is still unknown. We describe a 19-year-old man simultaneously diagnosed with both KFD and SLE complicated with deep vein thrombosis (DVT). To the best of our knowledge, this is the first case report of KFD associated with SLE complicated with antiphospholipid antibody syndrome (APS). Our patient was successfully treated with intravenous pulse methylprednisolone, anticoagulation with heparin, oral hydroxychloroquine, azathioprine, and low-dose aspirin.
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Affiliation(s)
- Hsiang-Cheng Chen
- Division of Rheumatology-Immunology-Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, 114 Neihu, Taipei, Taiwan
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Abstract
OBJECTIVE Kikuchi's disease (KD), or histiocytic necrotizing lymphadenitis, is a unique form of self-limiting lymphadenitis and typically affects the head and neck regions. It usually occurs in young adults and has a female predilection. The aim of this study was to review the authors' institutional experience with KD in children over a 16-year period. METHODS Between January 1986 and May 2002, a total of 23 patients who were younger than 16 years underwent cervical lymph node biopsies and received a diagnosis of KD. Clinical features, laboratory values, pathologic parameters, specific characteristics of our pediatric patients, and long-term follow-up results are discussed. The follow-up period averaged 8 years. RESULTS There were 8 girls and 15 boys with a mean age of 12.8. All 23 patients had affected cervical lymph nodes located in the posterior cervical triangle, and 2 cases additionally had affected nodes in the anterior triangle. Cervical lymph nodes were affected unilaterally in 82.6% (19) and bilaterally in 17.4% (4) of these patients. The dimensions of the affected lymph nodes were commonly in the range of 0.5 to 3 cm (52.2%; 12 of 23) and 3 to 6 cm (39.1%; 9 of 23). In 2 (8.7%) patients, the size of the enlarged lymph nodes reached >6 cm. Leukopenia was observed in 5 (21.7%) patients, and fever was observed in 7 (30.4%) patients. One child with KD developed systemic lupus erythematosus 5 years later. The cervical lymphadenopathy usually resolved itself without any medical treatment within 6 months after definite diagnosis was made. Neither recurrence nor persisting KD has since been noted. CONCLUSION KD, although rare, should be part of the differential diagnosis for posterior cervical lymphadenopathy in children, especially in patients of Asian descent. In our pediatric series, KD demonstrated a male predominance, which is in contrast to previously reported adult series demonstrating a female predominance. The children with KD require a systemic survey and regular follow-up for several years to rule out the development of systemic lupus erythematosus.
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Rezai K, Kuchipudi S, Chundi V, Ariga R, Loew J, Sha BE. Kikuchi-Fujimoto disease: hydroxychloroquine as a treatment. Clin Infect Dis 2004; 39:e124-6. [PMID: 15578393 DOI: 10.1086/426144] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Accepted: 09/01/2004] [Indexed: 02/01/2023] Open
Abstract
We describe a case of recurrent Kikuchi's disease in a South Asian-American man that was treated successfully with chloroquine and on recurrence with hydroxychloroquine. Each treatment led to a very prompt response.
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Affiliation(s)
- Katayoun Rezai
- Section of Infectious Diseases, Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, USA.
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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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Goteri G, Filosa A, Pieramici T, Fioravanti P, Barocci G, Bearzi I. Cutaneous Kikuchi's disease: report of a new case and review of the literature. Histopathology 2004; 45:300-1. [PMID: 15330812 DOI: 10.1111/j.1365-2559.2004.01851.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Toll A, Gilaberte M, Matias-Guiu X, Camacho L, Alomar A, Gonzalez-Gay MA, M Pujol R. Kikuchi's disease (necrotizing lymphadenitis) with cutaneous involvement associated with subacute cutaneous lupus erythematosus. Clin Exp Dermatol 2004; 29:240-3. [PMID: 15115501 DOI: 10.1111/j.1365-2230.2004.01454.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Necrotizing histiocytic lymphadenopathy (Kikuchi's disease) is a rarely observed clinical entity characterized by fever, and solitary or multiple lymphadenopathy predominantly in the posterior cervical region. Kikuchi's disease has been reported to precede, coexist with or follow the diagnosis of systemic lupus erythematosus. In only rare instances has its association with cutaneous lupus erythematosus without systemic involvement been reported. We report a 45-year-old woman who presented characteristic systemic and cutaneous manifestations of Kikuchi's disease. Several months later, after sun exposure, she developed lesions of subacute cutaneous lupus erythematosus. The American Rheumatism Association criteria for systemic lupus erythematosus were not fulfilled. The possible pathogenic relationships between the two processes are discussed.
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Affiliation(s)
- A Toll
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
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Hernando M, González C, Sánchez A, Guevara P, Navajo JA, Papisch W, González-Buitrago JM. Clinical evaluation of a new automated anti-dsDNA fluorescent immunoassay. Clin Chem Lab Med 2002; 40:1056-60. [PMID: 12476949 DOI: 10.1515/cclm.2002.185] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The measurement of anti-double-stranded DNA (anti-dsDNA) antibodies is a useful tool for the diagnosis and the follow-up of systemic lupus erythematosus (SLE). Anti-dsDNA antibodies are involved in the pathogenesis of lupus nephritis and they are, specially the high-avidity antibodies, the most specific antibodies associated with SLE nephritis and active SLE. The aim of the present study was to assess the clinical utility of an enzyme-linked immunosorbent assay (EUSA) that utilizes a circular double-stranded plasmid DNA as a nucleic acid source, adapted to an automated fluorescence immunoassay (EliA dsDNA, Pharmacia, Freiburg, Germany). Also, we compared this method with other immunoassays used in clinical laboratories. We have measured anti-dsDNA antibodies in the serum of 179 patients with a positive result for antinuclear antibodies (ANA). Seventy six sera were from SLE patients (14 men and 62 women), and the other 103 sera (from 20 men and 83 women) constituted the control group. This latter group includes nine Sjogren's syndrome patients, six patients with rheumatoid arthritis and 88 with various other diseases, including connective tissue diseases (n=34), hepatopathies (n= 17; 11 primary biliary cirrhosis and 6 autoimmune hepatitis), and 37 patients with nonautoimmune diseases (viral hepatitis, renal disease, diabetes, exanthema and hypertension). Methods used were "EliA dsDNA" (Pharmacia, Germany), "Varelisa dsDNA" (Pharmacia, Germany), Farr (Amersham, UK) and Chritidia luciliae immunofluorescence test (Vitro-Immun, Germany). We assessed sensitivity, specificity, positive predictive value and negative predictive value in the clinical study, and kappa index and scatter plots in the comparative study. The results show a low concordance between methods (kappa < 0.6). The evaluated EliA method shows a very good specificity for SLE (93.2%) and a good sensitivity for active SLE (70.8%).
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Ben Ghorbel I, Houman MH, Lamloum M, Khanfir M, Miled M, Kchir N, Bellil K, Sahtout S. [Concomitant association of Kikuchi disease and systemic lupus erythematosus. Case report]. Rev Med Interne 2002; 23:797-9. [PMID: 12378836 DOI: 10.1016/s0248-8663(02)00679-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Baumgartner BJ, Helling ER. Kikuchi's Disease: A Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2002. [DOI: 10.1177/014556130208100511] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Kikuchi's disease is a necrotizing lymphadenitis that is prevalent in Asia and is being increasingly recognized in other areas of the world. It usually occurs in women in their late 20s or early 30s and manifests as a posterior cervical adenopathy. It resolves spontaneously, usually over a period of several weeks to 6 months. Its initial clinical appearance is commonly similar to that of a lymphoma, and it can be pathologically misdiagnosed as such. Kikuchi's disease might be associated with systemic lupus erythematosus. We report a case of Kikuchi's disease that occurred in a 36-year-old Asian woman. We discuss the clinical features, differential diagnosis, radiographic evaluation, and pathology of this case, and we review the literature in an effort to assist otolaryngologists in diagnosing this benign and uncommon entity.
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Affiliation(s)
- Brian J. Baumgartner
- Department of Otolaryngology-Head and Neck Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Eric R. Helling
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, San Antonio, Tex
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Hermosillo-Romo D, Brey RL. Diagnosis and management of patients with neuropsychiatric systemic lupus erythematosus (NPSLE). Best Pract Res Clin Rheumatol 2002; 16:229-44. [PMID: 12041951 DOI: 10.1053/berh.2001.0223] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Neuropsychiatric systemic lupus erythematosus (NPSLE) involves a wide range of focal and diffuse central and peripheral nervous system disorders and affects up to 75% of SLE patients. NPSLE can occur any time in the course of SLE, even during periods in which no SLE disease activity is detected, and is likely to be caused by multiple factors, including autoantibody production, microvasculopathy and pro-inflammatory cytokines. Central to the diagnosis of NPSLE is the question of whether the presenting neuropsychiatric symptoms are due to SLE-mediated organ dysfunction, infection, medication side-effects or metabolic abnormalities (e.g. uraemia), or are due to an unrelated condition. The diagnostic inference of NPSLE can be made only after these secondary causes have been excluded. There is no one single diagnostic tool specific to NPSLE, and clinical diagnostic impressions must be based on the combined use of immunoserological testing, functional and/or structural neuroimaging and standardized neurological, rheumatological, psychiatric and neuropsychological assessments. The management of NPSLE includes symptomatic and/or immunosuppressive treatment strategies depending on the specific presenting neuropsychiatric symptoms and whether these occur in the setting of an SLE disease activity flare.
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Affiliation(s)
- David Hermosillo-Romo
- Division of Neurology 7883, 7703 Floyd Curl Drive, San Antonio, Texas 78229-3900, USA
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