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Kedar AK, Ghewade B, Jadhav U, Wagh P, Alone VD. Kikuchi-Fujimoto Disease: A Rare Presentation in a Young Male. Cureus 2024; 16:e55615. [PMID: 38586771 PMCID: PMC10995736 DOI: 10.7759/cureus.55615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare benign condition characterized by cervical lymphadenopathy and constitutional symptoms mimicking tuberculosis. We present the case of a 22-year-old male who presented with fever, dry cough, loss of appetite, multiple joint pains for 15 days, and loss of weight for one month. Physical examination revealed palpable cervical, occipital, axillary, and inguinal lymphadenopathy, and laboratory investigations were within normal limits except for raised erythrocyte sedimentation rate (ESR). Contrast-enhanced computed tomography (CECT) showed mediastinal lymphadenopathy with no pleuroparenchymal abnormality of the lung. Excision biopsy of a cervical lymph node confirmed necrotizing lymphadenitis consistent with KFD. The patient was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, resulting in the resolution of symptoms and regression of lymphadenopathy. This case signifies the importance of considering KFD in the differential diagnosis of lymphadenopathy and highlights the significance of histopathological evaluation for accurate diagnosis and management guidance.
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Affiliation(s)
- Aishwarya K Kedar
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Babaji Ghewade
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ulhas Jadhav
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pankaj Wagh
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vivek D Alone
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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2
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Nair PR, Bankar NJ, Choudhary A, Shrivastava D. Kikuchi Fujimoto Lymphadenitis: A Rare Association With COVID-19 Vaccination. Cureus 2023; 15:e45979. [PMID: 37900436 PMCID: PMC10600953 DOI: 10.7759/cureus.45979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is an uncommon cause of protracted cervical lymphadenopathy in both children and adults. Although the majority of cases have been documented in Asia, this disease has been characterized globally since it was first identified in Japan in 1972. KFD's etiology is not entirely understood, although various theories have been postulated. Usually benign, Kikuchi-Fujimoto disease resolves within six months. KFD must be distinguished from other causes of chronic lymphadenopathy, such as lymphoma, inflammatory illnesses, autoimmune conditions, viral lymphadenopathy, and also from tuberculosis, especially in India, where it is still endemic. Here, we present the case report of a healthcare worker with a known case of hypothyroidism and autoimmune skin disorder who presented with prolonged fever, joint pain, and generalized lymphadenopathy post-COVID vaccination and was diagnosed as having KFD on biopsy, which can be associated with a very unusual presentation of this disease.
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Affiliation(s)
- Priya R Nair
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nandkishor J Bankar
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amruta Choudhary
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepti Shrivastava
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Yamamura Y, Furuichi K, Toyama T, Oshima M, Ogura H, Sato K, Nakagawa S, Miyagawa T, Kitajima S, Hara A, Iwata Y, Sakai N, Shimizu M, Ikeda H, Toma T, Takasawa K, Yachie A, Wada T. Repeated Necrotizing Lymphadenitis with MEFV Gene Mutations. Intern Med 2022; 61:1105-1110. [PMID: 34511567 PMCID: PMC9038464 DOI: 10.2169/internalmedicine.7882-21] [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] [Indexed: 11/06/2022] Open
Abstract
We herein report a 36-year-old man with repeated necrotizing lymphadenitis due to MEFV gene mutations. The patient's chief complaints were a fever and painful cervical lymphadenopathy. We diagnosed him with necrotizing lymphadenitis based on the pathological findings of the lymph nodes and the exclusion of other differential diseases. The same episode recurred four times. We speculated the involvement of autoinflammatory backgrounds and detected MEFV gene mutations of E148Q (homo), P369S, and R408Q. Considering the elevation of interleukin-18, these mutations probably played roles in the repeated necrotizing lymphadenitis.
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Affiliation(s)
- Yuta Yamamura
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Kengo Furuichi
- Department of Nephrology, School of Medicine, Kanazawa Medical University, Japan
| | - Tadashi Toyama
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Megumi Oshima
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Hisayuki Ogura
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Koichi Sato
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Shiori Nakagawa
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Taro Miyagawa
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Shinji Kitajima
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Akinori Hara
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Yasunori Iwata
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Norihiko Sakai
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Miho Shimizu
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Hiroko Ikeda
- Department of Diagnostic Pathology, Kanazawa University Hospital, Japan
| | - Tomoko Toma
- Department of Pediatrics, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Kazuya Takasawa
- Department of Internal Medicine, Public Central Hospital of Matto Ishikawa, Japan
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
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4
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Huang C. The Differential Diagnosis of Bilateral Pleural Effusion and Multiple Mediastinal Lymphadenopathies Includes Kikuchi-Fujimoto Disease. J Investig Med High Impact Case Rep 2021; 8:2324709620933422. [PMID: 32517589 PMCID: PMC7288820 DOI: 10.1177/2324709620933422] [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] [Indexed: 11/17/2022] Open
Abstract
Kikuchi-Fujimoto disease is an uncommon lymphohistiocytic disorder that frequently presents with acute or subacute clinical disease course. Cervical lymphadenopathy is the most common involved lymph node. Very rare cases of pathologic diagnosis of Kikuchi-Fujimoto disease with bilateral pleural effusion and multiple mediastinal lymphadenopathies have been reported in the literature. In this article, we report the case of a 60-year-old male presented with bilateral pleural effusion and multiple mediastinal lymphadenopathies. He received video-assisted thoracoscopic surgery of the right pleura and thoracoscopic excision of the mediastinal lymph node. The pathologic findings from the lymph node and pleura were compatible with Kikuchi-Fujimoto disease. He was treated with oral hydroxychloroquine and oral prednisolone. A computed tomography scan of the chest 4 months later showed regressive mediastinal lymphadenopathy and bilateral pleural effusion. Our case is a first reported case of Kikuchi-Fujimoto disease diagnosis by the pathology of the lymph node and pleura in the literature. Results from our case suggest that Kikuchi-Fujimoto disease should be included in the differential diagnosis of bilateral pleural effusion and multiple mediastinal lymphadenopathies.
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Affiliation(s)
- Chienhsiu Huang
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Town, Chiayi County
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5
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Nelson ND, Meng W, Rosenfeld AM, Bullman S, Sekhar Pedamallu C, Nomburg JL, Wertheim GB, Paessler ME, Pinkus G, Hornick JL, Meyerson M, Luning Prak ET, Pillai V. Characterization of Plasmacytoid Dendritic Cells, Microbial Sequences, and Identification of a Candidate Public T-Cell Clone in Kikuchi-Fujimoto Disease. Pediatr Dev Pathol 2021; 24:193-205. [PMID: 33530869 DOI: 10.1177/1093526620987961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Kikuchi-Fujimoto disease (KFD) is a self-limited lymphadenitis of unclear etiology. We aimed to further characterize this disease in pediatric patients, including evaluation of the CD123 immunohistochemical (IHC) staining and investigation of potential immunologic and infectious causes. METHODS Seventeen KFD cases and 12 controls were retrospectively identified, and the histologic and clinical features were evaluated. CD123 IHC staining was quantified by digital image analysis. Next generation sequencing was employed for comparative microbial analysis via RNAseq (5 KFD cases) and to evaluate the immune repertoire (9 KFD cases). RESULTS In cases of lymphadenitis with necrosis, >0.85% CD123+ cells by IHC was found to be six times more likely in cases with a final diagnosis of KFD (sensitivity 75%, specificity 87.5%). RNAseq based comparative microbial analysis did not detect novel or known pathogen sequences in KFD. A shared complementarity determining region 3 (CDR3) sequence and use of the same T-cell receptor beta variable region family was identified in KFD LNs but not controls, and was not identified in available databases. CONCLUSIONS Digital quantification of CD123 IHC can distinguish KFD from other necrotizing lymphadenitides. The presence of a unique shared CDR3 sequence suggests that a shared antigen underlies KFD pathogenesis.
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Affiliation(s)
- Nya D Nelson
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wenzhao Meng
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aaron M Rosenfeld
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Bullman
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology and Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chandra Sekhar Pedamallu
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology and Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason L Nomburg
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology and Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gerald B Wertheim
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michele E Paessler
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Geraldine Pinkus
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Meyerson
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology and Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eline T Luning Prak
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vinodh Pillai
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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6
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Salamat S, Chan J, Jolly K, Powell G, Harrison K, Ahanger S, Hari C. Kikuchi-Fujimoto Disease and Prognostic Implications. Head Neck Pathol 2019; 14:272-275. [PMID: 30888636 PMCID: PMC7021859 DOI: 10.1007/s12105-019-01026-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/02/2019] [Indexed: 12/19/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenitis seen mostly in Asian populations (Kikuchi in Nippon Ketsueki Gakkai Zasshi 35:379-80, 1972). First described in 1972, KFD is a benign and self-limiting disease characterised by lymphadenopathy, mild fever, fatigue, and leukopenia (Fujimoto in Naika 30:920-7, 1972; Lin et al. in Otolaryngol Head Neck Surg 128(5): 650-3, 2003). We present a case of a 38-year-old woman with a 6-week history of cervical lymphadenopathy. Her ultrasound scan and fine needle aspiration cytology results were inconclusive. Excisional biopsy of the lymph node confirmed presence of KFD. The aetiology of KFD is unknown; however, there is strong association with systemic lupus erythematosus (SLE). Kucukardali reported 9% of European KFD patients and 28% of East Asian patients had concomitant SLE (Kucukardali et al. in Clin Rheumatol 26(1):50-4, 2007). We describe a follow-up algorithm for newly diagnosed KFD cases, based on the current literature. KFD is a rare cause of cervical lymphadenopathy. It is associated with increased risk of developing SLE, therefore early diagnosis and long-term follow-up are recommended.
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Affiliation(s)
- Sebastian Salamat
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
| | - Jacquline Chan
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
| | - Karan Jolly
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
| | - George Powell
- Department of Pathology, Shrewsbury and Telford NHS Trust, Telford, Shropshire UK
| | - Katherine Harrison
- Department of Pathology, Shrewsbury and Telford NHS Trust, Telford, Shropshire UK
| | - Sajad Ahanger
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
| | - Churunal Hari
- grid.415251.60000 0004 0400 9694Department of Otolaryngology, Princess Royal Hospital, Telford, Shropshire UK
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7
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Singh JM, Shermetaro CB. Kikuchi-Fujimoto Disease in Michigan: A Rare Case Report and Review of the Literature. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619828680. [PMID: 30833818 PMCID: PMC6393831 DOI: 10.1177/1179550619828680] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/28/2018] [Indexed: 11/16/2022]
Abstract
Background: Kikuchi-Fujimoto Disease (KFD), also known as Histiocytic Necrotizing Lymphadenitis, is a rare cause of prolonged cervical lymphadenopathy in both the pediatric and adult populations. It was first reported in Japan in 1972, and since, this disease has been described worldwide, although most cases have been reported in Asia. The etiology of KFD is not fully understood, although there are 2 theories that are described in detail in this review. Kikuchi-Fujimoto Disease typically follows a benign course, with resolution of the lymphadenopathy within 6 months. It is important to recognize KFD as a cause of persistent lymphadenopathy, as it shares many characteristics with and must be differentiated from other causes of lymphadenopathy, including lymphoma, inflammatory disorders, autoimmune conditions, and infectious causes of lymphadenopathy. Case presentation: Here is presented a case of an 11-year-old male who was born in Vietnam, but subsequently adopted and raised in the United States, who presented to a private practice community-based Otolaryngology group. His chief complaint was a persistent neck mass of approximately 3 months duration. He underwent excisional biopsy for suspected lymphoma, but final pathology rendered a diagnosis of KFD. Conclusion: The purpose of this article is not only to review the literature but also to contribute awareness of this entity in the differential diagnosis of persistent lymphadenopathy, especially for the general Otolaryngologist in a community-based setting. In addition, this review would be beneficial for other practitioners as well, specifically Pediatricians, Infectious Disease Physicians, Rheumatologists, Pathologists, and Medical Oncologists.
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Affiliation(s)
- Jeffrey Michael Singh
- Department of Otolaryngology/Head and Neck Surgery, McLaren Oakland Hospital, Pontiac, MI, USA
- Jeffrey Michael Singh, McLaren Oakland Hospital, 50 North Perry St, Pontiac, IL 48342, USA.
| | - Carl Bernard Shermetaro
- Department of Otolaryngology/Head and Neck Surgery, McLaren Oakland Hospital, Pontiac, MI, USA
- North Oakland Ear, Nose & Throat Centers, P.C., Clarkston, MI, USA
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8
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Gatto M, Zen M, Iaccarino L, Doria A. New therapeutic strategies in systemic lupus erythematosus management. Nat Rev Rheumatol 2018; 15:30-48. [DOI: 10.1038/s41584-018-0133-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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9
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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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10
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Abstract
Kikuchi disease is a rare, idiopathic, self-limited disorder affecting the cervical lymph nodes.
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11
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Baenas DF, Diehl FA, Haye Salinas MJ, Riva V, Diller A, Lemos PA. Kikuchi-Fujimoto disease and systemic lupus erythematosus. Int Med Case Rep J 2016; 9:163-7. [PMID: 27418858 PMCID: PMC4935008 DOI: 10.2147/imcrj.s106396] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Kikuchi-Fujimoto disease, or histiocytic necrotizing lymphadenitis, is an infrequent idiopathic disorder. It has been associated with autoimmune disorders, of which systemic lupus erythematosus is the most outstanding. The basis of its diagnosis relies on the histological examination of lymph nodes, which typically reveals necrosis surrounded by histiocytes with crescentic nucleus, immunoblasts and plasma cells, and absence of neutrophils. We report the case of a 27-year-old Argentinian female patient without any relevant past medical history to demonstrate the correlation between Kikuchi-Fujimoto disease and systemic lupus erythematosus.
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Affiliation(s)
| | | | | | - Verónica Riva
- Pathology Department, Hospital Privado Universitario de Córdoba Medical Center
| | - Ana Diller
- Pathology Department, Hospital Privado Universitario de Córdoba Medical Center
| | - Pablo A Lemos
- Clinical Medicine Department
- Instituto Universitario de Ciencias Biomédicas, Universitary Institute, Córdoba, Argentina
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12
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Rue KS, Rodger DC, Rao NA. Retinopathy in lupus transitioned to Kikuchi-Fujimoto disease. Am J Ophthalmol Case Rep 2016; 3:43-46. [PMID: 29503907 PMCID: PMC5757397 DOI: 10.1016/j.ajoc.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/13/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose We present a patient with systemic lupus erythematosus with significant vaso-occlusive retinal findings mimicking antiphospholipid antibody syndrome, who developed Kikuchi-Fujimoto disease. Observations Our patient was initially diagnosed with systemic lupus erythematosus with antiphospholipid antibody syndrome given consistent serologic markers and profound retinal vascular ischemia. However, on subsequent follow up, she presented with fever and lymphadenopathy and underwent lymph node biopsy, which declared histologic findings of Kikuchi-Fujimoto disease. Repeat markers for antiphospholipid antibody syndrome were negative and she was taken off lifelong anticoagulation. Conclusions and importance Systemic lupus erythematosus and Kikuchi-Fujimoto disease may have many similar features and even biomarkers, and given the potential overlap of presentation, clinicians must carefully distinguish between these diseases to prevent unnecessary treatment.
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Affiliation(s)
- Kelly S Rue
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Damien C Rodger
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Narsing A Rao
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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13
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Sharma V, Rankin R. Fatal Kikuchi-like lymphadenitis associated with connective tissue disease: a report of two cases and review of the literature. SPRINGERPLUS 2015; 4:167. [PMID: 25897412 PMCID: PMC4398681 DOI: 10.1186/s40064-015-0925-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Kikuchi-Fujimoto disease, is usually a benign self-limiting disease which typically affects young females under the age of 30 years and resolves without treatment within six months. However, when it occurs in the context of connective tissue disease, particularly systemic lupus erythematosus (SLE), it is usually associated with a flare-up of the patient's symptoms, requiring treatment, and can lead to severe, potentially life-threatening sequelae. CASE DESCRIPTION Here, we report and compare two cases of unclassifiable connective tissue disease who developed a Kikuchi-like lymphadenitis and sepsis-like clinical syndrome, including disseminated intravascular coagulation, which proved rapidly fatal. DISCUSSION AND EVALUATION In our review of the literature, we found 55 cases of Kikuchi-Fujimoto disease occurring in the context of definite connective tissue disease, 50 of which were associated with SLE. Of the 55 cases, 22 (40%) had simultaneous onset with, 19 (35%) predated the onset of and 14 (25%) developed after the associated connective tissue disease. Life-threatening autoimmune sequelae were reported in 8 cases, 2 of which were fatal. The aetiology of the association remains unknown. CONCLUSION Kikuchi-Fujimoto disease is a histopathological diagnosis, and although the classical form appears to represent a distinct entity, it is unclear whether it is always the same entity, regardless of the context in which it occurs, or whether it represents a histological pattern with a variety of possible causes. In any case, the possibility of auto-immune sequelae in patients with known autoimmune disease should always be considered if these patients present with a sepsis-like clinical syndrome and no infective source is identified.
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Affiliation(s)
- Vijay Sharma
- />Department of Pathology, Raigmore Hospital, Inverness, Scotland
- />Department of Pathology, Aberdeen Royal Infirmary, Foresterhill Aberdeen, Scotland
- />Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland
| | - Rosslyn Rankin
- />Department of Pathology, Raigmore Hospital, Inverness, Scotland
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14
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem organ involvement, heterogeneity of clinical features, and variety in degree of severity. The differential diagnosis is a crucial aspect in SLE as many other autoimmune diseases portray clinical similarities and autoantibody positivity. Lupus mimickers refer to a group of conditions that exhibit both clinical features and laboratory characteristics, including autoantibody profiles that resemble those present in patients with SLE, and prompt a diagnostic challenge in everyday clinical practice. Thus, lupus mimickers may present as a lupus-like condition (i.e., 2 or 3 criteria) or as one meeting the classification criteria for SLE. Herein we review and classify the current literature on lupus mimickers based on diverse etiologies which include infections, malign and benign neoplasms, medications, and vaccine-related reactions.
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Affiliation(s)
- Omar-Javier Calixto
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Juan-Sebastian Franco
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia.
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15
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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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Kikuchi–Fujimoto disease. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2013.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Di Lernia V, Bajocchi G, Piana S. Subacute cutaneous lupus erythematosus onset preceded by Kikuchi-Fujimoto disease. Dermatol Pract Concept 2014; 4:47-9. [PMID: 24520513 PMCID: PMC3919839 DOI: 10.5826/dpc.0401a06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/16/2013] [Indexed: 10/31/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is an uncommon clinicopathological entity characterized by fever and lymphadenopathy, predominantly involving cervical lymph nodes, accompanied by chills and leukopenia. The diagnosis relies primarily on the presence of typical morphological features in the swelling lymph nodes. KFD can occur as a benign and self-limiting lymphadenopathy, but it can sporadically precede, postdate or coincide with the diagnosis of systemic lupus erythematosus (SLE). The authors report a case of subacute cutaneous lupus erythematosus (SCLE) in a 42-year-old female preceded by prolonged fever, anemia, leukopenia, and cervical necrotizing lymphadenopathy. About two months later, the patient developed facial and scalp plaques suggestive of lupus skin disease. Histologic and immunologic investigations lead to the diagnosis of SCLE. It is not clear whether KFD associated with lupus skin disease are true KFD or a histopathologic feature of SLE.
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Affiliation(s)
- Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Gianluigi Bajocchi
- Rheumatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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Deaver D, Naghashpour M, Sokol L. Kikuchi-fujimoto disease in the United States: three case reports and review of the literature [corrected]. Mediterr J Hematol Infect Dis 2014; 6:e2014001. [PMID: 24455110 PMCID: PMC3894840 DOI: 10.4084/mjhid.2014.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 11/22/2013] [Indexed: 11/08/2022] Open
Abstract
Kikuchi-Fujimoto Disease (KFD), also known as histiocytic necrotizing lymphadenitis [corrected], is a benign, self-limiting disease that manifests primarily as cervical lymphadenopathy but may include low-grade fever, headache, and fatigue. There is a higher incidence of KFD in women aged 20-35 years and in Asian populations. A PubMed search revealed 590 articles that described KFD. Of these, 22 cases have been fully described in the United States. Ten of the 22 (45%) patients were male and 12 (55%) were female, with 20% Caucasian, 20% Asian American, and the remaining 60% of other ethnic backgrounds. In this study, we describe an additional 3 cases of KFD and discuss the diagnosis, pathology, and management of KFD.
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Affiliation(s)
- Darcie Deaver
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Mojdeh Naghashpour
- Department of Hematopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Sah RP, Wilson ME, Seningen J, Bhagra A. Relapsing fevers and lymphadenopathy in a young woman. BMJ Case Rep 2013; 2013:bcr-2013-200237. [PMID: 23853197 DOI: 10.1136/bcr-2013-200237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 23-year-old woman presented to the emergency department with severe occipital headache, nausea and fever. She was treated with intravenous antibiotics for suspected meningitis. After a brief period of response, her symptoms relapsed and remained refractory despite continuing intravenous antibiotics for 10 days leading to referral to our centre. Physical examination was significant for tender right cervical lymph node. Initial tests included pancytopenia, elevated C reactive protein, lactate dehydrogenase and unremarkable cerebrospinal fluid. Extensive infectious and rheumatology work-up was negative. Massive posterior cervical, axillary and inguinal lymphadenopathy was revealed on imaging. Excisional biopsy of the deep cervical lymph node showed histiocytic necrotising lymphadenitis suggesting a diagnosis of Kikuchi disease. Her course was complicated by acute renal failure. Her symptoms resolved in about a week with supportive treatment along with improvement in pancytopenia and renal function. She had two additional self-limited recurrences in the next 3 months and remains symptom free thereafter.
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Affiliation(s)
- Raghuwansh P Sah
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Bogusz AM, Bhargava P. Recurrent histiocytic necrotizing lymphadenitis with a long latency in a patient with autoimmunity: a case report and review of literature. Int J Surg Pathol 2012. [PMID: 23204033 DOI: 10.1177/1066896912467369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Kikuchi-Fujimoto disease (KFD), a histiocytic necrotizing lymphadenitis (HNL), characteristically presents as cervical lymphadenopathy in young Asian women. Most resolve spontaneously with rare recurrences described. We report a patient with biopsy-proven recurrence of KFD-like HNL after almost 8 years and analyze 65 additional published cases with recurrences. While those with recurrences similarly affect young (average age = 27 years), Asian (80%) women (76%), 73% had multiple sites of involvement and 32% of those tested had underlying autoimmune conditions. Our case is unusual with respect to the following: (a) Age: 50 years, the oldest among the reported patients with recurrences. (b) Race: African descent, with only 3 others reported with recurrent HNL. Of these 4 cases, 2 had underlying autoimmunity. (c) Underlying condition: Her clinical and laboratory features were best felt to represent Sjögren's syndrome (SjS). Only 2 other cases of SjS-associated HNL have been reported; in 2 recently reported cases SjS developed subsequently.
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Affiliation(s)
- Agata M Bogusz
- Department of Pathology, Division of Hematopathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, USA
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Mauleón C, Valdivielso-Ramos M, Cabeza R, Rivera T, García I. Kikuchi disease with skin lesions mimicking lupus erythematosus. J Dermatol Case Rep 2012; 6:82-5. [PMID: 23091585 DOI: 10.3315/jdcr.2012.1108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/02/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Kikuchi disease (Kikuchi-Fujimoto disease, histiocytic necrotizing lymphadenitis) is a systemic illness of unkown etiology. It is characterized by cervical lymphadenopathy and fever. The skin is the most frequently affected extranodal organ. Cuta-neous Kikuchi-Fujimoto disease can mimic both clinically and histolo-gically skin lesions in lupus erythema-tosus, a disorder with which it seems to be closely related. A close follow up is required as systemic lupus erythema-tosus develop-ment has been reported. MAIN OBSERVATION We report a case of a 23-year-old woman, who was admitted to our depart-ment with high fever, skin lesions and arthralgia. Scaly and erythematous plaques were noted on both cheeks and earlobes. In pads of feet and hands and periungual area, multiple purple papules with a perilesional erythematous halo were evident. A thoraco-abdominal computed tomography scan revealed lateral cervical, mediastinal, paratracheal, subcarinal and submandi-bular lympha-denopathy. Excisional node biopsy was consisten with Kikuchi disease with skin involvement. CONCLUSION It has to be kept in mind that Kikuchi disease is a differential diag-nosis in case of fever, lymphade-nopathy and lupus-like skin lesions. Skin lesions in this disease and may resemble clinically and histologically to those of subacute lupus erythema-tosus or systemic erythema-tosus lupus.
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Sopeña B, Rivera A, Vázquez-Triñanes C, Fluiters E, González-Carreró J, del Pozo M, Freire M, Martínez-Vázquez C. Autoimmune manifestations of Kikuchi disease. Semin Arthritis Rheum 2011; 41:900-6. [PMID: 22192931 DOI: 10.1016/j.semarthrit.2011.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 10/25/2011] [Accepted: 11/04/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Kikuchi's disease (KD) has been associated with the presence of autoantibodies, systemic lupus erythematosus (SLE), and other autoimmune diseases. The aim of this study was to assess the frequency of autoimmune manifestations in a KD cohort with a long follow-up. METHODS Twenty patients with histologically confirmed KD since January 1990 until December 2010 were studied; 12 of them were periodically followed up as outpatients. Another 7 patients were contacted by telephone to offer them a specific consultation and a complete autoimmunity study. RESULTS Thirteen of 20 patients were women (65%) with a mean age of 29 years (range, 15-79). The age at diagnosis was higher in men (44 vs 27 years, P < 0.05). Lymphopenia was present in 75% of the patients (15/20) and was the more frequent hematological abnormality. The mean follow-up of the 17 patients included in the autoimmunity study was 119 months (range, 15-252). Autoimmune diseases were detected in 9 women (53%): SLE was diagnosed in 4 patients (2 SLE before, 1 simultaneous, and 1 after KD), 2 patients developed primary Sjögren's syndrome after KD, 1 thyroiditis before KD, 1 SLE-like, and 1 antiphospholipid antibodies after KD. Leukocytoclastic vasculitis was found in 2 patients; 1 of them eventually developed SLE. Female sex, painful adenopathies, and cytopenias were significantly associated with autoimmune diseases. CONCLUSIONS Among patients with KD, only women developed autoimmune manifestations. Therefore, long-term follow-up and active surveillance of autoimmune diseases in patients with KD, especially women, are recommended.
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Affiliation(s)
- Bernardo Sopeña
- Thrombosis and Vasculitis Unit, Internal Medicine Service, Complexo Hospitalario Universitario of Vigo (CHUVI), Vigo, Pontevedra, Spain.
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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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Han KM, Go JH, Myong NH, Lee W. Fine Needle Aspiration Cytology of Kikuchi's Lymphadenitis: with Emphasis on Differential Diagnosis with Tuberculosis. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.6.626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kang Min Han
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Jai Hyang Go
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Na Hye Myong
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Wonae Lee
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
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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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26
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Sousa ADA, Soares JMA, Sá Santos MHD, Martins MPR, Salles JMP. Kikuchi-Fujimoto disease: three case reports. SAO PAULO MED J 2010; 128:232-5. [PMID: 21120436 PMCID: PMC10938983 DOI: 10.1590/s1516-31802010000400011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 06/09/2010] [Accepted: 06/11/2010] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Kikuchi-Fujimoto disease (KFD) manifests in most cases as unilateral cervical lymphadenomegaly, with or without accompanying fever. The disease mainly affects young women and has a self-limited course. It is more common in oriental countries, with few reports of its occurrence in Brazil. KFD should be included in the differential diagnosis of suspected cases of viral infections, tuberculosis, reactive lymphadenitis, systemic lupus erythematosus and metastatic diseases. It can be histologically confused with lymphoma. The disease is benign and self-limiting and an excisional biopsy of an affected lymph node is necessary for diagnosis. There is no specific therapy. CASE REPORTS This study reports on three cases of non-Asian female patients with KFD who were attended at our service between 2003 and 2006. A review of the literature was carried out, with a systematic search on this topic, with the aim of informing physicians about this entity that is manifested by cervical masses and fever.
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Affiliation(s)
- Alexandre de Andrade Sousa
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Cramer J, Schmiedel S, Alegre NG, Schäfer H, Burchard GD, Merz H. Necrotizing lymphadenitis: Kikuchi--Fujimoto disease alias lupus lymphadenitis? Lupus 2009; 19:89-92. [PMID: 19933723 DOI: 10.1177/0961203309345793] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Differentiation between lymphadenopathy in potentially life-threatening systemic lupus erythematosus (SLE) and self-limiting necrotizing lymphadenitis, also called Kikuchi- Fujimoto disease (KFD), is difficult. In the past, co-occurrence of SLE and KFD has been described repeatedly in case reports. Here, we report a case of necrotizing lymphadenitis, describe the clinical and histopathologic features in detail and discuss the current literature. KFD may in fact be a histopathologic characteristic of SLE supporting the hypothesis that KFD is a rare manifestation of SLE. To clarify whether KFD is the same entity as lupus lymphadenitis, more cases with SLE and lymphadenopathy should be examined in detail.
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Affiliation(s)
- Jp Cramer
- Section for Tropical Medicine, I, Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
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Byoun YS, Park BB, Song SH, Park SY, Chung SM, Lee JS, Kim SM, Kim YJ, Lee JH, Ryu JW, Choi JH, Lee YY, Kim IS. A Case of Kikuchi Fujimoto's Disease Accompanied by Hemophagocytic Lymphohistiocytosis. THE KOREAN JOURNAL OF HEMATOLOGY 2009. [DOI: 10.5045/kjh.2009.44.4.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Young-Sang Byoun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byeong-Bae Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Heon Song
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Soo-Yuck Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seong-Min Chung
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji-Sun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sun-Min Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yeon-Jae Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ju-Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji-Won Ryu
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jung-Hye Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young-Yiul Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - In-Soon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Seo JH, Shim HS, Park JJ, Jeon SY, Kim JP, Ahn SK, Hur DG, Ahn SY, Kwon OJ. A clinical study of histiocytic necrotizing lymphadenitis (Kikuchi's disease) in children. Int J Pediatr Otorhinolaryngol 2008; 72:1637-42. [PMID: 18789543 DOI: 10.1016/j.ijporl.2008.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 07/30/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Histiocytic necrotizing lymphadenitis (HNL) is a cervical lymphadenitis that occurs rarely in children. This study was conducted to identify the clinical characteristics of lymphadenitis in children and compare the clinical characteristics observed in children and adults. SUBJECT AND METHODS The clinical characteristics, diagnosis, treatment, and prognosis of the 20 patients 18 years of age or younger who were diagnosed with HNL based on histological tests conducted at Gyeongsang University Hospital from January 1998 to December 2006 were analyzed. RESULTS HNL affected males and females at a 1:1 ratio, but HNL was more common in boys (8:3) among the children and HNL affected more girls among the adolescents (2:7). Cervical lymphadenopathy was the main symptom. The antinuclear antibody test was positive in three patients. Two relapse cases were reported, but both patients recuperated within several months without complications. CONCLUSIONS HNL affected males and females at an equal incidence (1:1). But HNL occurred more often in male children than in female children, and more often in female adolescents than in male adolescents. Relapse occurred in 10% of the cases. HNL could progress into systemic lupus erythematosus in the three cases that were ANA-positive. Thus, a long follow-up period is important.
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Affiliation(s)
- Ji Hyun Seo
- Department of Pediatrics, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, South Korea
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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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