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Kelleher EF, Ali HM, Tiedt KA, Chen LP. A Rare Case of Cervical Lymphadenopathy and Weight Loss. Clin Pediatr (Phila) 2024:99228241260773. [PMID: 38872303 DOI: 10.1177/00099228241260773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Affiliation(s)
- Erin F Kelleher
- Department of Pediatrics, University of Wisconsin Health, Madison, WI, USA
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Haroon M Ali
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristin A Tiedt
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura P Chen
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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2
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Lou D, Song Y. Clinical features of histiocytic necrotizing lymphadenitis in children. Eur J Pediatr 2024; 183:1333-1339. [PMID: 38141136 DOI: 10.1007/s00431-023-05391-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Due to its nonspecific clinical characteristics, histiocytic necrotizing lymphadenitis (HNL) is often misdiagnosed as a suppurative cervical lymphadenitis and lymphoma. Thus, this study aimed to investigate the clinical characteristics of HNL in pediatric patients. We retrospectively identified 61 patients with histopathologically confirmed HNL. Clinical and laboratory data, including age, sex, clinical manifestations, laboratory investigations, histological discoveries, treatment, and outcomes, were collected from the medical records to determine associations with extracervical lymph node (LN) involvement. The mean age of patients was 9.7 ± 2.8 years (range, 1.5-14.0 years), and the male-to-female ratio was 2.2:1. The most common systemic symptom was fever in all patients. The median pre-admission and total durations of fever were 13.0 (interquartile range [IQR]: 9.0-22.5 days) and 22.0 days (IQR: 17.0-33.0 days), respectively. Patients with temporary fever (< 2 weeks) had a higher peak temperature and were more likely to undergo LN biopsy after admission than those with a prolonged fever (≥ 2 weeks). Multivariate analysis revealed that peak temperature ≥ 40 °C was significantly associated with a longer fever duration (P = 0.023). Laboratory values showed leukopenia (68.9%), which presented more frequently in solitary cervical LNs than in extracervical LNs (82.4% vs. 52.9%, p = 0.027) in patients with prolonged fever. CONCLUSIONS HNL is often misdiagnosed in older children with persistent fever and lymphadenopathy, leading to unnecessary diagnostic tests and evaluations, inappropriate antibiotic administration, and mismanagement. A multidisciplinary team, including primary care providers, rheumatologists, and pathologists, can improve patient outcomes by increasing their awareness of this rare condition. WHAT IS KNOWN • Histiocytic necrotizing lymphadenitis (HNL) is characterized by fever, leukopenia, and neck lymphadenopathy with unknown etiology. • The lack of neutrophils or eosinophils in the histology, immunohistochemistry results help distinguish HNL from infectious causes. Although HNL is a self-limiting disease, antibiotics and steroid treatments were used inappropriately. WHAT IS NEW • A fever peak ≥ 40 °C was associated with a longer fever duration in HNL patients. Leukopenia presented more frequently in solitary cervical lymph node (LNs) than in extracervical LNs inpatients with prolonged fever. • Steroids are not recommended as a routine treatment, however, in some severe or relapsing cases with persistent symptoms, prednisolone (5 mg twice a day for 2 days) or other steroids (an equivalent dose of prednisolone) responded favorably.
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Affiliation(s)
- DanDan Lou
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Ye Song
- Department of Pediatrics, The First Affiliated Hospital of Air Force Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, Shaanxi, 710032, People's Republic of China.
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Mahajan VK, Sharma V, Sharma N, Rani R. Kikuchi-Fujimoto disease: A comprehensive review. World J Clin Cases 2023; 11:3664-3679. [PMID: 37383134 PMCID: PMC10294163 DOI: 10.12998/wjcc.v11.i16.3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/29/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
Kikuchi-Fujimoto disease, a rare form of necrotizing lymphadenitis, is an uncommon, benign, self-limiting disorder of obscure etiology. It affects mostly young adults of both genders. Clinically, it presents with fever and lymphadenopathy of a firm to rubbery consistency frequently involving cervical lymph nodes while weight loss, splenomegaly, leucopenia, and elevated erythrocyte sedimentation rate feature in severely affected patients. Cutaneous involvement occurs in about 30%-40% of cases as facial erythema and nonspecific erythematous papules, plaques, acneiform or morbilliform lesions of great histologic heterogeneity. Both Kikuchi-Fujimoto disease and systemic lupus erythematosus share an obscure and complex relationship as systemic lupus erythematosus may occasionally precede, develop subsequently, or sometimes be associated concurrently with Kikuchi-Fujimoto disease. It is often mistaken for non-Hodgkin lymphoma while lupus lymphadenitis, cat-scratch disease, Sweet’s syndrome, Still’s disease, drug eruptions, infectious mononucleosis, and viral or tubercular lymphadenitis are other common differentials. Fine needle aspiration cytology mostly has features of nonspecific reactive lymphadenitis and immunohistochemistry studies usually show variable features of uncertain diagnostic value. Since its diagnosis is exclusively from histopathology, it needs to be evaluated more carefully; an early lymph node biopsy will obviate the need for unnecessary investigations and therapeutic trials. Its treatment with systemic corticosteroids, hydroxychloroquine, or antimicrobial agents mostly remains empirical. The article reviews clinicoepidemiological, diagnostic, and management aspects of KFD from the perspective of practicing clinicians.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Neeraj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Ritu Rani
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
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AKGOL GUR ST, TAHİROĞLU AL, KOCAK AO. Mortal Complication of Kikuchi–Fujimoto Disease; Lower Gastrointestinal Bleeding, Case Presantation and literature review. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2023. [DOI: 10.33706/jemcr.1200525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In this report, we inform you that a patient with CFD, known as a benign disease, died due to massive lower GI bleeding. Although KFD is a benign disease, we have seen in this case that it can result in death. A 28-year-old Turkish male patient was brought to the hospital with complaints of high fever, fatigue, sweating and difficulty breathing. A cervical examination revealed that the patient had lymphadenopathy. The patient did not have any cutaneous lesions. Genital examination revealed melena. A normal cranial and abdomen, thorax CT was obtained. The patient was intubated because of respiratory failure and unstable hemodynamics. The patient developed pancytopenia as a result of blood tests. The patient died due to massive lower gastrointestinal bleeding.
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Naoi Y, Tachibana T, Wani Y, Hotta M, Haruna K, Komatsubara Y, Kuroda K, Fushimi S, Nagatani T, Kataoka Y, Nishizaki K, Sato Y, Ando M. The fine-needle aspiration cytology and clinical findings of Kikuchi-Fujimoto disease in pediatric patients: a retrospective clinical study. Acta Otolaryngol 2022; 142:340-344. [PMID: 35235442 DOI: 10.1080/00016489.2022.2040744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Histological evaluation of lymph node is crucial for the definitive diagnosis of Kikuchi-Fujimoto disease (KFD). However, lymph node biopsy under local anesthesia is often difficult in pediatric patients. OBJECTIVES We evaluated cytological findings for pediatric patients with prolonged cervical lymphadenitis clinically suggestive of KFD and investigated the clinical characteristics of patients diagnosed with KFD by fine-needle aspiration cytology (FNAC). METHODS This retrospective clinical study included 58 Japanese pediatric patients with cervical lymphadenitis who underwent FNAC. RESULTS Cytological diagnosis was KFD for 22 and suspicion of KFD for 11 patients. The remaining 25 patients were diagnosed with non-specific lymphadenitis (NSL). Tenderness was independently associated with a higher frequency of both KFD in narrow and broad senses, compared with NSL (p = .009; p = .038). The percentage of patients who underwent FNAC within 28 days from symptom onset tended to be higher among patients with KFD in a narrow sense than those with NSL (p = .052). CONCLUSION This study indicated that the period from symptom onset to FNAC (<28 days) and the symptom of tenderness were associated with the cytological diagnosis of KFD.
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Affiliation(s)
- Yuto Naoi
- Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - Tomoyasu Tachibana
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Yoji Wani
- Department of Pathology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Machiko Hotta
- Department of Pathology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Katsuya Haruna
- Department of Inspection Technology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Yasutoshi Komatsubara
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Kazunori Kuroda
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Soichiro Fushimi
- Department of Pathology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Tami Nagatani
- Department of Inspection Technology, Japanese Red Cross Society Himeji Hospital, Himeji City, Japan
| | - Yuko Kataoka
- Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - Yasuharu Sato
- Department of Clinical Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - Mizuo Ando
- Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
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Zheng Y, Du Y, Zhu WH, Zhao CG. Clinical Analysis of 44 Children with Subacute Necrotizing Lymphadenitis. Infect Drug Resist 2022; 15:1449-1457. [PMID: 35392366 PMCID: PMC8979771 DOI: 10.2147/idr.s351191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Yue Zheng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 111004, People’s Republic of China
| | - Yue Du
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 111004, People’s Republic of China
| | - Wan-Hong Zhu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 111004, People’s Republic of China
| | - Cheng-Guang Zhao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 111004, People’s Republic of China
- Correspondence: Cheng-Guang Zhao, Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China, Tel +8618940255157, Email
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Omachi T, Atsumi N, Yamazoe T, Yamanouchi S, Matsuno R, Kitawaki T, Kaneko K. Differential Diagnosis of Histiocytic Necrotizing Lymphadenitis and Malignant Lymphoma with Simple Clinical Findings. CHILDREN 2022; 9:children9020290. [PMID: 35205010 PMCID: PMC8870061 DOI: 10.3390/children9020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
It is desirable that noninvasive differential diagnosis takes place without lymph node biopsy for histiocytic necrotizing lymphadenitis (HNL) or malignant lymphoma (ML). In this study, we propose a novel scoring model for the differential diagnosis of these diseases using clinical information and clinical findings. We retrospectively analyzed the data from 15 HNL and 13 ML pediatric patients. First, a univariate analysis identified 14 clinical factors with significant differences. Second, a subsequent analysis using receiver operating characteristic (ROC) curve analysis identified three factors among them with area under the ROC curve values of >0.95: body temperature (°C), maximum lymph node size (cm), and serum β2-microglobulin level (mg/L). Finally, the cut-off values of each of these three factors were determined and examined for the 28 cases. All 15 HNL cases were within 2–3 of the cut-off values among the three factors, no ML case was within two or more cut-off values. Thus, the diagnostic sensitivity and specificity of this novel scoring system were both 100%, indicating that clinical scoring with body temperature, maximum lymph node size, and β2-microglobulin are useful for distinguishing between HNL and ML.
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Affiliation(s)
- Taichi Omachi
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan; (T.O.); (T.Y.); (S.Y.); (R.M.)
| | - Naho Atsumi
- Department of Pathology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan;
| | - Takashi Yamazoe
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan; (T.O.); (T.Y.); (S.Y.); (R.M.)
| | - Sohsaku Yamanouchi
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan; (T.O.); (T.Y.); (S.Y.); (R.M.)
| | - Ryosuke Matsuno
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan; (T.O.); (T.Y.); (S.Y.); (R.M.)
| | - Tomoki Kitawaki
- Department of Mathematics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan;
| | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan; (T.O.); (T.Y.); (S.Y.); (R.M.)
- Correspondence: ; Tel.: +81-72-804-0101; Fax: +81-72-804-2569
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Khan AM, Ahmad M, Muhammad O, Taj S, Shiza ST. Kikuchi-Fujimoto Disease in a Young Female: A Case Report and Literature Review. Cureus 2021; 13:e19321. [PMID: 34900492 PMCID: PMC8649112 DOI: 10.7759/cureus.19321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 11/25/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is histiocytic necrotizing lymphadenitis, a rare immune-mediated disorder presenting with lymphadenopathy, leukopenia, and occasionally fever. Herein we report a case of KFD who presented with anorexia, fever, and cervical lymphadenopathy. Lymph node biopsy and immunohistochemistry confirmed the diagnosis of KFD. She was treated with prednisolone and paracetamol, and her condition improved gradually on subsequent follow-up. A patient presenting with fever and lymphadenopathy leads to prompt investigations for common diseases such as tuberculosis and lymphoma. However, rare diseases like KFD must be kept in mind, and a lymph node biopsy followed by histopathologic examination and immunohistochemistry should be done to confirm the diagnosis.
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Affiliation(s)
- Aadil M Khan
- Internal Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Moinuddin Ahmad
- Internal Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Owaise Muhammad
- General Medicine, Lugansk State Medical University, Kyiv, UKR
| | - Shafaq Taj
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | - Saher T Shiza
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
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Pan YT, Cao LM, Xu Y, Fan ZD, Yu HG. Kikuchi-Fujimoto Disease With Encephalopathy in Children: Case Reports and Literature Review. Front Pediatr 2021; 9:727411. [PMID: 34660488 PMCID: PMC8519585 DOI: 10.3389/fped.2021.727411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/08/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Kikuchi-Fujimoto disease (KFD) is a benign and self-limiting disease characterized by regional lymphadenitis and low-grade fever. Encephalopathy may present in children with KFD. We present three cases of KFD with encephalopathy in children and a literature review. Methods: Literature published between 2010 and 2020 was reviewed to understand the clinical features, laboratory findings, and treatments for encephalopathy occurring in children with KFD. Results: The interval between KFD and onset of neurological symptoms was 10 days to 3 months. Laboratory results were normal, except for high protein levels in cerebrospinal fluid findings. Brain magnetic resonance imaging (MRI) findings include hyperintense T2 and FLAIR signal in the supratentorial white matter, deep gray matter, brain stem, cerebellum, temporal lobes, pons, and basal ganglia. Glucocorticoids and immunoglobulin could be effective for treating KFD with encephalopathy. Conclusion: The early clinical manifestations of KFD with encephalopathy in children lack specificity, and the diagnosis is mainly based on CSF analysis and brain MRI findings. Early and timely immunomodulatory therapy is effective and can improve the prognosis of patients with KFD with encephalopathy.
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Affiliation(s)
- Yu-Ting Pan
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Li-Ming Cao
- Department of Infectious Disease, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Xu
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhi-Dan Fan
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Guo Yu
- Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Kim HY, Jo HY, Kim SH. Clinical and Laboratory Characteristics of Kikuchi-Fujimoto Disease According to Age. Front Pediatr 2021; 9:745506. [PMID: 34796153 PMCID: PMC8593182 DOI: 10.3389/fped.2021.745506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/12/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Little information exists regarding the differences in the clinical and laboratory characteristics of Kikuchi-Fujimoto disease (KFD) according to age. Objective: To evaluate the clinical and laboratory characteristics of KFD according to age. Methods: The relevance of sex, age, clinical features, laboratory findings, courses, and follow-up results were retrospectively evaluated in patients diagnosed with KFD at Pusan National University Hospital between 2010 and 2020. Results: Eighty patients (46 children and 34 adults) with a mean age of 21.5 ± 11.8 years (range, 3-49 years) were included in the study. Those aged 10-19 years accounted for the largest number of patients (42.5%). Among children, the male sex ratio was higher, especially for patients aged ≤ 9 years. In adults, the female sex ratio was higher, especially for patients aged 20-29 years. Fever, tenderness in the lymph node, and skin rashes were more common in children, while myalgia and weight loss were more common in adults. In children, the recurrence rate was significantly higher among boys than among girls (15.8 vs. 0.0%, P = 0.001); lower platelet count and higher CRP levels were observed among boys than among girls. EBV and ANA positivity rates were higher in boys than in girls. In adults, the recurrence rate was significantly higher in women than in men (18.2 vs. 0.0%, P = 0.005). ANA positivity rates were higher in women than in men. Conclusion: The clinical features, laboratory findings, and recurrence of KFD may differ depending on age and sex. Clinicians should be aware of this.
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Affiliation(s)
- Hye-Young Kim
- Department of Pediatrics, Medical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea.,Department of Pediatrics, Pusan National University Hospital, Busan, South Korea
| | - Ha Young Jo
- Department of Pediatrics, Pusan National University Hospital, Busan, South Korea
| | - Seong Heon Kim
- Department of Pediatrics, Seoul National University Children's Hospital & College of Medicine, Seoul, South Korea
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Hua CZ, Chen YK, Chen SZ, Gu WZ, Shu Q. Histiocytic Necrotizing Lymphadenitis Mimicking Acute Appendicitis in a Child: A Case Report. Front Pediatr 2021; 9:682738. [PMID: 34604132 PMCID: PMC8484880 DOI: 10.3389/fped.2021.682738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Histiocytic necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease (KFD), is a self-limiting inflammatory disease with low incidence and high misdiagnosis rate in children. Furthermore, cases where the clinical presentation resembles acute appendicitis are very rare. Case Presentation: A 14-year-old boy was misdiagnosed as acute appendicitis and received operative treatment at his early visit. He suffered from abdominal pain, vomiting, diarrhea, fever, and lymphadenitis at the ileocecal junction, which were found by B-ultrasonography examination and surgery. Lymphadenectomy, as well as appendectomy, was performed, and KFD was identified by pathological examination. The patient was transferred to our hospital for further therapy because of recurrent fever and abdominal pain after the appendectomy. His temperature became normal after methylprednisolone was administered, and no recurrence was observed till now during follow-up. Conclusions: Necrotizing lymphadenitis involving mesenteric lymph nodes may cause acute-appendicitis-like symptom; KFD should be a diagnostic consideration for mesenteric lymphadenitis.
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Affiliation(s)
- Chun-Zhen Hua
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yu-Kai Chen
- Department of General Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shun-Zhi Chen
- Department of Pediatric Surgery, Shaoxing People's Hospital, Shaoxing, China
| | - Wei-Zhong Gu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Jung HJ, Lee IJ, Yoon SH. Risk Assessment of Recurrence and Autoimmune Disorders in Kikuchi Disease. Risk Manag Healthc Policy 2020; 13:1687-1693. [PMID: 33061702 PMCID: PMC7519817 DOI: 10.2147/rmhp.s271283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Kikuchi disease (KD) is typically a benign disease. Recent studies reporting recurrence or serious cases suggest a possible association of KD with systemic autoimmune disorders. We performed a long-term analysis of the characteristics of KD in patients of all ages and assessed KD recurrence or progress to systemic autoimmune disorders. Patients and Methods Electronic medical records of patients diagnosed with KD between April 1995 and May 2017 were reviewed for clinical and laboratory manifestations. Results In total, 480 patients were confirmed to have KD based on histopathology findings. The mean age at KD diagnosis was 24.4 years. Recurrence occurred in 11.3% of patients; 2.7% developed autoimmune diseases after KD diagnosis. Patients who experienced recurrence had more extranodal symptoms, lymphopenia, and a longer lymphopenia-recovery duration. Patients who developed autoimmune diseases after KD were more likely to have extranodal symptoms, KD recurrence, and anti-nuclear antibody positivity. Conclusion KD patients with risk factors need to be followed-up for KD recurrence and the development of systemic autoimmune diseases.
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Affiliation(s)
- Hyun Joo Jung
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, South Korea
| | - Il Jae Lee
- Department of Plastic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, South Korea
| | - Seung-Hyun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, South Korea
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Park JE, Ryu YJ, Kim JY, Kim YH, Park JY, Lee H, Choi HS. Cervical lymphadenopathy in children: a diagnostic tree analysis model based on ultrasonographic and clinical findings. Eur Radiol 2020; 30:4475-4485. [PMID: 32189052 DOI: 10.1007/s00330-020-06794-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To establish a diagnostic tree analysis (DTA) model based on ultrasonography (US) findings and clinical characteristics for differential diagnosis of common causes of cervical lymphadenopathy in children. METHODS A total of 242 patients (131 boys, 111 girls; mean age, 11.2 ± 0.3 years; range, 1 month-18 years) with pathologically confirmed Kikuchi disease (n = 127), reactive hyperplasia (n = 64), lymphoma (n = 24), or suppurative lymphadenitis (n = 27) who underwent neck US were included. US images were retrospectively reviewed to assess lymph node (LN) characteristics, and clinical information was collected from patient records. DTA models were created using a classification and regression tree algorithm on the basis of US imaging and clinical findings. The patients were randomly divided into training (70%, 170/242) and validation (30%, 72/242) datasets to assess the diagnostic performance of the DTA models. RESULTS In the DTA model based on all predictors, perinodal fat hyperechogenicity, LN echogenicity, and short diameter of the largest LN were significant predictors for differential diagnosis of cervical lymphadenopathy (overall accuracy, 85.3% and 83.3% in the training and validation datasets). In the model based on categorical parameters alone, perinodal fat hyperechogenicity, LN echogenicity, and loss of fatty hilum were significant predictors (overall accuracy, 84.7% and 86.1% in the training and validation datasets). CONCLUSIONS Perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum were significant US findings in the DTA for differential diagnosis of cervical lymphadenopathy in children. KEY POINTS • Diagnostic tree analysis model based on ultrasonography and clinical findings would be helpful in differential diagnosis of pediatric cervical lymphadenopathy. • Significant predictors were perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea. .,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ji Young Park
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyoung Soo Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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14
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Selvanathan SN, Suhumaran S, Sahu VK, Chong CY, Tan NWH, Thoon KC. Kikuchi-Fujimoto disease in children. J Paediatr Child Health 2020; 56:389-393. [PMID: 31576642 DOI: 10.1111/jpc.14628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 02/02/2023]
Abstract
AIM Kikuchi-Fujimoto disease (KFD) is an important cause of lymphadenitis in children. The primary aim of this study was to investigate the clinical characteristics of children with KFD and to assess the recurrence of this disease. METHODS This is a retrospective study of patients younger than 18 years old, who were diagnosed with KFD from January 2000 to September 2017 at KK Women's and Children's Hospital. Records of children with a histological diagnosis of KFD from a lymph node biopsy were obtained from the Department of Pathology. Case notes and electronic medical records of the patients were reviewed. Data collected included patient characteristics, symptoms, clinical and laboratory findings, treatment and follow-up. RESULTS A total of 98 patients were identified. There were 52 boys and 46 girls with a median age of 11.2 years old. Recurrence occurred in 12 (12.2%) patients. One patient developed systemic lupus erythematosus 10 years after diagnosis of KFD. Recurrent cases were more likely to be managed as an inpatient and have fever at presentation of their first episode of KFD. CONCLUSION In our study, KFD in children had a higher prevalence among boys, and had a recurrence rate of 12.2%, with 1% of patients developing systemic lupus erythematosus. We recommend that patients be followed up for recurrence and advised to monitor for symptoms of recurrence.
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Affiliation(s)
- Shoba N Selvanathan
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Sharline Suhumaran
- Department of Child Development, KK Women's and Children's Hospital, Singapore
| | - Vinay K Sahu
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.,Duke-NUS Graduate School of Medicine, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, National Technological University, Singapore
| | - Chia Yin Chong
- Duke-NUS Graduate School of Medicine, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, National Technological University, Singapore.,Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Natalie Woon Hui Tan
- Duke-NUS Graduate School of Medicine, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, National Technological University, Singapore.,Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Koh Cheng Thoon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, National Technological University, Singapore.,Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
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15
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Al Mosawi Z, Ebrahim B, Baik S, Madan W, Aljufairi E. Kikuchi-Fujimoto Disease: Eleven Pediatric Cases and Literature Review. Arch Rheumatol 2020; 35:303-307. [PMID: 32851384 DOI: 10.46497/archrheumatol.2020.7646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/11/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Zakiya Al Mosawi
- Department of Pediatric, Salmaniya Medical Complex, Manama, Bahrain
| | - Batool Ebrahim
- Department of Pediatric, Salmaniya Medical Complex, Manama, Bahrain
| | - Salwa Baik
- Department of Pediatric, Salmaniya Medical Complex, Manama, Bahrain
| | - Wafa Madan
- Department of Pediatric, Salmaniya Medical Complex, Manama, Bahrain
| | - Eman Aljufairi
- Department of Pathology, Salmaniya Medical Complex, Manama, Bahrain
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16
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Lahma J, Arkoubi Z, Hejjouji R, Nitassi S, El Ayoubi A, Bencheikh R, Benbouzid MA, Oujilal A, Essakalli L. About a rare disease misdiagnosed as malignant lymphoma or tuberculosis: Kikuchi-Fujimoto's disease. Pan Afr Med J 2019; 31:77. [PMID: 31007824 PMCID: PMC6457726 DOI: 10.11604/pamj.2018.31.77.16569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/15/2018] [Indexed: 11/25/2022] Open
Abstract
Kikuchi-Fujimoto's disease KFD is a rare and benign cause of cervical lymphadenopathy. It is an anatomoclinical entity of unknown etiology. The confirmation of the diagnosis is always provided by histological lymph node study. The clinical picture sometimes evokes lymphoma or tuberculosis. The evolution is generally favorable with spontaneous healing after a few weeks. We report the case of a 26-year-old woman who had consulted for cervical lymphadenopathy associated with fever. The cervical lymph node biopsy concluded to Kikuch-Fujimoto's disease. The evolution was marked by rapid regression of lymphadenopathy under corticosteroid treatment.
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Affiliation(s)
- Jawad Lahma
- ENT Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Zakaria Arkoubi
- ENT Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Reda Hejjouji
- ENT Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Sophia Nitassi
- ENT Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Ali El Ayoubi
- ENT Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Razika Bencheikh
- ENT Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | | | - Abdelilah Oujilal
- ENT Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Leila Essakalli
- ENT Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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17
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Lelii M, Senatore L, Amodeo I, Pinzani R, Torretta S, Fiori S, Marchisio P, Bosis S. Kikuchi-Fujimoto disease in children: two case reports and a review of the literature. Ital J Pediatr 2018; 44:83. [PMID: 30021595 PMCID: PMC6052688 DOI: 10.1186/s13052-018-0522-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease is a rare, idiopathic and generally self-limiting cause of lymphadenitis of unknow etiology with a low recurrence rate. The typical clinical signs are cervical lymphadenopathy, fever, and symptoms of respiratory infection, and less frequently chills, night sweats, arthralgia, rash, and weight loss. CASE PRESENTATION Here we describe two case reports of Kikuchi Fujimoto disease presenting in Milan within the space of a few months. The first involved the recurrence of KFD in a young boy from Sri Lanka; the second was a rare case of severe KFD complicated by HLH. CONCLUSIONS Pediatricians must consider KFD in the differential diagnosis of fever of unknown origin in children, even in western countries. Although rare, recurrence and severe complications are possible. Where symptoms suggest KFD, a systematic diagnostic approach is key. Since no guidelines on the management of KFD are available, further studies should be conducted to investigate the therapeutic options and long term outcome in children.
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Affiliation(s)
- Mara Lelii
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Senatore
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pinzani
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Fiori
- Division of Pathology, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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18
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Affiliation(s)
- Dionna Mathews
- 1 Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA
| | - Pamela McMahon
- 1 Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA
| | - Michael Bolton
- 1 Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA
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19
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Tordjman M, Sommet J, Rega A, Benkerrou M, Berrebi D, Peuchmaur M. [An unexplained fever]. Ann Pathol 2017; 37:495-498. [PMID: 29153389 DOI: 10.1016/j.annpat.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 07/10/2017] [Accepted: 10/10/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Mickael Tordjman
- Service de pathologie, hôpital universitaire Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
| | - Julie Sommet
- Service de pédiatrie générale, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Université Diderot Paris 7 - SPC, 16, rue Huchard, 75018 Paris, France
| | - Adelaide Rega
- Service d'imagerie médicale, hôpital Robert-Debré, AP-HP, 75019 Paris, France; Université Diderot Paris 7 - SPC, 16, rue Huchard, 75018 Paris, France
| | - Malika Benkerrou
- Service d'hématologie, centre de drépanocytose, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - Dominique Berrebi
- Service de pathologie, hôpital universitaire Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université Diderot Paris 7 - SPC, 16, rue Huchard, 75018 Paris, France
| | - Michel Peuchmaur
- Service de pathologie, hôpital universitaire Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université Diderot Paris 7 - SPC, 16, rue Huchard, 75018 Paris, France
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20
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Jang KM, Lee JM. A Case of Recurrent Steroid-dependent Kikuchi–Fujimoto Disease Successfully Treated with Hydroxychloroquine. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2017. [DOI: 10.15264/cpho.2017.24.2.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyung Mi Jang
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae Min Lee
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
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21
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Lin YC, Huang HH, Nong BR, Liu PY, Chen YY, Huang YF, Chiou YH, Lee HS. Pediatric Kikuchi-Fujimoto disease: A clinicopathologic study and the therapeutic effects of hydroxychloroquine. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 52:395-401. [PMID: 29050748 DOI: 10.1016/j.jmii.2017.08.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/07/2017] [Accepted: 08/31/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND To investigate the clinical features of Kikuchi-Fujimoto disease (KFD) in children, and place an emphasis on the therapeutic effects of hydroxychloroquine as monotherapy. METHODS We retrospectively reviewed the medical records of all children diagnosed with KFD during the period January 1992 to September 2016 at a tertiary medical center in Taiwan. RESULTS 40 patients were histopathologically confirmed as KFD, and the mean age of the patients was 13.9 ± 3.1 years. The male to female ratio was 1:1. The lymph node involvements were often cervical (95%) with features of unilateral predisposition (75%), polyadenopathy (84.4%) and tenderness (56.3%). Fever, cough, rhinorrhea, and tonsillitis were other common presentations. Laboratory findings included leukopenia (56.5%), monocytosis (63.6%), with positive results of EB-VCA IgG (88.9%), EB-VCA IgM (22.2%), EBEA IgG (22.2%) and EBNA IgG (88.9%). The univariate analyses of prolonged fever with lymphopenia, monocytosis, thrombocytopenia and necrotizing type in histopathology were disclosed as statistically significant (P < 0.05). Corticosteroids and hydroxychloroquine were administered in 15.6% of patients respectively, along with symptomatic treatments for the rest. Recurrence occurred in 13.0% of patients without corticosteroids or hydroxychloroquine treatment. There were neither recurrences nor relevant major adverse effects in all the five KFD cases treated with hydroxychloroquine. CONCLUSION KFD should be suspected in children with febrile cervical lymphadenopathy, especially when concomitant with leukopenia and monocytosis. Lymphopenia, monocytosis, thrombocytopenia and necrotizing type in histopathology are reliable predictors for prolonged fever. Hydroxychloroquine may be an alternative choice to corticosteroids for its favorable effects and safety.
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Affiliation(s)
- Yung-Chih Lin
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Hsiu-Hui Huang
- Department of Pathology and Laboratory, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Bao-Ren Nong
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Yen Liu
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ying-Yao Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yung-Feng Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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22
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Elfihri S, Laine M, Kettani F, Ben Amor J, Bourkadi JE. [Kikuchi-Fujimoto disease: about a case]. Pan Afr Med J 2017; 27:144. [PMID: 28904672 PMCID: PMC5567932 DOI: 10.11604/pamj.2017.27.144.12102] [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: 02/26/2017] [Accepted: 06/12/2017] [Indexed: 11/11/2022] Open
Abstract
Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a rare cause of benign cervical adenopathies. It is an anatomoclinic entity of unknown cause. Diagnosis is based on histologic examination of the lymph nodes. Patient's evolution is generally favorable with spontaneous healing after a few weeks. We here report the case of a 9-year old girl presenting with cervical lymphadenopathy associated with fever. Cervical lymph node biopsy showed Kikuchi-Fujimoto disease. Patient's evolution was marked by regression of adenopathies without receiving any treatment.
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Affiliation(s)
- Sanaa Elfihri
- Service de Pneumo-Phtisiologie, Hôpital Moulay Youssef, CHU Ibn Sina, Rabat, Maroc
| | - Mustapha Laine
- Service de Pneumo-Phtisiologie, Hôpital Moulay Youssef, CHU Ibn Sina, Rabat, Maroc
| | - Fouad Kettani
- Laboratoire d'Anatomie Pathologique Nations Unies, Rabat, Maroc
| | - Jaouda Ben Amor
- Service de Pneumo-Phtisiologie, Hôpital Moulay Youssef, CHU Ibn Sina, Rabat, Maroc
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Kikuchi Disease Causing Fever of Unknown Origin and Generalized Lymphadenopathy. Arch Rheumatol 2017; 32:271-272. [PMID: 30375539 DOI: 10.5606/archrheumatol.2017.6291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/05/2016] [Indexed: 11/21/2022] Open
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Kim JY, Lee H, Yun BL. Ultrasonographic findings of Kikuchi cervical lymphadenopathy in children. Ultrasonography 2016; 36:66-70. [PMID: 27998053 PMCID: PMC5207361 DOI: 10.14366/usg.16047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to analyze the ultrasonographic (USG) findings of Kikuchi cervical lymphadenopathy in pediatric patients. Methods Between April 2007 and September 2016, 84 children (42 male and 42 female; mean±standard deviation age, 12.9±3.2 years; range, 5 to 18 years) confirmed with Kikuchi disease were enrolled. Clinical findings and USG findings of Kikuchi cervical lymphadenopathy were retrospectively reviewed. Localized symptoms, systemic symptoms, and laboratory findings including the white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were analyzed. An analysis of the USG findings included evaluation of the location, size, and presence of intranodal abscess; intranodal calcification; perinodal fat swelling; localized fluid collection; and loss of nodal echogenic hilum. Results Among the patients, 49 (58%) showed localized tenderness at the cervical lymphadenopathy. Fever was present in 55 (66%), while 27 (32%) had prolonged fever. Of 74 with lab results, 54 (73%) had leukopenia but none had leukocytosis. Among the same 74, there was a high ESR (>50 mm/hr) in 10 (14%) and a high CRP level (>5 mg/dL) in seven (9%). The USG findings of most of the patients (n=72, 86%) showed unilateral neck involvement, especially in the left side neck (45 of 72, 63%). The most common site of Kikuchi lymphadenopathy involvement was the area at cervical lymph node level V, at the posterior triangle (n=77, 92%). Conglomerated nodal distribution (n=57, 68%), preserved central nodal echogenic hilum (n=84, 98%), and perinodal fat swelling (n=55, 65%) were common USG findings in the children with Kikuchi. In addition, multiple cervical lymph nodes showed a relatively even size distribution (n=73, 87%). Conclusion The common USG findings of Kikuchi disease in the pediatric population of our study were multiple conglomerated unilateral cervical lymphadenopathy showing perinodal fat swelling and even size distribution.
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Affiliation(s)
- Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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25
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Clinical Characteristics of Severe Histiocytic Necrotizing Lymphadenitis (Kikuchi-Fujimoto Disease) in Children. J Pediatr 2016; 171:208-12.e1. [PMID: 26852178 DOI: 10.1016/j.jpeds.2015.12.064] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/27/2015] [Accepted: 12/23/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To analyze the clinical characteristics of children with Kikuchi-Fujimoto disease focusing on cases with prolonged fever. STUDY DESIGN This was a retrospective study of children diagnosed with Kikuchi-Fujimoto disease from March 2003 to February 2015 in South Korea. Electronic medical records were searched for clinical and laboratory manifestations. RESULTS Among 86 histopathologically confirmed cases, the mean age was 13.2 (SD ± 3.1) years, and male to female ratio was 1:1.32. Cervical lymph node enlargement, found in 85 of the patients (99%), was predominantly unilateral in 64 (75%), and involved the cervical lymph node level V in 67 (81%). Fever was present in 76% of the cases, with a median duration of 9 days (IQR 0.25-17.0). Multivariate analysis revealed that a high fever peak ≥ 39.0°C (P = .010) and presentation with ≥ 2 systemic symptoms other than fever (P = .027) were factors that were significantly associated with longer fever duration. As the size of the largest lymph node's short diameter increased, the fever duration increased (P = .015). Leukopenia (P = .022) also had a significant association with a longer fever duration. Patients with sonographic findings of conglomerated enlarged lymph nodes had a longer median duration of fever compared with those with separate enlarged lymph nodes (11 vs 4.5 days, P = .019). CONCLUSIONS Patients with high fever, more systemic symptoms, leukopenia, and larger lymph nodes with a conglomerated distribution may benefit from early recognition and selective consideration of corticosteroid therapy.
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Lee KY. A common immunopathogenesis mechanism for infectious diseases: the protein-homeostasis-system hypothesis. Infect Chemother 2015; 47:12-26. [PMID: 25844259 PMCID: PMC4384454 DOI: 10.3947/ic.2015.47.1.12] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Indexed: 01/09/2023] Open
Abstract
It was once believed that host cell injury in various infectious diseases is caused solely by pathogens themselves; however, it is now known that host immune reactions to the substances from the infectious agents and/or from the injured host cells by infectious insults are also involved. All biological phenomena in living organisms, including biochemical, physiological and pathological processes, are performed by the proteins that have various sizes and shapes, which in turn are controlled by an interacting network within the living organisms. The author proposes that this network is controlled by the protein homeostasis system (PHS), and that the immune system is one part of the PHS of the host. Each immune cell in the host may recognize and respond to substances, including pathogenic proteins (PPs) that are toxic to target cells of the host, in ways that depend on the size and property of the PPs. Every infectious disease has its own set of toxic substances, including PPs, associated with disease onset, and the PPs and the corresponding immune cells may be responsible for the inflammatory processes that develop in those infectious diseases.
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Affiliation(s)
- Kyung-Yil Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. ; Department of Pediatrics, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
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27
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Kikuchi-fujimoto disease: a rare cause of Fever in the returning traveller. Case Rep Med 2014; 2014:868190. [PMID: 25574174 PMCID: PMC4276685 DOI: 10.1155/2014/868190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/27/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Kikuchi-Fujimoto disease (KFD) is typically a self-limited, benign illness which presents with fever and lymphadenopathy. It is rare in Caucasians, normally occurring in those of Asian descent. The aetiology is poorly understood, but it appears to be an autoimmune disorder with a possible infectious trigger. The clinical features are such that it is often mistaken for infectious diseases or malignancy. Case Report. Here we describe a case of a 36-year-old Asian man who presented following a recent trip to Delhi, India. He described fever, neck swelling, and arthralgia. Given his travel history an infectious cause for his presentation was presumed but multiple investigations were negative. Persistence of his symptoms led to lymph node biopsy to investigate for malignancy; surprisingly this revealed a necrotizing lymphadenitis in keeping with KFD. The patient made a full recovery with supportive treatment only. Conclusion. This case presented an opportunity to reflect on two common presenting complaints-fever in the returning traveller and unexplained lymphadenopathy. Both presentations have a wide range of aetiologies to consider. Although KFD is rare, it is an important diagnosis to make as it can prevent further expensive and invasive investigations, as well as potentially harmful treatments and psychological stress to the patient.
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Yoo IH, Na H, Bae EY, Han SB, Lee SY, Jeong DC, Kang JH. Recurrent lymphadenopathy in children with Kikuchi-Fujimoto disease. Eur J Pediatr 2014; 173:1193-9. [PMID: 24714877 DOI: 10.1007/s00431-014-2306-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 03/24/2014] [Indexed: 11/25/2022]
Abstract
UNLABELLED Kikuchi-Fujimoto disease (KFD) is characterized by self-limiting regional lymphadenopathy with prolonged fever. Although the reported recurrence rate of KFD is known to be 3-4 %, this rate appears to be higher in our clinical experience, and rates up to 38.5 % have been previously reported. In this retrospective study, we reviewed medical records of children with pathologically confirmed KFD to investigate the factors associated with recurrent KFD. Enrolled children were divided into two groups according to the recurrence of KFD, and clinical and laboratory factors were compared between the two groups. The recurrence of KFD was determined based not on repeated pathologic confirmation but on the presence of clinical febrile lymphadenopathy. A total of 33 children with KFD, 26 boys (78.8 %) and 7 girls (21.2 %), with a median age of 12 years (9 months to 19 years), were enrolled. Thirty-one children (93.9 %) complained of fever, and most of the children (90.9 %) complained of cervical lymphadenopathy. Neutropenia (<1,500/μL) or lymphopenia (<1,500/μL) was observed in 51.5 %. Lactate dehydrogenase level, erythrocyte sedimentation rate, and C-reactive protein level were elevated in 90.9, 96.9, and 54.5 % of children, respectively. Fourteen children (42.4 %) experienced recurrent KFD, including ten children after biopsy and four children before and after biopsy. In a multivariate analysis, a past history of other systemic illnesses (p = 0.013) and a higher absolute lymphocyte count (p = 0.023) were significantly associated with recurrent KFD. These systemic illnesses were chronic idiopathic thrombocytopenic purpura, autoimmune thyroiditis, nephrotic syndrome, perinatal cytomegalovirus infection, and hemophagocytic lymphohistiocytosis. CONCLUSION Our results suggest that recurrent KFD is more frequent than reported, and recurrent KFD should be considered in children with a history of other systemic illnesses such as immune disorders.
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Affiliation(s)
- In Hyuk Yoo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
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Characteristics of Kikuchi-Fujimoto disease in children compared with adults. Eur J Pediatr 2014; 173:111-6. [PMID: 23955486 DOI: 10.1007/s00431-013-2131-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign, self-limiting disease characterized by cervical lymphadenopathy. Although it was primarily thought to be a disease of young adults, it has been increasingly recognized in children. To define the characteristics of KFD in children, we reviewed the medical records of patients younger than 18 years of age who were diagnosed with KFD from 2001 to 2012 at Korea University Medical Center, as well as worldwide published reports of KFD. A total of 140 pediatric patients and 733 patients of all ages was analyzed. Compared to the female predominance found in adults (2:1), young boys were more commonly affected than young girls (1.4:1). Cervical lymphadenopathy was the most common clinical finding in children, as it was in adults. Lymphadenopathy was more likely to be tender (69 vs. 44 %, p < 0.001) but less generalized (1 vs. 8 %, p < 0.05) in children compared to adults. Fever (82 vs. 35 %, p < 0.001) and rash (10 vs. 4 %, p < 0.05) were observed in children more commonly than in adults. Leukopenia was observed in 50 and 38 % of children and adults, respectively. Rates of recurrence and association with autoimmune diseases in children were comparable to those of adults. Cervical lymphadenopathy was the most common clinical manifestation of KFD in all ages. While fever and rash were more common in children with KFD compared to adults, generalized lymphadenopathy was rarer.
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Kikuchi's disease masquerading as prolonged fever. Indian J Pediatr 2013; 80:175-6. [PMID: 22766905 DOI: 10.1007/s12098-012-0832-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
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Go EJ, Jung YJ, Han SB, Suh BK, Kang JH. A case of Kikuchi-Fujimoto disease with autoimmune thyroiditis. KOREAN JOURNAL OF PEDIATRICS 2012; 55:445-8. [PMID: 23227065 PMCID: PMC3510275 DOI: 10.3345/kjp.2012.55.11.445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/19/2012] [Accepted: 07/23/2012] [Indexed: 11/27/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign self-limiting disease characterized by fever and lymphadenitis. The etiology and pathogenesis of KFD is unclear. However, two hypotheses have been suggested: a viral infection hypothesis and an autoimmune hypothesis. Several KFD patients with various types of autoimmune diseases have been reported, and these reports support the hypothesis for autoimmune pathogenesis of KFD. Here, we report the case of a 17-year-old female patient diagnosed with KFD and autoimmune thyroiditis. This case serves as additional evidence that the etiology of KFD is autoimmune origin.
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Affiliation(s)
- Eun Ji Go
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
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Marrec C, Picherot G, Kandel C, Caquard M. Une cause rare chez l’enfant de poly-adénopathie fébrile : la maladie de Kikuchi–Fujimoto. Arch Pediatr 2012; 19:38-41. [DOI: 10.1016/j.arcped.2011.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/06/2011] [Accepted: 10/06/2011] [Indexed: 11/30/2022]
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Li YY, Chang WC, Hsu YP, Liao LJ. Ultrasound Features of Pediatric Kikuchi–Fujimoto Disease: Report of Two Cases. J Med Ultrasound 2011. [DOI: 10.1016/j.jmu.2011.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Allmendinger AM, Spektor V, Sadler M, Harrington W, McLaughlin V. Kikuchi-Fujimoto disease with spontaneous subdural hematoma in a middle-aged Hispanic male. Clin Imaging 2010; 34:388-92. [PMID: 20813306 DOI: 10.1016/j.clinimag.2009.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 11/05/2009] [Indexed: 10/19/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is an uncommon disorder that usually presents in young adults of Asian descent with fever and cervical lymphadenopathy. Clinically, this disease is often misdiagnosed as lymphoma or tuberculosis, and biopsy is needed for confirmation. The authors report an unusual case of KFD in a Hispanic male presenting with a subacute subdural hematoma, whose care was complicated by extranodal features not typically associated with KFD. The clinical, histopathologic, and radiographic manifestations of KFD are discussed.
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de Gaudio M, Moshal K, Malone M, Novelli V. Kikuchi-Fujimoto disease causing fever of unknown origin in a nine-year-old boy. ACTA ACUST UNITED AC 2010; 42:946-9. [PMID: 20735329 DOI: 10.3109/00365548.2010.509867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe a case of fever of unknown origin (FUO) in a 9-y-old boy finally diagnosed with Kikuchi-Fujimoto disease (KFD) and discuss the implications for the management of FUO in children. KFD should be considered in the differential diagnosis of patients presenting with FUO to prevent misdiagnosis and inappropriate treatment.
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Affiliation(s)
- Marina de Gaudio
- Department of Sciences for Woman and Child's Health, University of Florence, Florence, Italy.
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Pal Saini A, Jamil S, Dulai M. Kikuchi's disease causing persistent fever and iliac lymphadenopathy in an 8-year-old boy. Clin Pediatr (Phila) 2010; 49:601-4. [PMID: 20100742 DOI: 10.1177/0009922809350497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Yoshioka K, Miyashita T, Nakamura T, Inoue T, Yamagami K. Treatment of histiocytic necrotizing lymphadenitis (Kikuchi's disease) with prolonged fever by a single course of methylprednisolone pulse therapy without maintenance therapy: experience with 13 cases. Intern Med 2010; 49:2267-70. [PMID: 20962448 DOI: 10.2169/internalmedicine.49.3919] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 26-year-old man was hospitalized with a 1-month history of fever. Cervical lymph node biopsy showed necrosis in the paracortical area with abundant nuclear debris and proliferation of histiocytes. A diagnosis of histiocytic necrotizing lymphadenitis (HNL) (Kikuchi's disease) was made. He received methylprednisolone pulse therapy (MPT) (0.5 g/day for 3 days) without maintenance therapy and experienced dramatic improvement. We also used MPT for another 12 cases of HNL. All patients became afebrile within 1 day without adverse events. Four patients relapsed after the initial MPT, but only 1 patient relapsed during the following year. Our results suggest that MPT is warranted in HNL patients with prolonged fever.
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Han HJ, Lim GY, Yeo DM, Chung NG. Kikuchi's disease in children: clinical manifestations and imaging features. J Korean Med Sci 2009; 24:1105-9. [PMID: 19949667 PMCID: PMC2775859 DOI: 10.3346/jkms.2009.24.6.1105] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 02/23/2009] [Indexed: 12/02/2022] Open
Abstract
Previously published studies on Kikuchi disease (KD) have frequently addressed the computed tomography (CT) findings in the adult population, however, only a few studies have been reported for the pediatric age group. The purpose of this study is to analyze the clinical characteristics and imaging features of KD in children. Fifteen children (2-14 yr) who had a neck CT and pathology diagnosis of KD were included in this study. Clinical features, including the duration of lymphadenopathy and fever, prognosis, and laboratory values, were evaluated. We analyzed the sites, size, and lymph node pattern as seen on their CT scans. The median duration of fever was 10 days. Fourteen patients experienced improvement in their condition, although four of these patients experienced recurrent episodes of KD. All patients had affected cervical nodes at level V. Perinodal infiltrates were observed in the affected cervical nodes in 14 cases (93%), and non-enhancing necrosis was also noted within the affected cervical nodes in 10 cases (63%). In conclusion, the combination of imaging findings in conjunction with clinical findings of KD may help to determine whether or not to perform pathology analysis and follow-up studies.
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Affiliation(s)
- Hye Jeong Han
- Department of Radiology, St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Gye-Yeon Lim
- Department of Radiology, St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Dong-Myung Yeo
- Department of Radiology, St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Nak-Gyun Chung
- Department of Pediatrics, St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Lim GY, Cho B, Chung NG. Hemophagocytic lymphohistiocytosis preceded by Kikuchi disease in children. Pediatr Radiol 2008; 38:756-61. [PMID: 18496683 DOI: 10.1007/s00247-008-0894-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 04/21/2008] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Kikuchi disease (KD) is a type of benign, self-limiting lymphadenitis, but it has also been associated with hemophagocytic lymphohistiocytosis (HLH). To date, only a few reports have suggested an association between HLH and KD. OBJECTIVE To report the imaging findings and clinical characteristics of KD accompanied by HLH in children. MATERIALS AND METHODS Five children with a prolonged fever and cervical lymphadenopathy were diagnosed as having HLH accompanied by KD. The authors retrospectively analyzed the clinical characteristics and the imaging findings in these children. The histology of excision biopsy samples of cervical lymph nodes in all children confirmed the diagnosis of KD. HLH was confirmed by bone marrow biopsy and laboratory criteria provided by the Histiocyte Society. RESULTS The greatest dimension of the enlarged nodes ranged from 0.5 cm to 2.5 cm and the nodes were most frequently located at level V. CT scans visualized perinodal infiltrates in most of the affected cervical nodes (four of five children) and extracervical nodes (three of three children). On enhanced CT scans, nonenhancing necrosis within the affected cervical nodes was noted in three children. CONCLUSION KD might be related to HLH in children. Systemic evaluations and follow-up of children with KD might help to identify HLH related to KD.
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Affiliation(s)
- Gye-Yeon Lim
- Department of Radiology, St. Mary's Hospital, The Catholic University of Korea, Seoul, 150-713, Korea.
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41
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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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Kim HJ, Yeom JS, Park JS, Park ES, Seo JH, Lim JY, Park CH, Woo HO, Cho JM, Lee JH, Youn HS. Analysis of disease mechanism of subacute necrotizing lymphadenitis in children. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.11.1198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hyun Jung Kim
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jung Suk Yeom
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ji Suk Park
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Eun Sil Park
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ji Hyun Seo
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jae Young Lim
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Chan Hoo Park
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyang Ok Woo
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jae Min Cho
- Department of Radiology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jeong Hee Lee
- Department of Pathology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hee Shang Youn
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea
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Lazzareschi I, Barone G, Ruggiero A, Liotti L, Maurizi P, Larocca LM, Riccardi R. Paediatric Kikuchi-Fujimoto disease: a benign cause of fever and lymphadenopathy. Pediatr Blood Cancer 2008; 50:119-23. [PMID: 16755552 DOI: 10.1002/pbc.20918] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare and benign disease that typically affects the cervical lymph nodes. Its aetiology is unknown and a role of the autoimmune system in the pathogenesis is hypothesized. This self-limiting disease is often confused with malignancies. No specific management is generally required but long-term follow-up should be planned despite the low risk of recurrence, as recurrences have been described many years after the first episode and there is a high risk of development of an autoimmune disease or even lymphoma. We review the clinical and histological features of KFD and report an unusual case presenting with cervical and supraclavicular lymphadenopathy, and persistent fever.
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Affiliation(s)
- Ilaria Lazzareschi
- Division of Paediatric Oncology, Department of Paediatric Sciences, Catholic University, Rome
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Adjaoud D, Boudjemaa S, Boccon-Gibod L, Leverger G. [Kikuchi-Fujimoto's disease: report of 5 cases and literature review]. Arch Pediatr 2007; 14:1333-6. [PMID: 17936598 DOI: 10.1016/j.arcped.2007.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 07/04/2007] [Indexed: 11/24/2022]
Abstract
Kikuchi-Fujimoto's disease or histiocytic necrotizing lymphadenitis is a benign disease predominantly occurring in young women which etiology remains unknown and revealed by cervical lymphadenitis and/or prolonged fever. It has rarely been reported in children. Among the 5 cases reported, 1 child had a systemic localization. The diagnosis is based on the histological examination of a lymph node biopsy. The disease course was spontaneously favourable in 2 cases; a corticotherapy was needed in 3 children. A pathogen agent was found in 2 patients. Kikuchi's disease can reveal or evolve into autoimmune disease particularly lupus, thus a long clinical and biological follow-up is necessary.
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Affiliation(s)
- D Adjaoud
- Service d'hématologie et d'oncologie pédiatriques, hôpital d'enfants Armand-Trousseau, Assistance publique-Hôpitaux de Paris, 26, avenue du Docteur-A.-Netter, 75012 Paris, France.
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Manzano Infante MJ, Camacho Lovillo MS, Obando Santaella I, Mateos Checa R, Rodríguez González M. Enfermedad de Kikuchi-Fujimoto como causa de linfadenopatías. An Pediatr (Barc) 2007; 67:83-5. [PMID: 17663915 DOI: 10.1157/13108089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lee KY, Han JW, Lee JS. Kawasaki disease may be a hyperimmune reaction of genetically susceptible children to variants of normal environmental flora. Med Hypotheses 2007; 69:642-51. [PMID: 17337130 PMCID: PMC7117004 DOI: 10.1016/j.mehy.2006.12.051] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Accepted: 12/21/2006] [Indexed: 12/31/2022]
Abstract
Kawasaki disease (KD) is an acute febrile systemic vasculitis of unknown etiology that occurs predominantly in children <5 years of age. For the etiopathogenesis of KD, there is no agreement even as to whether KD is an infectious disease or an immune-mediated disease. The epidemiologic characteristics of KD, including the strict predilection of age in all ethnic groups and the gradually increased incidence after the KD emergence, suggest that KD is affected by the immune maturation in early childhood that may be determined by genetic factors, and KD is also affected by the changed environmental circumstances such as improved public hygiene. We postulated that the pathogenesis of KD is a hyperimmune reaction in genetically susceptible children to the variants of normal flora, which are induced by the environmental factors. Using this hypothesis, we might partly explain the clinical and epidemiological characteristics of KD. We expect that this hypothesis may help to determine the causative agents for KD in the near future.
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Affiliation(s)
- Kyung-Yil Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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47
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Gerritsen A, Lam K, Marion Schneider E, van den Heuvel-Eibrink MM. An exclusive case of juvenile myelomonocytic leukemia in association with Kikuchi's disease and hemophagocytic lymphohistiocytosis and a review of the literature. Leuk Res 2006; 30:1299-303. [PMID: 16487587 DOI: 10.1016/j.leukres.2005.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 12/30/2005] [Accepted: 12/30/2005] [Indexed: 11/29/2022]
Abstract
We present a case of juvenile myelomonocytic leukemia (JMML) accompanied by immune-mediated hemophagocytic lymphohistiocytosis (HLH) and Kikuchi's disease, both as a paraneoplastic phenomenon. As this combination, to the best of our knowledge, has not been described before, consensus on preferable treatment is lacking. Our patient was treated with prednisolone according to the few described cases of HLH and Kikuchi's disease in non-JMML patients, resulting in disappearance of the clinical symptoms.
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Affiliation(s)
- Annemieke Gerritsen
- Department of Pediatric Oncology/Hematology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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48
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Satavahana Chowdary V, Vinay Kumar EC, Swarna Latha G, Sudha Rani R. Kikuchi - Fujimoto disease. Indian J Otolaryngol Head Neck Surg 2006; 58:287-90. [PMID: 23120318 DOI: 10.1007/bf03050845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Kikuchi - fujimoto disease also known as histiocytic necrotizing lymphadenitis is an idiopathic benign self limiting condition with a favourable outcome, usually affecting young women. The following cases have burn reported for clinical interest and for the rarity of the reports about this condition in ENT literature. In our series, we had 2 female patients aged 18 years and 25 years respectively and a male patient aged 45 years, presenting with fever, bilateral tender multiple cervical adenopathy including posterior triangle nodes not responding to routine antibiotics and anti-inflammatory drug treatment. ENT findings were within normal limits. Routine clinical investigations were within normal limits except for the raised ESR. Biopsy from one of the enlarged glands revealed necrotizing lymphadenitis. All the patients subsequently showed significant improvement locally in the neck and systemically without any further active treatment.
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Affiliation(s)
- V Satavahana Chowdary
- Dept. of ENT & Head and Neck Surgery, Dept. of Pathology, Apollo Hospitals, Jubilee Hills, Hyderabad. (A.P)
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Immunoglobulin G has a role for systemic protein modulation in vivo: a new concept of protein homeostasis. Med Hypotheses 2006; 67:848-55. [PMID: 16759810 DOI: 10.1016/j.mehy.2006.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 04/10/2006] [Indexed: 02/03/2023]
Abstract
The constant level of various proteins including albumin and cellular components in intravascular pool in vivo is strictly controlled by an unknown homeostatic mechanism, although there are fluctuations seen in pathologic conditions. Because the majority of the IgG in the serum is regarded as self-reactive natural autoantibodies, IgG may have a role to react with all proteins in vivo. It is hypothesized that like an immune system, a homeostatic mechanism for the protein pool also has a sensitive role to identify and memorize the extent and repertoire of both normal and pathogenic proteins on an individual basis, and IgG may be one of the major players in performing these functions. This hypothesis may explain the unresolved clinical observations as followed: (1) the marked increased IgG levels observed in self-limiting diseases presumed to come from immunological insults such as acute poststreptococcal glomerulonephritis and Kikuchi-Fujimoto disease, (2) an immediate reduction of all protein levels except immunoglobulins after intravenous immunoglobulin (IVIG) treatment in Kawasaki disease, (3) a unified explanation for the variety of immunomodulating effects exerted by IVIG, (4) the IgG-enzyme complexes observed in benign conditions such as macroamylasemia and hyperphosphatasemia, and (5) the marked decreased IgG level, which is correlated with the albumin level in minimal change nephrotic syndrome. IgG may be a 'watch-dog' for the disturbances of protein homeostasis in vivo. IgG may control the pathogenic proteins that appeared in disordered states, and it may help prevent the loss of proteins in case of nephrotic syndrome.
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Kucukardali Y, Solmazgul E, Kunter E, Oncul O, Yildirim S, Kaplan M. Kikuchi-Fujimoto Disease: analysis of 244 cases. Clin Rheumatol 2006; 26:50-4. [PMID: 16538388 DOI: 10.1007/s10067-006-0230-5] [Citation(s) in RCA: 228] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Revised: 01/24/2006] [Accepted: 01/25/2006] [Indexed: 12/21/2022]
Abstract
Kikuchi-Fujimoto Disease (KFD) was first described in Japan in 1972. The disease frequently mimics tuberculous lymphadenitis, malign lymphoma, and many other benign and malignant conditions. To our knowledge, there is no previous study comparing the clinical and laboratory characteristics of patients from different geographical parts of the world. We searched literature records beginning from 1991 and analyzed epidemiological, clinical, and laboratory data of 244 patients (including cases diagnosed in our institution) reported in 181 publications. Of the 244 cases, 33% were male and 77% were female. Mean age was 25 (1-64) and 70% was younger than 30. Most of the cases were reported from Taiwan (36%), USA (6.6%), and Spain (6.3%). Fever (35%), fatigue (7%) and joint pain (7%) were the most frequent symptoms, while lymphadenomegaly (100%), erythematous rashes (10%), arthritis (5%), hepatosplenomegaly (3%), leucopenia (43%), high erythrocyte sedimentation rate (40%), and anemia (23%) being the most common findings. KFD was associated with SLE (32 cases), non-infectious inflammatory diseases (24 cases), and viral infections (17 cases). SLE was more frequent in cases from Asia than Europe (28 and 9%, respectively). The disease was self-limiting in 156 (64%) and corticosteroid treatment was necessary in 16 (16%) of the cases. The mortality rate was 2.1%. Early diagnosis is crucial as the clinical and laboratory presentation generally imitates situations needing lengthy and costly diagnostic and therapeutic interventions. Additionally, association with SLE needs further investigation.
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Affiliation(s)
- Yasar Kucukardali
- Internal Medicine, Gata Haydarpasa Training Hospital, Istanbul, Turkey
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