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Zhang X, Jin X, Zhang X, Shen Y. Clinical features and recurrence predictors of histiocytic necrotizing lymphadenitis in Chinese children. Pediatr Rheumatol Online J 2024; 22:61. [PMID: 38862943 PMCID: PMC11167820 DOI: 10.1186/s12969-024-00996-y] [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: 02/11/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVES To characterize the clinical features and to identify the predictors of recurrence of histiocytic necrotizing lymphadenitis (HNL) in Chinese children. STUDY DESIGN This study retrospectively analyzed the clinical characteristics, laboratory and pathological findings, and recurrence status of children diagnosed with HNL at a single center in China from January 2018 to May 2023. Logistic regression analysis was employed to identify predictors of HNL recurrence. RESULTS 181 Chinese children with histopathologically confirmed HNL were enrolled (121 males and 60 females). The mean age was 9.3 ± 2.9 years. The most prominent clinical features were fever (98.9%) and cervical lymphadenopathy (98.3%). Aseptic meningitis was the most frequent complication (38.5%), while hemophagocytic lymphohistiocytosis and autoimmune disease were rare (1.7% and 1.2%, respectively). Recurrence occurred in 12.7% of patients. Erythrocyte sedimentation rate (> 30 mm/h) was the significant predictors of HNL recurrence, with odds ratios of 6.107, respectively. CONCLUSION Our study demonstrates that fever and cervical lymphadenopathy are the most frequent clinical manifestations of HNL in Chinese children, which often coexist with aseptic meningitis. HNL patients with risk factors require follow-up for recurrence.
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Affiliation(s)
- Xiaoning Zhang
- Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's hospital, Zhengzhou Children's Hospital, Zhengzhou, 450008, China
| | - Xiuhong Jin
- Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's hospital, Zhengzhou Children's Hospital, Zhengzhou, 450008, China
| | - Xiangfeng Zhang
- Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's hospital, Zhengzhou Children's Hospital, Zhengzhou, 450008, China
| | - Yuelin Shen
- Respiratory Department II, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, NO.56, Nanlishi Road, Beijing, 100045, China.
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Nair PR, Bankar NJ, Choudhary A, Shrivastava D. Kikuchi Fujimoto Lymphadenitis: A Rare Association With COVID-19 Vaccination. Cureus 2023; 15:e45979. [PMID: 37900436 PMCID: PMC10600953 DOI: 10.7759/cureus.45979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is an uncommon cause of protracted cervical lymphadenopathy in both children and adults. Although the majority of cases have been documented in Asia, this disease has been characterized globally since it was first identified in Japan in 1972. KFD's etiology is not entirely understood, although various theories have been postulated. Usually benign, Kikuchi-Fujimoto disease resolves within six months. KFD must be distinguished from other causes of chronic lymphadenopathy, such as lymphoma, inflammatory illnesses, autoimmune conditions, viral lymphadenopathy, and also from tuberculosis, especially in India, where it is still endemic. Here, we present the case report of a healthcare worker with a known case of hypothyroidism and autoimmune skin disorder who presented with prolonged fever, joint pain, and generalized lymphadenopathy post-COVID vaccination and was diagnosed as having KFD on biopsy, which can be associated with a very unusual presentation of this disease.
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Affiliation(s)
- Priya R Nair
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nandkishor J Bankar
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amruta Choudhary
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepti Shrivastava
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Monsour M, Borlongan CV. The central role of peripheral inflammation in ischemic stroke. J Cereb Blood Flow Metab 2023; 43:622-641. [PMID: 36601776 PMCID: PMC10108194 DOI: 10.1177/0271678x221149509] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/23/2022] [Accepted: 12/11/2022] [Indexed: 01/06/2023]
Abstract
Stroke pathology and its treatments conventionally focus on the brain. Probing inflammation, a critical secondary cell death mechanism in stroke, has been largely relegated to the brain. To this end, peripheral inflammation has emerged as an equally potent contributor to the onset and progression of stroke secondary cell death. Here, we review novel concepts on peripheral organs displaying robust inflammatory response to stroke. These inflammation-plagued organs include the spleen, cervical lymph nodes, thymus, bone marrow, gastrointestinal system, and adrenal glands, likely converging their inflammatory effects through B and T-cells. Recognizing the significant impact of this systemic inflammation, we also discuss innovative stroke therapeutics directed at sequestration of peripheral inflammation. This review paper challenges the paradigm of a brain-centered disease pathology and treatment and offers a peripheral approach to our stroke understanding.
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Affiliation(s)
- Molly Monsour
- Center of Excellence for Aging and Brain Repair,
Department of Neurosurgery and Brain Repair, University of South Florida Morsani
College of Medicine, Tampa, FL 33612, USA
| | - Cesar V Borlongan
- Center of Excellence for Aging and Brain Repair,
Department of Neurosurgery and Brain Repair, University of South Florida Morsani
College of Medicine, Tampa, FL 33612, USA
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Gaffoor N, Shetty A, Shivayogi VN, Murali N. Clinical Masquerades in Physiognomy of Sebaceous Cysts Unveiled on Histopathological Examination: a Spectrum of Cases. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03629-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Hashmat M, Iftikhar S, Aemaz Ur Rehman M, Rehman AU, Farooq H, Asmar A, Ebaad Ur Rehman M. Aseptic meningitis in Kikuchi-Fujimoto Disease - Rare manifestation of a rare disease. eNeurologicalSci 2022; 29:100429. [PMID: 36281347 PMCID: PMC9587360 DOI: 10.1016/j.ensci.2022.100429] [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: 07/14/2022] [Revised: 09/17/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Kikuchi-Fujimoto Disease (KFD) is a rare disease marked by necrotizing lymphadenitis, often presenting as unilateral cervical lymphadenopathy, along with various extranodal manifestations such as fever, skin rash, hepatosplenomegaly, and arthritis, etc. KFD is thought to be secondary to either a viral infection or an autoimmune process, however, evidence in favor of both models is scarce and non-definitive. We report a case of a young female who presented with persistent high-grade fever, bilateral cervical and axillary lymphadenopathy, and leukopenia. Excisional biopsy of affected lymph nodes revealed well-circumscribed foci of necrosis with karyorrhectic debris and scattered fibrin deposits characteristic of KFD. The patient was promptly initiated on non-steroidal anti-inflammatory drugs (NSAIDs), however, despite an early improvement in symptoms, the patient soon developed aseptic meningitis, a rare neurological complication of KFD. Intravenous followed by oral corticosteroid therapy reported a good prognosis, with no observable residual neurological deficits. Knowledge of the disease and its complications significantly helped in the avoidance of unnecessary investigations and a delay in treatment. Central nervous system involvement may be seen in Kikuchi Fujimoto Disease (KFD). Aseptic meningitis is a rare neurological complication of KFD. It may present after the resolution of KFD symptoms. Prompt treatment and recognition holds favorable prognosis.
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Affiliation(s)
- Masooma Hashmat
- Department of Medicine, Mayo Hospital, King Edward Medical University, Lahore 54000, Pakistan
| | - Sadaf Iftikhar
- Assistant Professor of Neurology, Mayo Hospital, King Edward Medical University, Lahore 54000, Pakistan
| | | | - Aqeeb Ur Rehman
- Department of Medicine, Mayo Hospital, King Edward Medical University, Lahore 54000, Pakistan
| | - Hareem Farooq
- Department of Medicine, Mayo Hospital, King Edward Medical University, Lahore 54000, Pakistan
- Corresponding author.
| | - Abyaz Asmar
- Department of Neurology, Mayo Hospital, King Edward Medical University, Lahore 54000, Pakistan
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Rana G, Awad A, Wang E, Webb S, Zahir H, Ree A. Unique presentation of recurrent subdural effusions and subsequent abdominal lymphadenopathy in a patient diagnosed with Kikuchi-Fujimoto disease. Radiol Case Rep 2022; 17:1163-1168. [PMID: 35169421 PMCID: PMC8829530 DOI: 10.1016/j.radcr.2021.12.049] [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: 11/22/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Kikuchi Fujimoto Disease, originally discovered in 1972, is a rare lymphoproliferative disorder traditionally characterized by cervical lymphadenopathy, fevers, parotid gland enlargement, and several other nonspecific manifestations. Differentials include lymphoma, other viral diseases such as Epstein-Bar Virus, as well as other autoimmune conditions such as Systemic Lupus Erythematosus. Central nervous system involvement is exceptionally rare, with manifestations including meningitis as well as subdural effusions, as presented in this case. This review will summarize a case of a 24-year-old man with recurrent subdural effusions requiring intervention, subsequent relapse with abdominal lymphadenopathy, and possible IgG4 related disease. The background epidemiology, radiology, and potential pathophysiology will be reviewed.
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Affiliation(s)
- Gaurav Rana
- John H Stroger Hospital of Cook County, Chicago, IL
- Corresponding author.
| | - Ahmed Awad
- John H Stroger Hospital of Cook County, Chicago, IL
| | - Edwin Wang
- John H Stroger Hospital of Cook County, Chicago, IL
| | - Shaun Webb
- University of Illinois at Chicago, Chicago, IL
| | - Haziq Zahir
- John H Stroger Hospital of Cook County, Chicago, IL
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