Kikuchi-Fujimoto Disease in Nepal: A Study of 6 Cases

Kikuchi-Fujimoto disease in a tertiary care teaching hospital in Coastal South India: A 8-year retrospective study

Background: Kikuchi-Fujimoto disease (KFD) is a rare, benign condition of unknown etiology, presenting as cervical lymphadenitis. Lymphadenopathy is usually tender and maybe associated with systemic symptoms. Despite the extensive literature on this disease, it continues to be misdiagnosed owing to its misleading clinical presentation.

Methods:

A retrospective hospital-based descriptive cross-sectional study was conducted in tertiary care hospitals from 2011 to 2019. All patients with confirmed KFD diagnosis were included and after ethics committee approval the clinical details and histopathological data was retrieved from the medical records department and analyzed.

Results:

A total of 67 cases were included. The mean age was 26.9±11.3 years with a female: male ratio of 1.9:1. There were 50 patients with tender cervical lymphadenopathy which was the most common clinical presentation. The mean length and width of palpable lymph nodes were 2.3±1.0 cm and 2.2±0.7 cm respectively. Histology revealed proliferative stage in majority of patients ( n=40, 59.7%). Lymphadenopathy resolved in 83.6% within 2 months. There were 42 patients who had complete recovery with symptomatic treatment within a period of 9 months.

Conclusions:

KFD is prevalent in young, female patients of Asian descent and often presents as tender cervical lymphadenopathy. Early diagnosis with excisional lymph node biopsy is crucial to avoid unnecessary investigations and treatment. Treatment is symptomatic unless complicated, where steroid therapy is considered. KFD has an excellent prognosis with almost no risk of fatality.

Bilateral preretinal hemorrhage associated with Kikuchi-Fujimoto disease

Purpose

To present a case of a patient with human immunodeficiency virus (HIV) disease and Kikuchi-Fujimoto disease (KFD) who presented with a unique pattern of retinopathy.

Observations

A 7-year-old Taiwanese girl with HIV disease who was recently diagnosed with KFD had a sudden onset of blurry vision in both eyes one month after her KFD systemic symptoms had relatively resolved. Ophthalmic examination showed decreased visual acuity in both eyes (OU). On fundus examination, she had bilateral preretinal, subhyaloid, and vitreous hemorrhage that was more severe than anemic retinopathy.

Conclusion

Ocular manifestations in Kikuchi-Fujimoto disease are rare; however, if they occur, presentations may vary. The exact etiology of the disease has remained elusive and controversial. This case is the first report of a patient with HIV disease and KFD presenting with ocular involvement. Furthermore, bilateral preretinal, subhyaloid, and vitreous hemorrhage, which was beyond anemic retinopathy, is an unprecedented manifestation of KFD that has not been previously reported. This case highlights the necessity for clinicians to consider all possible differential diagnoses when evaluating patients with similar findings to identify the best therapeutic approach and avoid unnecessary treatment.

Clinical and Laboratory Characteristics of Kikuchi-Fujimoto Disease According to Age

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.

Kikuchi-Fujimoto disease in children

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.

An uncommon presentation of Kikuchi Fujimoto disease: a case report with literature review

BACKGROUND

Kikuchi-Fujimoto disease is so named because Kikuchi and Fujimoto were the first scientists to describe it in Japan in 1972. Although the disease has been reported from all over the world and more so from Asia, it is rare. To date only eight cases have been reported from Nepal. Cervical lymphadenopathy, fever and raised Erythrocyte Sedimentation Rate are usual presenting features of this disease. We describe a case which presented with thrombocytopenia and axillary lymphadenopathy in addition to the usual features. Out of the total eight cases that have been reported from Nepal so far, no patients had thrombocytopenia and only one patient had axillary lymphadenopathy.

CASE PRESENTATION

A 24-year-old Nepali female presented with a 3-week history of low-grade fever, headache, and painful, discrete, unilateral left-sided cervical and axillary lymphadenopathy. Among the multitude of tests that were carried out, Erythrocyte Sedimentation Rate was raised and there was thrombocytopenia while other tests were normal. Painful lymphadenopathy pointed to bacterial lymphadenitis while chronic low-grade fever suggested tuberculosis. A cervical lymph node was excised for histopathological examination to reach an accurate diagnosis. On the basis of pathognomonic features viz., paracortical foci composed of various types of histiocytes including crescentic type in the background of abundant apoptotic karyorrhectic debris, a diagnosis of Kikuchi-Fujimoto disease was made. On follow-up evaluation after 6 weeks, the patient had no systemic symptoms, enlarged lymph nodes had regressed in size significantly, and Erythrocyte Sedimentation Rate and platelet count had become normal.

CONCLUSION

Kikuchi-Fujimoto disease should be kept in the differential diagnosis of lymphadenopathy in young patients, female or male even in tuberculosis-endemic countries and even in patients who have unusual features; for example thrombocytopenia and involvement of axillary lymph nodes in addition to cervical lymph nodes as in this case.

Kikuchi-Fujimoto disease and acute appendicitis

A 29-year-old Japanese man developed fever, nausea, vomiting, diarrhoea, right lower quadrant abdominal pain and rebound tenderness. With the clinical suspicion of appendicitis, an abdominal CT scan was performed, which revealed mesenteric lymphadenitis. The patient was hospitalised and treated with antibiotics, but was ultimately found to have Kikuchi-Fujimoto disease (KFD). This diagnosis was facilitated by the use of positron emission tomography scan that identified an accessible inguinal lymph node for biopsy and histopathological evaluation. Invasive abdominal surgery was thereby averted and the patient made a complete recovery on subsequent follow-up. Review of the published literature reveals that pseudoappendicitis due to KFD is a rare occurrence that has generally required abdominal surgery to establish the diagnosis, thus supporting the potential value of the approach taken here.

Kikuchi-fujimoto disease: a study of 24 cases

Kikuchi-Fujimoto disease (KFD) is a rare benign disorder predominantly affecting young adults and has a site predilection for cervical lymph nodes. The objective of this study is to analyze the clinicopathological features of KFD. A retrospective study of 24 cases of KFD presenting at a tertiary care hospital in southern India over a 4 year period is presented here. Clinical findings, histopathological findings and follow up data were reviewed. Of the 24 cases encountered, 17 were females and 7 were males. Painless cervical lymphadenopathy was the most common presenting feature. All cases showed typical morphology of KFD with necrosis, karyorrhectic debris and presence of the typical cell types namely crescentic histiocytes and plasmacytoid monocytes. Of the 19 cases with follow up, all resolved within 1 month. The pathologist should be aware of the typical presentation and morphology of KFD in order to distinguish it from the more common causes of cervical lymphadenopathy like tuberculosis (especially in countries like India) as well lymphomas.

Kikuchi disease in Connecticut

Kikuchi disease is a self-limited disorder of unknown etiology characterized by focal painful lymphadenitis, fever, and weight loss that can be mistaken for malignancy. Diagnosis is established by node biopsy. Kikuchi disease is endemic in Asia; 10 cases have been reported in the US to date. We report 3 cases and review other US cases.

A case of fever of unknown origin: co-existence of Kikuchi-Fujimoto disease and acute disseminated encephalomyelitis (ADEM)

It is believed that viral infections and the hyperimmune reaction due to these infections are involved in the etiology of Kikuchi-Fujimoto Disease (KFD), a rare cause of fever of unknown origin. Axillary lymphadenopathy and neurologic involvement are rare in KFD. We present a patient diagnosed with KFD histopathologically during an investigation of the origin of fever and axillary lymphadenopathy. Subsequently, incidental sinus aspergilloma was diagnosed radiologically in the patient and acute disseminated encephalitis developed during follow-up. This report aims to draw attention to the co-existence of KFD and Acute Disseminated Encephalomyelitis, two diseases of which the origins are not clear.

Axillary and intramammary lymphadenopathy caused by Kikuchi-Fujimoto disease mimicking malignant lymphoma

We describe a rare case of intramammary and axillary lymphadenopathy caused by Kikuchi-Fujimoto disease (KFD). A 30-year-old woman presented with enlarged axillary lymph nodes and a right breast mass with tenderness. Computed tomography, ultrasonography, F-2-deoxy-fluoro-D-glucose positron emission tomography and fine-needle aspiration cytology were performed, and malignant lymphoma (ML) was suspected. Histological diagnosis of a needle biopsy and surgical specimen showed histiocytic necrotizing lymphadenitis. It is important to differentiate KFD from ML because of differences in treatment choice and clinical outcome.

Catastrophic antiphospholipid syndrome and Kikuchi-Fujimoto disease: the first case reported

The case of a man with diagnosis of Kikuchi-Fujimoto disease (KFD) and catastrophic antiphospholipid syndrome (CAPS) is reported. He presented prolonged fever, lymphadenopathies, arthralgia, weight loss, hepatosplenomegaly and positive IgM for cytomegalovirus. While he was empirically treated with tuberculostatic drugs, he suddenly developed systemic inflammatory response syndrome, multiple organ failure and distal necrosis. On suspicion of severe sepsis, antibiotics, corticoids and recombinant human activated protein C (XIGRIS) were administrated. Exhaustive laboratory searching was negative. Histopathologic examinations of lymph node first disclosed malignant lymphoma but later KFD was confirmed. One month later, laboratory tests showed the presence of antiphospholipid antibodies (aPL). The patient was discharged after two months of hospitalization. This case exhibits a KFD complicated by definite CAPS. Cytomegalovirus could be involved in the development of both CAPS and KFD. Because of the severity of the case, we believe that XIGRIS noticeable improved the altered coagulation profile associated with CAPS.

Histiocytic necrotising lymphadenitis (Kikuchi-Fujimoto disease) in Saudi Arabia: clinicopathology and immunohistochemistry

BACKGROUND

Kikuchi-Fujimoto disease (KFD) is a rare entity of uncertain cause that commonly presents as a benign self-limiting disease of unknown origin. The objective of this study was to document the clinical features, mode of presentation, histopathological and immunohisto-chemical (IHC) features of KFD at our institutions since little is known about this disease in our region.

METHODS

We reviewed the histopathological reports of all lymph nodes resected at or referred to King Abdulaziz University Hospital between 1990 and 2003 and King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia between 2000 and 2003. All cases diagnosed as KFD were identified and the histological slides and clinical data were reviewed. IHC was performed for the proliferative marker Ki-67 and the apoptosis-related markers Bcl-2 and p53.

RESULTS

In 2500 lymph node biopsies, 15 cases were diagnosed as KFD. The female to male ratio was 2.7:1. One patient presented with axillary lymphadenopathy and the others presented with cervical lymphadenopathy. Ages averaged 29 years and ranged from 13 to 46 years. There was no recurrence of the lymphadenopathy over 1 to 10 years of follow up. Bcl-2 and p53 were negative and Ki-67 was positive in 11 of 15 cases.

CONCLUSION

The results support earlier findings that KFD is a self-limiting disorder that requires no specific management. We suggest a clinical follow-up for several years. The female predominance was striking. Apoptosis-regulating proteins are not helpful in the diagnosis. KFD usually expressed the proliferation-associated nuclear antigen Ki-67. Increased awareness of KFD will minimize the risk of confusing this entity with malignant lymphoma or other serious conditions.

Kikuchi-Fujimoto disease: a case report

Kikuchi-Fujimoto disease is a rare benign cervical lymphadenopathy, which often affects young adult women. Its etiology and pathogenesis are unknown. We present the case of Kikuchi-Fujimoto disease in the Polish population and analyse the difficulties in differentiating this disease from the systemic lupus erythematosus.