1
|
Gouda W, Alsaqabi F, Almurshed M, Mostafa AA, Albasri A, Negm A, Islam MA, Kamal M. Kikuchi-Fujimoto disease, simultaneously diagnosed with systemic lupus erythematosus in an Arabic female: an agonizing combination. J Int Med Res 2024; 52:3000605241248884. [PMID: 38713457 PMCID: PMC11080725 DOI: 10.1177/03000605241248884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/28/2024] [Indexed: 05/08/2024] Open
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign condition affecting young Oriental-Asian females. It is characterized by fever and tender cervical lymphadenopathy with an unclear aetiology, and in most longitudinal reviews, KFD occurs before systemic lupus erythematosus (SLE). Herein, the case of a 28-year-old Kuwaiti female without any relevant past medical history, who was simultaneously diagnosed with KFD and SLE following an Ebstein-Barr virus infection, is reported. The patient was treated with oral prednisolone, hydroxychloroquine, cyclosporin, and belimumab and her response was clinically and biochemically favourable. Although KFD is prevalent in Asian populations, it may affect all races. Early diagnosis of KFD is difficult, particularly when simultaneously diagnosed with SLE, but crucial to preventing inappropriate therapy. Clinicians need to know about this rare disease, especially when patients present with fever and swollen lymph nodes, due to a risk of misdiagnosis with tuberculosis or lymphoma, as these are more often thought to be the cause of such symptoms.
Collapse
Affiliation(s)
- Wesam Gouda
- Department of Rheumatology, Faculty of Medicine, Al Azhar University, Egypt
- Rheumatology Unit, Al‐Sabah Hospital, Kuwait
| | | | | | - Ashraf A. Mostafa
- Department of Rheumatology, Faculty of Medicine, Al Azhar University, Egypt
| | | | - Ahmed Negm
- Department of Rheumatology, Faculty of Medicine, Al Azhar University, Egypt
- Rheumatology Unit, Medical Affairs Department, Dubai Hospital, Dubai, UAE
| | - Md Asiful Islam
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mohamed Kamal
- Department of Rheumatology, Faculty of Medicine, Al Azhar University, Egypt
- Faculty of Medicine, Taibah University, Medina, Saudi Arabia
| |
Collapse
|
2
|
Lu ES, Hoyek S, Yuan M, El Khatib BA, Gonzalez E, Rothermel H, Gise R, Patel NA. Occlusive Retinal Vasculitis in a Pediatric Patient With Kikuchi-Fujimoto Disease and Sickle Cell Trait. Ophthalmic Surg Lasers Imaging Retina 2024; 55:235-239. [PMID: 38319054 DOI: 10.3928/23258160-20240123-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
A 13-year-old Black male patient with a history of Kikuchi-Fujimoto disease (KFD) and sickle cell trait presented with acute painless vision loss and no light perception vision (NLP) in his left eye. The examination was indicative of occlusive retinal vasculitis with near total central retinal artery occlusion (CRAO). He was started on oral steroids with dramatic reperfusion and improvement of the retinal hemorrhages. However, his vision remained at NLP. Oral steroids were tapered, and rituximab infusion was initiated. While ocular involvement is uncommon in KFD, vision-limiting complications, such as occlusive retinal vasculitis, ophthalmic artery occlusion, and CRAO can occur. Early systemic immunosuppression is key in achieving rapid remission. [Ophthalmic Surg Lasers Imaging Retina 2024;55:235-239.].
Collapse
|
3
|
Chen Q, Zhang J, Huang H, Qiu T, Jin Z, Shi Y, Zhu H, Fan L, Li J, Shi W, Miao Y. Histiocytic necrotizing lymphadenitis with hemophagocytic lymphohistiocytosis in adults: A single-center analysis of 5 cases. Immun Inflamm Dis 2024; 12:e1202. [PMID: 38411294 PMCID: PMC10898206 DOI: 10.1002/iid3.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Histiocytic necrotizing lymphadenitis (HNL) is a self-limited inflammatory disease of unknown pathogenesis. A very small fraction of patients with HNL could develop hemophagocytic lymphohistiocytosis (HLH), a hyperinflammatory disorder. These patients are diagnosed as HNL with HLH (HNL-HLH). HNL-HLH in the pediatric population has been systemically studied, however, the clinical, laboratory, and radiological features and outcomes of adult patients with HNL-HLH remain to be explored. We aimed to explore the clinical, laboratory, and radiological features and outcomes of adult patients with HNL-HLH. METHODS We collected the clinical data of patients with HNL-HLH admitted to the First Affiliated Hospital of Nanjing Medical University from October 2010 to June 2015. All the patients underwent lymph node biopsy and have a pathological diagnosis of HNL. The age, gender, clinical presentation, lymph node signs, laboratory findings and imaging data, and pathological findings of the patients were collected. RESULTS In this study, we reported five adult patients with HNL-HLH. All five patients showed enlarged lymph nodes and prolonged fever. Laboratory findings were consistent with the diagnosis of HLH. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed enlarged lymph nodes with increased FDG uptake and splenic hypermetabolism could be present. All the patients responded well to corticosteroids and had a good prognosis. Two of the five patients were diagnosed with systemic lupus erythematosus during the follow-up. CONCLUSIONS Our study demonstrated that adult patients with HNL-HLH showed distinct clinical, laboratory, and radiological features. And the prognosis is good and patients could be managed with steroids and supportive care.
Collapse
Affiliation(s)
- Qingqing Chen
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Jing Zhang
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Huijun Huang
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Tonglu Qiu
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Ze Jin
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Yu Shi
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Huayuan Zhu
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Lei Fan
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Jianyong Li
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenyu Shi
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yi Miao
- Department of Hematology, Pukou CLL Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| |
Collapse
|
4
|
Giannakos E. [Recurrent lymphadenitis was Kikuchi-Fujimoto disease]. Lakartidningen 2024; 121:23118. [PMID: 38343315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Kikuchi-Fujimoto disease, or histiocytic necrotizing lymphadenitis, is in most cases a benign disease which affects lymph nodes in the cervical region. Cervical adenopathy and fever are the most common symptoms, and young adults are mostly affected. Lymph node biopsy is the mode of diagnosis with demonstration of paracortical areas of apoptotic necrosis with abundant karyorrhectic debris and a proliferation of histiocytes, plasmacytoid dendritic cells, and CD8+ T cells in the absence of neutrophils. In most cases, the disease is self-limiting but it can be recurrent or evolve to SLE. Treatment varies from symptomatic to more systemic with cortisone and intravenous immunoglobulin.
Collapse
Affiliation(s)
- Evangelos Giannakos
- specialistläkare, reumatolog, kliniken för reumatologi samt hud- och könssjukdomar Sörmland, Mälarsjukhuset, Eskilstuna
| |
Collapse
|
5
|
Yu JL, Li Z, Zhang B, Huang YN, Zhao TY. Case report: Kikuchi-Fujimoto disease: unveiling a case of recurrent fever and enlarged cervical lymph nodes in a young female patient with a literature review of the immune mechanism. Front Immunol 2024; 14:1279592. [PMID: 38313434 PMCID: PMC10837848 DOI: 10.3389/fimmu.2023.1279592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024] Open
Abstract
The inflammatory response to viral infection is an important component of the antiviral response, a process that involves the activation and proliferation of CD8+ T, CD4+ T, and dendritic cells; thus, viral infection disrupts the immune homeostasis of the organism, leading to an increased release of inflammatory factors. Kikuchi-Fujimoto disease (KFD) is an inflammatory self-limited disorder of unknown etiology, and it is generally believed that the pathogenesis of this disease includes two aspects: viral infection and autoimmune response. Various immune cells, such as CD8+ T lymphocytes, CD4+ T lymphocytes, and CD123+ plasmacytoid dendritic cells, as well as the cytokines they induce and secrete, such as interferons, interleukins, and tumor necrosis factors, play a crucial role in the pathogenesis of KFD. In this article, we present a case study of a young female patient from China who exhibited typical symptoms of lymph node inflammation and fever. The diagnosis of KFD was confirmed through a lymph node biopsy. She presented with elevated ESR, IL-6, and IFN-γ. Viral markers showed elevated IgG and IgM of cytomegalovirus (CMV) and elevated IgG of Epstein-Barr virus (EBV), while changes occurred in the CD4+ T and CD8+ T cell counts. Eventually, the patient achieved disease relief through steroid treatment. Based on these findings, we conducted a comprehensive review of the involvement of viral infection-induced inflammatory response processes and autoimmunity in the pathogenesis of Kikuchi-Fujimoto disease.
Collapse
Affiliation(s)
- Jia-Li Yu
- Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhen Li
- Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bo Zhang
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ya-Nan Huang
- Department of Infectious Disease, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tian-Yu Zhao
- Department of Infectious Disease, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
6
|
Anini EM, AlBaik TM, Ibrahim AT, AbuKaresh NA, Albandak M, Alshalaldeh R, Natsheh M, Abunejma FM. Kikuchi-Fujimoto Disease: A Case Report of Prolonged Fever and Lymphadenopathy in a Young Girl. J Investig Med High Impact Case Rep 2024; 12:23247096241246618. [PMID: 38605558 PMCID: PMC11010749 DOI: 10.1177/23247096241246618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/13/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign and self-limited disorder that usually presents with regional cervical lymphadenopathy and fever. We report a case of a 12-year-old female who complained of fever, night sweating, significant weight loss, and tender right cervical lymph node enlargement for 2 months. A full workup including laboratory tests and imaging studies, an excisional biopsy, and histopathological analysis were done, and the diagnosis of KFD was confirmed. The patient was treated with analgesia and oral prednisolone, resulting in good improvement. A high degree of clinical suspicion is imperative for physicians, given the rarity of the disease and the associated diagnostic challenges.
Collapse
|
7
|
Ichikawa T, Furukawa R, Shimojima Y, Hoshino Y, Kishida D, Sekijima Y. Immune-mediated necrotizing myopathy with concomitant development of Kikuchi-Fujimoto disease. Int J Rheum Dis 2024; 27:e14894. [PMID: 37653623 DOI: 10.1111/1756-185x.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Immune-mediated necrotizing myopathy (IMNM) is a distinct type of idiopathic inflammatory myositis, pathologically characterized by myofiber necrosis and degeneration in the absence of lymphocyte infiltration. Herein, we present a case of IMNM with concomitant development of Kikuchi-Fujimoto disease (KFD), characterized by histiocytic necrotizing lymphadenitis, in a 36-year-old woman who had a treatment history for rheumatoid arthritis (RA). Treatment with oral prednisolone and tacrolimus as immunosuppressants resulted in the remission of the skeletomuscular involvement and lymphadenopathy. To the best of our knowledge, this is the first report of IMNM and KFD developing concomitantly during the clinical course of RA.
Collapse
Affiliation(s)
- Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryo Furukawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yumi Hoshino
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| |
Collapse
|
8
|
Yousefi M, Rukerd MRZ, Binafar H, Shoaie S, Mirkamali H, Pourzand P, Kaveh R. The co-occurrence of Kikuchi-Fujimoto disease and systemic lupus erythematosus: a case report. J Med Case Rep 2023; 17:448. [PMID: 37884991 PMCID: PMC10605312 DOI: 10.1186/s13256-023-04186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease is an uncommon systemic disease that mostly affects young women. Kikuchi-Fujimoto disease typically manifests as necrotizing lymphadenopathy, which frequently follows by a fever; however, Kikuchi-Fujimoto disease occurs rarely in extranodal regions. One of the most important accompaniments of Kikuchi-Fujimoto disease is its connection with autoimmune diseases such as systemic lupus erythematosus. This case presents a simultaneous occurrence of Kikuchi-Fujimoto disease with liver involvement and systemic lupus erythematosus in a young female patient. CASE PRESENTATION We present a rare case of a 20-year-old white woman who presented with fever, joint pains, myalgia, and shortness of breath. Initial hospitalization and treatment for fever of unknown origin did not yield improvement. Physical examination revealed cervical and supraclavicular lymphadenopathy, and laboratory investigations showed abnormal blood counts, elevated inflammatory markers, and positive autoimmune serologies. Imaging studies revealed bilateral pleural effusion and liver lesions. Lymph node biopsy confirmed the diagnosis of Kikuchi-Fujimoto disease, and liver biopsy showed extranodal involvement. The patient was diagnosed with Kikuchi-Fujimoto disease-associated systemic lupus erythematosus and treated with hydroxychloroquine and corticosteroids. The patient showed gradual resolution of symptoms and lymphadenopathy with treatment. CONCLUSION Kikuchi-Fujimoto disease is a rare systemic condition primarily impacting young females. It is characterized by necrotizing lymphadenopathy, often accompanied by fever. Although Kikuchi-Fujimoto disease is predominantly seen in the lymph nodes, occurrences in non-nodal areas are infrequent. When diagnosing Kikuchi-Fujimoto disease, it is essential to screen patients for systemic lupus erythematosus. In this particular case, we observed liver involvement along with the presence of both Kikuchi-Fujimoto disease and systemic lupus erythematosus.
Collapse
Affiliation(s)
- Maysam Yousefi
- Infectious Diseases Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Rezaei Zadeh Rukerd
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Hanieh Binafar
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Sahar Shoaie
- Department of Internal Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Hanieh Mirkamali
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Pouria Pourzand
- Department of Emergency Medicine, School of Medicine, University of Medicine, Minneapolis, USA
| | - Roxana Kaveh
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
9
|
Abstract
BACKGROUND Kikuchi disease (KD) is a rare and generally benign condition of uncertain etiology that presents with nonspecific symptoms including fever and cervical lymphadenopathy. Clinical presentations can vary. Here, we present an atypical case of KD in a 10-year-old girl, as well as an updated literature review of the clinical presentation, laboratory features and management of KD in children. METHODS Studies (published up until February 2020) were identified through searches of PubMed using the following search items: Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis or Kikuchi disease. Our primary search resulted in 1117 publications. A total of 34 publications with a total of 670 patients were included in the final analysis. RESULTS All children present with lymphadenopathy. Almost all (96.3%) have cervical lymphadenopathy. Fever is recorded in the majority of children (77.1%). Analysis of laboratory features found that the majority of children have leukopenia (56.0%) and a raised erythrocyte sedimentation rate (56.0%). Over 30% have a raised C-reactive protein and anemia. Other features such as leukocytosis, thrombocytopenia and antinuclear antibodies positivity are less common. KD is mostly self-limiting, but steroids, hydroxychloroquine and intravenous immunoglobulin are used in protracted courses. Their efficacy has yet to be established in clinical trials. CONCLUSIONS The presentation of KD is variable, and there is no specific set of symptoms or laboratory features that reliably establishes the diagnosis. Thus, histopathology is crucial. Definitive evaluation and establishment of effective treatments will require future prospective research studies for a more comprehensive description of the clinical course and effects of treatment. Given the rarity of the disease, this will have to be performed in collaborative consortia.
Collapse
Affiliation(s)
- Ahmed Abdu
- From the Oxford University Medical School, University of Oxford, Oxford, United Kingdom
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Else M Bijker
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| |
Collapse
|
10
|
Fiori M, Spina P, Monotti R, Salvadé I. Abdominal Kikuchi-Fujimoto lymphadenopathy: an uncommon presentation of a rare disease. BMJ Case Rep 2022; 15:e244732. [PMID: 35210223 PMCID: PMC8883202 DOI: 10.1136/bcr-2021-244732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 34-year-old man presented to our hospital with a 5-day history of progressive abdominal pain and fever. A CT scan identified extensive mesenteric lymphadenopathy. Initial diagnostic tests were inconclusive. Abdominal lymph node biopsy showed histiocytic necrotising lymphadenitis, compatible with Kikuchi-Fujimoto disease (KFD). This benign and self-limiting disease generally resolves following supportive treatment. In this case, remission occurred within 3 weeks of initial presentation. KFD is a very uncommon cause of lymphadenopathy, and selective mesenteric involvement is rare. Definitive diagnosis often requires lymph node biopsy. It is important to exclude more common and serious differential diagnoses associated with mesenteric lymphadenopathy, while maintaining a minimally invasive diagnostic approach, before progressing to nodal biopsy.
Collapse
Affiliation(s)
- Marco Fiori
- Internal Medicine, EOC, Bellinzona, Switzerland
| | - Paolo Spina
- Cantonal Institute of Pathology, EOC, Bellinzona, Switzerland
| | | | | |
Collapse
|
11
|
Zhang R, Liang L, Li D, Bai Y, Li X. Analysis of the clinical manifestations and 18F-FDG PET-CT findings in 40 patients with histiocytic necrotizing lymphadenitis. Medicine (Baltimore) 2021; 100:e27189. [PMID: 34477179 PMCID: PMC8415950 DOI: 10.1097/md.0000000000027189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/19/2021] [Indexed: 01/05/2023] Open
Abstract
Histiocytic necrotizing lymphadenitis (HNL) is a rare, benign, and self-limiting inflammatory disease that mainly involves the lymph nodes. There is a lack of large sample studies concerning the clinical manifestations and imaging features of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) of HNL.The clinical symptoms, laboratory examination results, 18F-FDG PET/CT imaging features, and treatment outcome were investigated in this retrospective study.A total of 40 HNL patients were recruited. The onset age was between 14 and 65 years, with a median of 25 years. The white blood cell count was 3.9 (2.9, 7.1) × 109/L, C-reactive protein level was 20.2 (6.6, 63.8) mg/L, erythrocyte sedimentation rate was 29.0 (18.0,45.0) mm/h, and ferritin was 616.5 (205.6, 2118.1) ng/mL. An abnormal liver function was observed in 23 patients. 18F-FDG PET-CT showed that an abnormal lymph node metabolism was observed in 38 patients, among which the highest 18F-FDG maximal standard uptake value (SUVmax) of the lymph nodes ranged between 3.4 and 41.9; the nodes were mainly distributed in the neck and axilla regions. Meanwhile, a total of 2502 lymph nodes (721 lymph nodes with a short axis greater than 10 mm) were found in the 38 patients, including 1837 lymph nodes with an 18F-FDG SUVmax ≥ 2.5. The 18F-FDG SUVmax of the spleen ranged from 2.5 to 9.2 in 20 patients, while that of central and peripheral bone marrow ranged from 2.7 to 36.0 in 30 patients. After follow-up for an average period of 1 month, the symptoms improved after prednisone treatment.HNL often occurs in adolescents. Scanning with 18F-FDG PET/CT showed that most patients had multiple involved lymph nodes that were hypermetabolic, and only few lymph nodes are enlarged. Besides, the spleen or central and peripheral bone marrow could sometimes be hypermetabolic. Glucocorticoid treatment for the HNL patients is effective.
Collapse
Affiliation(s)
- Rui Zhang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lidan Liang
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Daoming Li
- Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuling Bai
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangzhou Li
- Department of Nuclear Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
12
|
Abstract
BACKGROUND Kikuchi disease, also known as Kikuchi-Fujimoto disease, is a rare, benign cause of cervical lymphadenitis. It is characterized by painful cervical lymphadenopathy with fevers, leukopenia, and an elevated erythrocyte sedimentation rate. It is diagnosed by obtaining a biopsy specimen from a lymph node that shows characteristic histopathologic findings. CASE REPORT We highlight a 42-year-old Japanese man who presented with persistent fevers and cervical lymphadenopathy who was misdiagnosed at multiple urgent care facilities and emergency departments. He was eventually diagnosed with Kikuchi disease after a biopsy specimen was obtained from a lymph node 1 month after his symptoms began. He was treated with hydroxychloroquine and prednisone with resolution of his symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although Kikuchi disease has been previously described in various specialty medical journals, the published literature on Kikuchi disease in emergency medicine is relatively scarce. Given that cervical lymphadenopathy is a common presentation to emergency departments, it is important for emergency physicians to be cognizant of Kikuchi disease in the differential diagnosis of cervical lymphadenopathy to prevent misdiagnoses and unnecessary treatments.
Collapse
Affiliation(s)
- Alexandra M Frankel
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Sam Frenkel
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Amir Aminlari
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Theodore Chan
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| |
Collapse
|
13
|
Sultan S, Mushtaq H, Manan A. Kikuchi-Fujimoto Diseasae: An Important Differential of Tuberculous Lymphadenitis. J Coll Physicians Surg Pak 2020; 30:987-988. [PMID: 33036688 DOI: 10.29271/jcpsp.2020.09.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
Kikuchi-Fujimoto disease, also called necrotising histiocytic lymphadenitis, is a rare disease of usually benign outcome. A case of a 21-year female is reported here. She presented with high grade fever and cervical lymphadenopathy. She was started on anti-tubercular treatment (ATT) with suspicion of tuberculous lymphadenitis as she had very strong history of tubercular (TB) contact. Kikuchi-Fujimoto disease was diagnosed after cervical lymph node biopsy, thus ATT was stopped. She was treated with oral steroids and complete recovery was made. Of significant note, two of patient's siblings were treated for pulmonary TB, because of which she had strong history of direct TB contact. Although a few cases of Kikuchi-Fujimoto disease have been reported in Pakistan, this is first case being reported in setting of very strong positive history of TB contact. Key Words: Lymphadenitis, Tuberculosis, Kikuchi-Fujimoto disease.
Collapse
Affiliation(s)
- Shaheen Sultan
- Department of Medicine, Liaquat National Hospital, Karachi, Pakistan
| | - Hina Mushtaq
- Department of Medicine, Liaquat National Hospital, Karachi, Pakistan
| | - Abdul Manan
- Department of Medicine, Liaquat National Hospital, Karachi, Pakistan
| |
Collapse
|
14
|
Chowdhury SR. Extra-nodal Kikuchi Disease and Kikuchi Encephalitis. Indian Pediatr 2019; 56:881-882. [PMID: 31724549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Kikuchi disease is a rare but benign, self-limiting disease that typically presents with prolonged fever and cervical lymphadenopathy. We report neurological manifestations in an adolescent girl with recurrent Kikuchi disease.
Collapse
|
15
|
Honda F, Tsuboi H, Toko H, Ohyama A, Takahashi H, Abe S, Yokosawa M, Asashima H, Hagiwara S, Hirota T, Kondo Y, Matsumoto I, Sumida T. Recurrent Kikuchi-Fujimoto Disease Successfully Treated by the Concomitant Use of Hydroxychloroquine and Corticosteroids. Intern Med 2017; 56:3373-3377. [PMID: 29021444 PMCID: PMC5790731 DOI: 10.2169/internalmedicine.9205-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 04/24/2017] [Indexed: 11/06/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign disease of unknown etiology characterized by lymphadenopathy and a fever. For the majority of patients with KFD, the course is self-limited; however, the optimum method of managing recurrent cases has not yet been established. We herein report a case of a 42-year-old Japanese woman with KFD (confirmed by a lymph node biopsy). Although high-dose prednisolone (PSL) rapidly induced remission, she experienced four recurrences on treatment tapering. Concomitant use of hydroxychloroquine (HCQ) with low-dose PSL induced continuous remission. This is the first case to suggest the effectiveness of HCQ for recurrent KFD in a Japanese patient.
Collapse
Affiliation(s)
- Fumika Honda
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hirofumi Toko
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Ayako Ohyama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hidenori Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Saori Abe
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Masahiro Yokosawa
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiromitsu Asashima
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Shinya Hagiwara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Tomoya Hirota
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| |
Collapse
|
16
|
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. J Microbiol Immunol Infect 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
17
|
Rezkalla J, Lynch DW. A Rare Case of Lymphadenopathy: Kikuchi-Fujimoto Disease. S D Med 2017; 70:311-313. [PMID: 28806027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A relatively unknown cause of cervical lymphadenopathy is Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis. This is a rare and benign condition that presents with painful cervical lymphadenopathy, fevers, night sweats, and weight loss. This disease is most prevalent in Asian women between the age of 20-35 years. The diagnosis of Kikuchi Disease is made histologically and is characterized by paracortical areas of necrosis and a notable complete absence of neutrophils. The painful lymphadenopathy can be simply treated with antipyretics, but due to its presenting symptoms of Kikuchi disease, it is often mistaken for malignant lymphoma. As such, accurate diagnosis is required to avoid unnecessary testing. The evaluation of lymphadenopathy without an obvious cause can be quite challenging. When patients present with relapsing remitting lymphadenopathy, Kikuchi disease may warrant consideration.
Collapse
Affiliation(s)
- Josh Rezkalla
- Univerisity of South Dakota Sanford School of Medicine
| | - Douglas W Lynch
- Sanford Health Pathology Clinic, Sioux Falls, South Dakota
- University of South Dakota Sanford School of Medicine
| |
Collapse
|
18
|
Andola SK, Sinha A, Biradar S. Kikuchi-Fujimoto's Disease: Clinicopathological Correlation. J Assoc Physicians India 2016; 64:83-84. [PMID: 27735163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Kikuchi-Fujimoto's disease is a benign, self-limiting disorder characterized by regional tender lymphadenopathy fever and night sweats. It most commonly affects Asian adult females younger than 40 years of age. We report a case of 26 year female who presented with cervical lymphadenopathy, which on FNAC revealed Necrotizing Granulomatous inflammation which was unresponsive for three months of antitubercular therapy. A diagnosis of Kikuchi Fujimoto's disease was suggested on review of the slides at our institute and a biopsy confirmed the diagnosis.
Collapse
Affiliation(s)
| | | | - Sangram Biradar
- Associate Professor, Department of Medicine, M. R. Medical College, Gulbarga, Karnataka
| |
Collapse
|
19
|
Aznab M, Kamalian N, Navabi J, Kavianimoghadam K. Kikuchi-Fujimoto Disease: a Case Report. Acta Med Iran 2015; 53:725-727. [PMID: 26786995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 06/05/2023] Open
Abstract
Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is an idiopathic, self-limiting disorder and predominantly affects young women. We report a 35-year-old female who presented with soft to firm cervical lymphadenopathy and neck pain. She had multiple enlarged cervical nodes. Examination of other systems was normal. Lymph node biopsy was performed, and the histological features, and immunohistochemistry confirmed the diagnosis. The Patient was treated with non-steroidal anti-inflammatory drugs and low-dose prednisolone. A significant decrease in the size of lymph node and relief of neck pain occurred. During four years of follow-up, the patient developed no malignant disease or systemic and autoimmune diseases such as systemic lupus erythematosus. Kikuchi-Fujimoto disease is rare, clinicians should be aware of this condition as early diagnosis of the disease will lessen concerns of the patient's family.
Collapse
Affiliation(s)
- Mozaffar Aznab
- Department of Internal Medicine, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Naser Kamalian
- Department of Pathology, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaffar Navabi
- Department of Internal Medicine, Taleghani Hospital, Kermanshah, Iran
| | - Kaveh Kavianimoghadam
- Department of Paramedical, School of Medicine, Kermanshah of University Medical Sciences, Kermanshah, Iran
| |
Collapse
|
20
|
He N, Cheng SQ, Yan W, Chen XN. [Clinical and pathological characteristics and prognosis of children with histiocytic necrotizing lymphadenitis]. Zhongguo Dang Dai Er Ke Za Zhi 2015; 17:1257-1260. [PMID: 26575889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Na He
- Department of Pediatrics, Haikou Maternal and Child Health Care Hospital, Haikou 570203, China
| | | | | | | |
Collapse
|
21
|
Dumas G, Prendki V, Haroche J, Amoura Z, Cacoub P, Galicier L, Meyer O, Rapp C, Deligny C, Godeau B, Aslangul E, Lambotte O, Papo T, Pouchot J, Hamidou M, Bachmeyer C, Hachulla E, Carmoi T, Dhote R, Gerin M, Mekinian A, Stirnemann J, Charlotte F, Farge D, Molina T, Fain O. Kikuchi-Fujimoto disease: retrospective study of 91 cases and review of the literature. Medicine (Baltimore) 2014; 93:372-382. [PMID: 25500707 PMCID: PMC4602439 DOI: 10.1097/md.0000000000000220] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenopathy, most often cervical. It has been mainly described in Asia. There are few data available on this disease in Europe. We conducted this retrospective, observational, multicenter study to describe KFD in France and to determine the characteristics of severe forms of the disease and forms associated with systemic lupus erythematosus (SLE). We included 91 cases of KFD, diagnosed between January 1989 and January 2011 in 13 French hospital centers (median age, 30 ± 10.4 yr; 77% female). The ethnic origins of the patients were European (33%), Afro-Caribbean (32%), North African (15.4%), and Asian (13%). Eighteen patients had a history of systemic disease, including 11 with SLE. Lymph node involvement was cervical (90%), often in the context of polyadenopathy (52%), and it was associated with hepatomegaly and splenomegaly in 14.8% of cases. Deeper sites of involvement were noted in 18% of cases. Constitutional signs consisted mainly of fever (67%), asthenia (74.4%), and weight loss (51.2%). Other manifestations included skin rash (32.9%), arthromyalgia (34.1%), 2 cases of aseptic meningitis, and 3 cases of hemophagocytic lymphohistiocytosis. Biological signs included lymphocytopenia (63.8%) and increase of acute phase reactants (56.4%). Antinuclear antibodies (ANAs) and anti-DNA antibodies were present in 45.2% and 18% of the patients sampled, respectively. Concomitant viral infection was detected in 8 patients (8.8%). Systemic corticosteroids were prescribed in 32% of cases, hydroxychloroquine in 17.6%, and intravenous immunoglobulin in 3 patients. The disease course was always favorable. Recurrence was observed in 21% of cases. In the 33 patients with ANA at diagnosis, SLE was known in 11 patients, diagnosed concomitantly in 10 cases and in the year following diagnosis in 2 cases; 6 patients did not have SLE, and 4 patients were lost to follow-up (median follow-up, 19 mo; range, 3-39 mo). The presence of weight loss, arthralgia, skin lesions, and ANA was associated with the development of SLE (p < 0.05). Male sex and lymphopenia were associated with severe forms of KFD (p < 0.05). KFD can occur in all populations, irrespective of ethnic origin. Deep forms are common. An association with SLE should be investigated. A prospective study is required to determine the risk factors for the development of SLE.
Collapse
Affiliation(s)
- Guillaume Dumas
- From the Department of Internal Medicine (GD, CR), Hôpital d'Instruction des Armées Bégin, Saint-Mandé; Department of Internal Medicine 2 (JH, ZA), Pitié-Salpêtrière University Hospital, Paris; Department of Internal Medicine (PC), Pitié-Salpêtrière University Hospital, Paris; Department of Clinical Immunology (LG), Saint-Louis University Hospital, Paris; Department of Rheumatology (OM), Bichat University Hospital, Paris; Department of Internal Medicine (CD), Martinique University Hospital, Fort-de-France; Department of Internal Medicine (BG), Mondor University Hospital, Créteil; Department of Internal Medicine (EA), Cochin University Hospital, Paris; Department of Internal Medicine (OL), Bicêtre University Hospital, Le Kremlin-Bicêtre; Department of Internal Medicine (TP), Bichat University Hospital, Paris; Hôpital Européen Georges Pompidou (JP), Paris; Department of Internal Medicine (MH), Hôtel-Dieu University Hospital, Nantes; Department of Internal Medicine (CB), Tenon University Hospital, Paris; Department of Internal Medicine (EH), Huriez University Hospital, Lille; Department of Internal Medicine (TC), Hôpital d'Instruction des Armées du Val de Grace, Paris; Department of Internal Medicine (RD), Avicenne University Hospital, Bobigny; Department of Internal Medicine (MG, AM, OF), Jean Verdier University Hospital, Bondy; Department of Pathology (FC), Pitié-Salpêtrière University Hospital, Paris; Department of Internal Medicine (DF), Saint-Louis University Hospital, Paris; Department of Pathology (TM), Necker University Hospital, Paris; France; and Department of Internal Medicine (VP), Hôpital des Trois-Chêne, Hôpitaux Universitaires de Genève, Genève; and Department of Internal Medicine (JS), Hôpitaux Universitaires de Genève, Genève, Switzerland. Drs. Prendki and Fain contributed equally
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Guan W, Hu AM. [One case report of treating Kikuchi disease by Yinqiao powder]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2014; 34:631-632. [PMID: 24941859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
23
|
Affiliation(s)
- Shakeel Ahmed
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman.
| | | | | |
Collapse
|
24
|
Ruiz Beguerie J, Fernandez Penas P, Sharma R. Kikuchi-Fujimoto disease with cutaneous presentation in a patient with subacute cutaneous lupus erythematosus. Dermatol Online J 2012; 18:8. [PMID: 23031375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
We report the case of a 45-year-old female patient previously diagnosed with subacute cutaneous lupus erythematosus who presented with a one-week history of fever, tender erythematous nodules on her limbs, and palpable lymphadenopathy. Two incisional biopsies showed histiocytic infiltrates with abundant nuclear debris in the dermis and at the dermosubcutaneous junction with absence of neutrophils, characteristic of Kikuchi-Fujimoto disease (KFD). The dermatologic and dermopathologic details of KFD are very heterogeneous and yet poorly described. We have reviewed the literature regarding KFD cases reported with cutaneous involvement trying to assess the skin features of the KFD or histiocytic necrotizing lymphadenitis.
Collapse
|
25
|
Rammohan A, Cherukuri SD, Manimaran AB, Manohar RR, Naidu RM. Kikuchi-Fujimoto disease: a sheep in wolf's clothing. J Otolaryngol Head Neck Surg 2012; 41:222-226. [PMID: 22762705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting disorder that typically affects the cervical lymph nodes. Recognition of this condition is crucial, especially because it can easily be mistaken for tuberculosis, lymphoma, or even adenocarcinoma. Awareness of this disorder will help prevent misdiagnosis and inappropriate treatment. METHODS From January 2006 to December 2008, 30 patients who underwent a biopsy of a cervical lymph node and proved histologically to have KFD were enrolled in this study. We studied clinical manifestations, laboratory results, treatment, and recurrence for each patient. Patients were followed up for a mean period of 2 years. RESULTS There were 24 women and 6 men, with a mean age of 18 years. Two patients had a past history of tuberculosis. Major clinical symptoms and signs were fever (70%) and lymphadenopathy (100%). The affected cervical lymph nodes were most commonly located in the posterior cervical triangle. Unilateral and bilateral cervical lymph nodes were affected in 25 and 5 patients, respectively. The affected lymph nodes were most commonly less than 3 cm in size. Leukopenia was observed in 46.7%, and a raised erythrocyte sedimentation rate was seen in 56.7% of the cases. Treatment strategies included no medication, nonsteroidal antiinflammatory drugs (NSAIDs) alone, steroids alone, or a combination of NSAIDs and steroids. Ninety percent improved within 3 months, whereas one patient showed improvement only after 9 months of continued treatment. No recurrence has since been noted. CONCLUSION KFD is a benign disease that masquerades as other more sinister diseases and can lead to unnecessary treatment-induced physiologic, psychological, and financial morbidity to the patient. Tissue diagnosis is necessary in all cases, and an effective communication between the surgeon and the pathologist is imperative in making an accurate diagnosis.
Collapse
Affiliation(s)
- Ashwin Rammohan
- Department of General Surgery, Apollo Hospitals, Chennai, India
| | | | | | | | | |
Collapse
|
26
|
Corral M, Huergo I, Alianak M, Staffieri F, Fainberg A, Staffieri F. [Kikuchi-Fujimoto disease]. Medicina (B Aires) 2012; 72:33-36. [PMID: 22257454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a rare, benign, self-limited condition of unknown etiology. A 16-year-old woman with no relevant clinical history seeks medical attention for fever and cervical adenopathies. In a physical examination the patient is found to be febrile (38.5 C) with multiple bilateral, hard-elastic cervical adenopathies, congestive oropharynx and mild splenomegaly with no other relevant pathological findings. The laboratory examination shows signs of pancytopenia and an increase in the erythrocyte sedimentation rate, Β2-microglobulin, transaminases and lactate dehydrogenase. Several serological tests are carried out with negative results except for immunoglobulin G for parvovirus, which is positive. A computerized axial tomography scan of head, neck, thorax, abdomen and pelvis shows bilateral lateral cervical adenomegalies (the largest with a size of 15 mm) and bilateral axillary adenomega- lies of less than 10 mm in diameter; small basal lung condensations with mild pleural effusion, mild homogeneous splenomegaly, and a small amount of free fluid in the abdominal cavity at the bottom of the Douglas cul-de-sac. Possible respiratory and gynecological infections are treated with ampicillin/sulbactam together with doxycycline. The patient progresses with persistence of the symptoms. A lymph node biopsy is then performed, revealing a morphology compatible with Kikuchi-Fujimoto disease. Treatment with prednisone is initiated with a clinical and laboratory improvement in the patient's condition. Kikuchi-Fujimoto disease is probably under-reported and under-diagnosed due to the low index of suspicion. Greater awareness of this illness would result in clinicians arriving at this diagnosis more often.
Collapse
Affiliation(s)
- Mariquena Corral
- Concurrencia de Clínica Médica, Sanatorio Americano, Rosario, Santa Fe.
| | | | | | | | | | | |
Collapse
|
27
|
Yilmaz M, Mamanov MA, Rashidov R, Ibrahimov M, Kyscu A, Karaman E. [A rare case of cervical lymphadenopathy--Kikuchi-Fujimoto's disease]. Vestn Otorinolaringol 2012:65-66. [PMID: 22678646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Kikuchi-Fujimoto's disease is a form of histocytic necrotizing lymphadenitis that largely affects women of Asian descent. The cause of this pathology remains to be elucidated although it is supposed that it has immunological and infectious nature. Clinically, Kikuchi-Fujimoto's disease manifests itself as unilateral lymphadenoapthy accompanied by febrile state and other non-specific symptoms. The diagnosis is based on the results of puncture (in the first place, excision) biopsy. No effective treatment of histocytic necrotizing lymphadenitis has thus far been proposed. Spontaneous regression of lymphadenopathy may occur within 1-6 months after the onset. A clinical observation of a 36 year-old patient presenting with a confirmed form of Kikuchi-Fujimoto's disease is presented.
Collapse
|
28
|
Lamzaf L, Harmouche H, Maamar M, Adnaoui M, Aouni M, Tazi Mezalek Z. [Kikuchi-Fujimoto's disease: Report of 4 cases and literature review]. Rev Laryngol Otol Rhinol (Bord) 2012; 133:207-211. [PMID: 24006828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION 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. OBSERVATIONS This report describes a survey of four patients who developed Kikuchi's lymphadenitis occurring concomitantly with LES in one case and actinomycosis in another case. The definite diagnosis is usually made through histopathological examination of a lymph node biopsy. The evolution was favorable under corticosteroid therapy in two patients, antibiotics in the third and only antipyretic in the fourth. CONCLUSION The authors bring report through these three observations, the diagnostic difficulties, the therapeutic means of the disease of Kikuchi, as well as its evolutionary aspects.
Collapse
Affiliation(s)
- L Lamzaf
- CHU Ibn Sina Rabat, Service de Médecine Interne, Rabat, Maroc.
| | | | | | | | | | | |
Collapse
|
29
|
Mukta V, Jayachandran K, Hemapriya S. Kikuchi-Fujimoto's disease: a report of five cases. J Assoc Physicians India 2011; 59:183-184. [PMID: 21751634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Kikuchi Fujimoto's disease is a rare, self limiting disorder characterized by fever and cervical lymphadenitis. It is often an incidental finding in a patient suspected to have tuberculosis or lymphoproliferative disorder. We diagnosed this disease in a young 23-year-old female who was suffering from prolonged fever, cervical lymphadenopathy, anemia, leucopenia and mild splenomegaly; based on histopathological study of the excised lymphnode. We reviewed the clinical records and histopathologic findings of four more patients of Kikuchi-Fujimoto's disease, who were treated by others at our institute. All five patients improved with NSAIDS (non steroidal anti inflammatory drugs). Histopathological finding of histiocytic necrotizing lymphadenitis or Kikuchi's disease proved invaluable in characterization of these cases.
Collapse
Affiliation(s)
- V Mukta
- Department of Medicine, PSGIMS&R, Peelamedu Coimbatore 641004, Tamil Nadu
| | | | | |
Collapse
|
30
|
Londhey VA, Buche AS, Kini SH, Rajadhyaksha GC. Kikuchi fujimoto disease and systemic lupus erythematosus--a rare association. J Assoc Physicians India 2010; 58:642-643. [PMID: 21510120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Kikuchi-Fujimoto disease is rarely associated with systemic lupus erythematosus (SLE). Kikuchi Fujimoto disease may precede, follow or coincide with the diagnosis of SLE. We report a case who was initially diagnosed as Kikuchi Fujimoto disease with SLE. She is presently in remission after treatment of SLE.
Collapse
Affiliation(s)
- V A Londhey
- Department of Medicine, T. N. Medical College and B.Y.L. Nair Ch. Hospital, Mumbai 400008
| | | | | | | |
Collapse
|
31
|
Gómez C, Eraso RM, Aguirre CA, Pérez MDP. [Kikuchi-Fujimoto disease: pediatric case presentation]. Biomedica 2010; 30:465-472. [PMID: 21713349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 06/10/2010] [Indexed: 05/31/2023]
Abstract
Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a rare, benign condition, usually self-limited to a six-month period. Classic clinical presentation is characterized by cervical lymphadenopathy, leukopenia and prolonged fever. It affects principally young, Asiatic adult women, although a few cases in the pediatric population have been reported. This disease frequently mimics tuberculous lymphadenitis, malign lymphoma, systemic lupus erythematosus and other benign and malignant conditions. The etiology is unknown, although a viral or autoimmune pathogenesis has been suggested. Laboratory investigations are usually unremarkable, and the most frequent findings are leukopenia, elevated erythrocyte sedimentation rate, anemia and positive antinuclear antibodies. To make an accurate diagnosis, histopathological studies are required. To avoid the use of antibiotics (which have no effect), early diagnosis is necessary. Herein the case of a 10 years old girl is described that presented with high, prolonged fever and marked cervical lymphadenopathy secondary to Kikuchi-Fujimoto disease.
Collapse
Affiliation(s)
- Carolina Gómez
- Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | | | | | | |
Collapse
|
32
|
Justice EA, Warfield AT, Winer JB, Rankin EC. Late recurrence of Kikuchi-Fujimoto disease in a young male complicated by sensory neuropathy. Clin Exp Rheumatol 2010; 28:587-588. [PMID: 20609295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 12/16/2009] [Indexed: 05/29/2023]
|
33
|
Iba Ba J, Nzenze JR, Missounga L, Bignoumba Ibouili R, Anquetil C, Moussavou Kombila JB, Boguikouma JB. [Kikuchi-Fujimoto disease in Gabon. Description of first 2 cases in Gabon]. Med Trop (Mars) 2010; 70:175-176. [PMID: 20486357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Kikuchi-Fujimoto disease is a rare disorder sometimes associated with systemic lupus. It has rarely been reported in the black African population. The purpose of this report is to describe the first two cases in Gabon. In patients presenting enlarged cervical lymph nodes, it is first necessary to rule out infectious disease. Histology can allow diagnosis by demonstrating necrotizing histiocyte lymphadenitis.
Collapse
Affiliation(s)
- J Iba Ba
- Service de Médecine A, Centre hospitalier de Libreville, Gabon.
| | | | | | | | | | | | | |
Collapse
|
34
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
|
35
|
Huang Y, Liang J. [The clinical characteristics of histiocytic necrotizing lymphadenitis: analysis of 11 cases]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2009; 23:676-677. [PMID: 19947249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To study the clinical features of histiocytic necrotizing lymphadenitis. METHOD Eleven patients with histiocytic necrotizing lymphadenitis were collected to analyze the clinical features, pathological features of biopsy lymph nodes, diagnosis and treatment. RESULT Lymph node swelling of neck and persistent fever were detected in all patients. The leukocyte reduction and swiftness of ESR in serum were detected in most patients. The final diagnosis of histiocytic necrotizing lymphadenitis was confirmed by biopsy investigation of the pathology. The pathological features included distinctive necrosis, loss of lymph node structure, infiltration with histiocytes and lymphocytes, absence of neutrophils. All patients were treated with glucocorticoid for 2 to 4 months. The patients improved significantly and were not recurrence during follow up visit. CONCLUSION There was no specific clinical manifestation of histiocytic necrotizing lymphadenitis and which easy to misdiagnoses. Diagnosis of histiocytic necrotizing lymphadenitis relies on the pathological examination of enlarged lymph nodes.
Collapse
Affiliation(s)
- Yulin Huang
- Department of Otolaryngology, People's Hospital of Panyu, Guangzhou, 511400, China.
| | | |
Collapse
|
36
|
Grosicka A, Grosicki S, Wandzel P. [Spontaneous remission of Kikuchi-Fujimoto disease (lymphadenopathy) with focal skin parakeratosis]. Wiad Lek 2009; 62:159-162. [PMID: 20229711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Kikuchi-Fujimoto disease is subacute, necrotizing lymphadenopathy affecting mainly young women, and manifested by cervical lymphadenopathy. It is often observed, and described in Asia, but in other world regions sporadically too. Etiology is unknown, but it has been postulated that this condition is induced by infectious factor. We described a case of 20-year-old Caucasian woman with diagnosis of Kikuchi-Fujimoto lymphadenopathy. First symptoms as a cervical lymph nodes enlargement 2 cm in diameter was associated with elevated body temperature, without associated symptoms of infection appeared about one year ago (data from history). Lymphadenopathy and general symptoms receded after empiric therapy with amoxicilin. Relapse of cervical lymphadenopathy alongshore sternocleidomastoid muscles bilateral to about 2 cm in diameter with pseudo-flu symptoms like fever and joints and muscles pains. Focal hiperpigmentation of abdomen, arms and legs skin appeared. In histopathology of collected lymph node histiocytic necrotizing lymphadenopathy without neutrophils infiltration Kikuchi type was diagnosed. In peripheral blood morphology transitional leucopenia 2.58 x 10(9)/l with granulocytopenia 0.64 x 10(9)/l was noted. Anemia and thrombocytopenia did not be observed. In serology active CMV, EBV or toxoplasmosis were excluded. In immunology presence of eleveted levels of anti-Jo, anti-nuclear and anticardiolipin antibodies was excluded too. Serum protein electrophoresis and additional biochemical parameters was normal. In chest X-ray and abdomen ultrasonography abnormalities was not found. In skin and muscles biopsy specimens focal parakeratosis was found. Despite no empiric antiinfectious therapy after 3-4 weeks remission of general symptoms and lymphadenopathy was noted.
Collapse
Affiliation(s)
- Anida Grosicka
- Klinika Chorób Wewnetrznych i Reumatologii, Samodzielny Publiczny Szpital Kliniczny Nr 7 SUM w Katowicach.
| | | | | |
Collapse
|
37
|
Parveen R, Rahman SH, Yasmin R, Quadir MS, Muazzam N, Alam MN. Kikuchi-Fujimoto disease. Mymensingh Med J 2009; 18:95-98. [PMID: 19182759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 14 year-old Bangladeshi girl presented with high fever, painful swellings in the neck, anorexia, weight loss and night sweating. On examination she had multiple enlarged and tender cervical lymph nodes. Other systems were normal. Laboratory investigations for sepsis and autoimmune diseases were negative. Initial fine needle aspiration and cytology of affected lymph node was suggestive of tubercular lymphdenitis. But she did not respond to anti-tubercular treatment. Kikuchi-Fujimoto disease was diagnosed from the histopathological appearance of excised lymph node. She completely recovered with symptomatic treatment. Kikuchi-Fujimoto disease, also called Kikuchi's disease or histiocytic necrotizing lymphadenitis is a rare, benign but enigmatic disease of unknown aetiology. The disease is self-limited and has an excellent prognosis. Its recognition is crucial because it can be mistaken for systemic lupus erythematosus, malignant lymphoma, tubercular lymphadenitis or even, for metastatic adenocarcinoma. Clinicians' and pathologists' awareness of this disease may help prevent misdiagnosis and inappropriate treatment.
Collapse
Affiliation(s)
- R Parveen
- Dhaka Medical College, and Department of Immunology & Molecular Biology, National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
| | | | | | | | | | | |
Collapse
|
38
|
Mosharraf-Hossain AKM, Datta PG, Amin ASA, Uddin MJ. Kikuchi-Fujimoto Disease presenting with fever, lymphadenopathy and dysphagia. J PAK MED ASSOC 2008; 58:647-649. [PMID: 19024143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Kikuchi Fujimoto Disease (KFD) can present with dysphasia, fever and lymphadenopathy. A young Bangladeshi girl presented with fever, cervical lymphadenopathy, dysphasia, weight loss and skin rash. Antitubercular drugs were given on clinical judgement, with no improvement after one month. Later, fine needle aspiration and histopathology of Lymph Node suggested KFD. Computerized Tomography (CT) scan of neck revealed enlarged retropharyngeal lymphnode (LN) causing pharyngeal narrowing. Oral Prednisolone was given showing improvement and no relapse was encountered. KFD may present with dysphasia uncommonly along with fever and lymphadenopathy. Awareness of this disorder by clinicians and pathologists will help prevent misdiagnosis and inappropriate treatment.
Collapse
|
39
|
Chase SP, Templer JW, Miick R, Diaz-Arias AA. Cervical lymphadenopathy secondary to Kikuchi-Fujimoto disease in a child: case report. Ear Nose Throat J 2008; 87:350-353. [PMID: 18561119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
While most cases of cervical lymphadenopathy resolve with conservative management, persistent adenopathy can lead to costly investigations and invasive treatments. One cause of persistent adenopathy, as well as a variety of other associated systemic symptoms, is Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis). This rare entity can be diagnosed only by excisional biopsy on the basis of its characteristic histologic appearance. We describe a case of persistent cervical lymphadenopathy secondary to Kikuchi-Fujimoto disease in an 11-year-old girl.
Collapse
Affiliation(s)
- Steven P Chase
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
| | | | | | | |
Collapse
|
40
|
Kalambokis G, Economou G, Nikas S, Bai M, Lampri E, Kosta P, Tsianos EV. Concurrent development of spontaneous pyomyositis due to Staphylococcus epidermidis and Kikuchi-Fujimoto disease. Intern Med 2008; 47:2139-43. [PMID: 19075539 DOI: 10.2169/internalmedicine.47.0946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Staphylococcus epidermidis is a common cause of infections associated with prosthetic devices and immunocompromised patients. Spontaneous pyomyositis due to the above pathogen is very uncommon. Kikuchi-Fujimoto disease (KFD) is a subacute necrotizing lymphadenitis, first described in Japan. A T cell-mediated hyperimmune response to various pathogens in a genetically susceptible individual has been primarily been considered in its pathogenesis. We report a patient who developed spontaneous pyomyositis caused by S. epidermidis concurrently with KFD, and discuss the possibility of S. epidermidis infection being the stimulant of KFD.
Collapse
Affiliation(s)
- Georgios Kalambokis
- The 1st Division of Internal Medicine, University Hospital, Ioannina, Greece
| | | | | | | | | | | | | |
Collapse
|
41
|
Jun-Fen F, Chun-Lin W, Li L, Dayan C, Guan-Ping D, Fang H. Kikuchi-Fujimoto disease manifesting as recurrent thrombocytopenia and Mobitz type II atrioventricular block in a 7-year-old girl: a case report and analysis of 138 Chinese childhood Kikuchi-Fujimoto cases with 10 years of follow-up in 97 patients. Acta Paediatr 2007; 96:1844-7. [PMID: 17931395 DOI: 10.1111/j.1651-2227.2007.00523.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The diagnosis of Kikuchi-Fujimoto disease (KFD) is challenging for a paediatrician. Recognizing unusual clinical presentations and features of KFD is essential for doctors to obtain a thorough understanding of this clinical entity. METHOD We reported a case recently diagnosed in our ward with manifestation of recurrent thrombocytopenia and Mobitz type II atrioventricular block, which is very unusual in childhood KFD. We also used three powerful Chinese Journal Search Engines (Cqvip.com, Wanfang.data and ScienceChina) to search the cases reported in China from 1989 to 2006. RESULTS One hundred seventy-three patients younger than 16 years old with pathologic proof of KFD were identified. Among them, 138 cases with detailed clinical records from eight different provinces and cities were analyzed, and of which 97 patients were followed-up for average of 10 years and the outcomes are discussed. CONCLUSIONS KFD is characterized by a spectrum of distinctive features, but also a variety of systemic manifestations. A hyperimmune reaction to unidentified agents as well as an autoimmune component may play an important role in this disease. Early corticosteroid therapy may improve the long-term prognosis of KFD in children.
Collapse
Affiliation(s)
- Fu Jun-Fen
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China.
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
HISTORY AND ADMISSION FINDINGS A 26-year-old Pakistani woman was admitted to hospital with fever, nausea and vomiting, abdominal pain and general weakness for the previous two weeks, but no diarrhea or constipation. Antibiotic therapy as an out-patient had not provided relief. She also had enlarged cervical lymph nodes. She reported that she had always been in good health before onset of the described symptoms. INVESTIGATIONS Laboratory tests revealed pancytopenia and a decrease in C3 and C4. The ANA titer was positive. The serum was positive for preceding infections with EBV, CMV, Chlamydia trachomatis, HHV type 6, and toxoplasmosis. There was no evidence of current or previous infections with HIV, Bartonella henselae, Treponema pallidum, Listeria, Hantavirus, Leishmania or dengue fever. The patient's symptoms were found to be associated with Hashimoto's thyroiditis in conjunction with latent hypothyroidism. Abdominal, thoracic and cervical CT scan revealed enlarged lymph nodes, up to 2 cm in size, and enlarged spleen and liver. THERAPY AND CLINICAL COURSE Histopathology of a cervical lymph node showed features of Kikuchi (Kikuchi-Fujimoto) disease (histiocytic necrotizing lymphadenitis). Prednisone administration (2 mg/kg body weight) led to the patient's rapid recovery. CONCLUSION Kikuchi disease should be considered in patients with cervical but also general lymphadenopathy, after exclusion of other causes. The specific diagnosis is based on biopsy of affected lymph nodes.
Collapse
Affiliation(s)
- A Brecht
- Medizinische Klinik III, Nephrologie und Rheumatologie.
| | | | | | | |
Collapse
|
43
|
Ianushkevich TN, Stakhova TV, Shcherbak AV, Nikiforova NV, Pavlovskaia AI, Sholokhova EN. [A two-year follow-up of Kikushi-Fugimoto disease (necrotising histiocytic lymphadenitis)]. TERAPEVT ARKH 2007; 79:72-4. [PMID: 17684973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
|
44
|
Ambrocio DU, John D. 57-year-old Asian-American man with Kikuchi's disease. Hawaii Med J 2006; 65:315-7. [PMID: 17265991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Kikuchi's Disease (KD) is a subacute necrotizing lymphadenitis more commonly reported from Asia. The classic presentation includes low-grade fever and cervical lymphadenopathy in a previously healthy woman. The ratio of affected women to men is 4:1 with the average age of onset less than 30 years. We report a case of KD in a 57-year-old Asian-American man whose presentation is associated with Adult Still's Disease.
Collapse
Affiliation(s)
- Deryll U Ambrocio
- University of Hawai'i, Internal Medicine Residency Program, 1356 Lusitana St., 7th Floor, Honolulu, HI 96813-2427, USA.
| | | |
Collapse
|
45
|
Join-Lambert OF, Ouache M, Canioni D, Beretti JL, Blanche S, Berche P, Kayal S. Corynebacterium pseudotuberculosis necrotizing lymphadenitis in a twelve-year-old patient. Pediatr Infect Dis J 2006; 25:848-51. [PMID: 16940849 DOI: 10.1097/01.inf.0000234071.93044.77] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the case of a 12-year-old girl with Corynebacterium pseudotuberculosis necrotizing lymphadenitis. Awareness of this disease is critical for the diagnosis given that corynebacteria are often considered as skin contaminants. The isolate was highly susceptible to antibiotics but only ciprofloxacin, rifampin and gentamicin exerted bactericidal activity.
Collapse
Affiliation(s)
- Olivier F Join-Lambert
- Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, and Faculté de Médecine Descartes Paris, Paris, France
| | | | | | | | | | | | | |
Collapse
|
46
|
Ahmad Z. More on Diagnosis and Management of Kikuchi Disease. J Clin Rheumatol 2006; 12:158-9. [PMID: 16755250 DOI: 10.1097/01.rhu.0000222052.81190.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
47
|
Mahmood A, Mir R, Salama SR, Miarrostami RM, Lapidus C, Pujol F. Kikuchi's disease: an unusual presentation and a therapeutic challenge. Yale J Biol Med 2006; 79:27-33. [PMID: 17876373 PMCID: PMC1942177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Kikuchi's disease, or necrotizing histiocytic lymphadenitis, is a rare disease that presents predominantly in young women in their 20s and 30s from the Far East. Our case depicts an African-American male, in his sixth decade of life, presenting with Kikuchi's disease, making our case unusual. The clinical presentation, together with laboratory and pathological tests described here, specifically the utilization of immunohistochemistry, aid in establishing a diagnosis. We advocate the use of steroids as symptomatic therapy and provide a novel and successful therapeutic regimen. We do not recommend antibiotic therapy until an infectious etiology is confirmed.
Collapse
Affiliation(s)
- Ali Mahmood
- New York Methodist Hospital, New York, NY, USA.
| | | | | | | | | | | |
Collapse
|
48
|
|
49
|
Angel-Moreno A, Hernández-Cabrera M, Pérez-Arellano JL. Kikuchi's Disease or Kikuchi's Syndrome? Clin Infect Dis 2006; 42:578-9; author reply 579-80. [PMID: 16421809 DOI: 10.1086/500017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
50
|
Altuntas F, Sari I, Canoz O, Yildiz O, Eser B, Cetin M, Unal A. Kikuchi-Fujimoto disease: a rare but important cause of fever and lymphadenopathy in pregnant women. Am J Hematol 2006; 81:118-20. [PMID: 16432868 DOI: 10.1002/ajh.20495] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a case of Kikuchi-Fujimoto disease (KFD) in a 28-year-old pregnant woman with prolonged fever and generalized lymphadenopathy. We evaluated the patient for etiology of the fever and adenopathy, which were unresponsive to antibiotic therapy. Cervical lymph node histology showed KFD. Currently, there is scant data available regarding the course and treatment of KFD during pregnancy. We administered steroid therapy (prednisone 1 mg/kg/day) to control severe systemic and constitutional symptoms. We observed a reduction in lymph node size as well as abatement of fever and other constitutional symptoms. The patient carried the fetus to full term with no apparent adverse effect. Our experience showed that steroid therapy may be used effectively to control KFD-related symptoms after the first 16 weeks without terminating the pregnancy.
Collapse
Affiliation(s)
- Fevzi Altuntas
- Department of Hematology-Oncology, Erciyes University, Faculty of Medicine, Dedeman Oncology Hospital, Kayseri, Turkey.
| | | | | | | | | | | | | |
Collapse
|