Rare Complications of Kikuchi's Disease: Beyond Pain Control

Diagnostic challenges and management of kikuchi-fujimoto disease: a rare case report

Introduction

Kikuchi-Fujimoto disease, otherwise referred to as histiocytic necrotizing lymphadenitis, is a rare and self-limiting disorder characterized by fever, lymphadenopathy, and upper respiratory symptoms. The main target of the illness is young Asian adults and is more prevalent in females. This disease probably has viral triggering or autoimmune responses, and diagnosis depends on histopathological examination.

Case Presentation

We present a case of an 18-month history of recurrent high-grade fever with marked weight loss and an enlarged occipital lymph node in a 42-year-old diabetic male from Karachi, Pakistan. The patient's symptoms did not subside despite being hospitalized several times and receiving multiple courses of antibiotics. Physical examination revealed a firm, non-tender occipital lymph node. Laboratory studies showed mild anemia and leukopenia, raised inflammatory markers, but unremarkable imaging studies and autoimmune tests. An excisional biopsy of the lymph node confirmed KFD with necrotizing lymphadenitis showing characteristic karyorrhectic debris.

Discussion

This case epitomizes the diagnostic challenges of KFD, which can mimic a host of conditions like tuberculosis and lymphoma. The recurrent fevers in the presence of significant weight loss and failure to respond to the usual treatments raised suspicion for further detailed investigation. Excisional biopsy established the diagnosis and differentiated it from other conditions. The patient's rapid improvement with corticosteroid therapy aligns with established treatment protocols for KFD, thus proving its efficacy.

Conclusion

KFD should be included in the differential diagnosis of fever of unknown origin. Diagnosis and management of KFD can avoid misdiagnosis and hence improve patient outcomes.

Case Report: Histiocytic Necrotizing Lymphadenitis (Kikuchi-Fujimoto Disease) Concurrent With Aseptic Meningitis

Kikuchi–Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign, self-limiting disease characterized by local lymphadenopathy. Central nervous system involvement in KFD is extremely rare and remains a diagnostic challenge. Only 41 cases of aseptic meningitis associated with KFD have been reported worldwide, with just four cases (including our case) of KFD with meningitis as the first symptom. We report a case of KFD accompanied by aseptic meningitis with severely high intracranial pressure (400 mmH₂O), increased white blood cell count (56 × 10⁶/L), and moderately elevated protein level (0.52 g/L). This case is unique in the delayed appearance of lymphadenopathy. After 1 month of treatment with steroids, fever, headache, and lymphadenopathy gradually disappeared, and the result of cerebrospinal fluid examination gradually became normal. In conclusion, based on our case findings and our literature review on KFD with aseptic meningitis, a diagnosis of KFD should be considered when delayed appearance of lymphadenopathy is observed in patients with aseptic meningitis.

Kikuchi-Fujimoto disease: an uncommon cause of neck swelling

Kikuchi-Fujimoto's disease (KFD) is a rare, benign condition characterized by histiocytic necrotizing lymphadenitis predominantly in the cervical region and prolonged fever. It has a higher prevalence in the Japanese and Asian populations although it may be seen in a wide geographic distribution, but rare are the cases reported in Europe. While symptoms resolve spontaneously between 2 weeks and 2 months, complications are described in: CNS, eyes, respiratory tract, kidney and liver. KFD also described an association with systemic lupus erythematosus. This paper describes a rare case of Kikuchi-Fujimoto lymphadenitis and discusses the features of the disease. A 24-year-old man presented with fever and a swollen 3-cm lymph node in the left side of the neck. The definitive diagnosis was established, after excision of level VB nodes on the left, by histologic examination. It revealed structurally intact tissue with scalloping in the paracortical area presenting activated T cells, focal monocytoid B cells, sinus histiocytosis and normally polarized follicles. Other two samples presented focal alterations of the tissue structure due to broad areas of necrosis, conspicuous nuclear debris, large lymphoid cells as well as numerous histiocytes. Immunohistochemistry revealed CD3+ and CD8+ T lymphocytes and histiocytes expressing CD68/PGM-1 (specific for macrophage lineage) and myeloperoxidase (MPO, specific for myeloid lineage). Correct, prompt diagnosis should be established through the findings of imaging and pathologic studies to avoid unnecessary investigation and ineffective therapies.