Histiocytic necrotizing lymphadenitis (Kikuchi's disease)

EBV-associated Kikuchi's histiocytic necrotizing lymphadenitis with cutaneous manifestations

The clinical and pathologic findings of Kikuchi's histiocytic necrotizing lymphadenitis may mimic those of malignant lymphoma. We describe a 6-year-old boy with generalized lymphadenopathy, spiking fever, chills, myalgias, malaise, and erythematous, crusted papules. Although cutaneous manifestations have been noted in 16% to 40% of patients with histiocytic necrotizing lymphadenitis, only three publications described skin lesions. The skin lesions and affected lymph nodes revealed histiocytic aggregates, atypical lymphoid cells, karyorrhectic debris, and patchy necrosis. Spontaneous resolution occurred in 2 months. Results of serologic studies, Epstein-Barr virus (EBV) latent membrane protein immunoperoxidase staining, EBER-1 RNA in-situ hybridization, and EBV EBNA-1 DNA polymerase chain reaction implicate EBV as the causative agent.

[Kikuchi-Fujimoto necrotizing histiocytic lymphadenitis: apropos of 2 cases and review of the literature]

The Kikuchi-Fujimoto's syndrome is an histiocytic necrotizing lymphadenitis which is observed at any ages but preferentially among young adults. The sex ratio is about 4:1 in favour of women. It is clinically characterized by cervical lymph nodes in a context of fever and asthenia. Sometimes, there is transitory leucopenia and an increase of the erythrocyte sedimentation rate. The course of the disease is spontaneously favourable in 1 or 3 months but recurrence is possible. The histology of the lymph node could mimic a malignant lymphoma and the immunohistochemical findings are of a great importance (Ki-M1P or KP1 antibody). The etiology remains unknown but some infectious diseases have been suspected (toxoplamosis, Epstein-Barr virus). Its association with a systemic lupus erythematous had been described and this set the problem of its physiopathology. We report two new cases of Kikuchi-Fujimoto's syndrome which one was attributed to Epstein-Barr virus primo-infection and the other associated with a systemic lupus erythematous.

Necrotizing lymphadenitis of the neck (Kikuchi's disease)

Kikuchi's histiocytic necrotizing lymphadenitis is a benign condition originally described in the Japanese literature in 1972. We here describe the clinicopathological features, including fine needle aspirate and bone marrow biopsy, of a case of Kikuchki's disease, which to our knowledge is the first reported from a Scandinavian country. The histopathological features of the enlarged lymph nodes were documented by multiple small necrotic foci showing karyorrhectic debris and haemorrhage. The necrotic foci were surrounded by a mantle of large histiocytic-like cells with vesicular nuclei and clear cytoplasm. The nodal architecture was almost completely effaced and the node infiltrated by a mixture of lymphoid cells of variable size. Neutrophils, eosinophils, and plasma cells were very few. The fine needle aspirate biopsy showed a mixture of small dark lymphocytes, larger activated lymphocytes, and many histiocytes. The bone marrow biopsy showed normal haematopoiesis but some large cells with phagocytosed leukocytes, i.e. similar to haemophagocytosis. Kikuchi's disease has a predilection for lymph nodes in the neck of young women, and is usually self-limited and subsides in 1 to 4 months. The patient described in this report received no treatment. Within 5 weeks the fever subsided and the lymph nodes diminished in size. One year later the patient is well and free of disease. We emphasize the benign nature of Kikuchi's disease, and that SLE and malignant lymphoma are the majori differential diagnoses.

Pathologic analyses of non-overt necrotizing type Kikuchi and Fujimoto's disease

Twenty-eight cases of non-overt necrotizing type Kikuchi-Fujimoto disease (KF disease, histiocytic necrotizing lymphadenitis) were investigated clinicopathologically, immunohistochemically and electron microscopically in order to analyze the nature of this disease. In addition, investigations to detect the presence of Epstein-Barr virus (EBV) using the polymerase chain reaction (PCR) and in situ hybridization (ISH) were also performed as a high incidence of positive serum immunoreactivity to EBV had been revealed in the cases examined. The clinical features were an equal male to female ratio, mean age of 26 years, mild leukopenia and about 40% association with fever over 38 degrees C. The major particular pathologic features were: (i) varying amounts of nuclear debris in the pathologic areas, identified as apoptosis by electron microscopy; (ii) presence of medium to large sized transformed lymphocytes (immunoblasts), a very small number of them positive for both UCHL1 and L26, and plasmacytoid cells, some of them positive for UCHL1; and (iii) characteristically shaped histiocytes predominant in the pathologic areas, with irregular nuclei and strongly positive for anti-lysozyme and anti-alpha 1-antitrypsin antibodies. Investigations with PCR and ISH revealed a complete absence of EBV in these cases despite excellent results for positive controls. It was therefore considered that EBV was not a causative virus for KF disease.

Histiocytic necrotizing lymphadenitis (Kikuchi's disease): cytologic diagnosis by fine-needle biopsy

A cytologic diagnosis of histiocytic necrotizing lymphadenitis (Kikuchi's lymphadenitis) was made in a 14-yr-old female with cervical lymphadenopathy, fever, neutropenia, and hepatosplenomegaly. A predominance of reticulum cells, foamy macrophages, and karyorrhectic debris are clues to the diagnosis in the fine-needle biopsy smears. Subsequent histology confirmed the diagnosis of Kikuchi's lymphadenitis. The differential diagnoses are discussed including malignant lymphoma, which was excluded by morphology as well as flow cytometry and polymerase chain reaction (PCR) studies.

A fatal case of multicentric Kikuchi's histiocytic necrotizing lymphadenitis

Kikuchi's histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a histologically alarming but self-limiting lesion typically affecting the cervical lymph nodes of young adults. The authors report the first case of fatality occurring during the active phase of Kikuchi's disease. The 38-year-old patient presented with fever and generalized lymphadenopathy. During hospitalization, he developed abrupt onset of heart failure and died. Postmortem examination revealed enlarged lymph nodes all over the body showing typical histologic changes of Kikuchi's disease, but there was no encroachment on vital structures. The heart was dilated and flabby, with multiple microscopic foci of necrosis and mild fatty change. There were no other significant findings, and all cultures were negative. The authors speculate that large amounts of cytokines produced by the histiocytes or high endogenous catecholamines resulting from the stress response might be responsible for the myocardial damage. Alternatively, infection by an as yet uncharacterized microbial might be the underlying cause for both the lymphadenitis and myocardial disease.