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Qin W, Yang S, Zhang L, Liu M, Tian J, Yang J, Zhou G, Rong X. Kikuchi-Fujimoto disease evolves into lupus encephalopathy characterized by venous sinus thrombosis: a case report. Front Immunol 2024; 15:1389993. [PMID: 38665917 PMCID: PMC11043565 DOI: 10.3389/fimmu.2024.1389993] [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: 02/22/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign, self-limiting illness that can progress to systemic lupus erythematosus (SLE) in approximately 30% of cases. Neurological injuries can occur in both diseases, albeit with distinct presentations. Venous sinus thrombosis is a serious cerebrovascular complication in patients with neuropsychiatric SLE but is rarely observed in patients with KFD. The involvement of various antibodies, particularly antiphospholipid antibodies, can cause vascular endothelial cell injury, resulting in focal cerebral ischemia and intracranial vascular embolism in SLE. However, there are cases in which thrombotic pathology occurs without antiphospholipid antibody positivity, attributed to vascular lesions. In this report, we present a case of KFD and lupus encephalopathy featuring cerebral venous sinus thrombosis, despite the patient being negative for antiphospholipid antibody. We also conducted a comparative analysis of C3 and C4 levels in cerebrospinal fluid (CSF) and peripheral blood, along with the protein ratio in CSF and serum, to elucidate the pathological changes and characteristics of lupus encephalopathy.
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Affiliation(s)
- Wenyi Qin
- Department of Rheumatology and Immunology/Department of Integrated Traditional Chinese and Western Medicine. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuangshuang Yang
- Department of Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lijuan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengqi Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiayu Tian
- Department of Rheumatology and Immunology/Department of Integrated Traditional Chinese and Western Medicine. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Yang
- Department of Rheumatology and Immunology/Department of Integrated Traditional Chinese and Western Medicine. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoqing Zhou
- Department of Rheumatology and Immunology/Department of Integrated Traditional Chinese and Western Medicine. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaofeng Rong
- Department of Rheumatology and Immunology/Department of Integrated Traditional Chinese and Western Medicine. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yu RB, Chen YJ, Chang CH, Chen YL, Chen JW. Kikuchi-Fujimoto Disease Associated With Mycoplasma Pneumoniae Infection. Ear Nose Throat J 2024; 103:NP223-NP225. [PMID: 34605286 DOI: 10.1177/01455613211044225] [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: 11/15/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a self-limited disease that is more common in young Asian women. Typical presentations included fever and cervical lymphadenopathy. The etiology of KFD is unknown, and diagnosis is based mainly on lymph node biopsy. KFD has been reported to be associated with Mycoplasma pneumoniae infection. However, the role of antibiotic treatment is unclear. We reported 2 cases of KFD associated with Mycoplasma pneumoniae infection and were successfully treated with a macrolide.
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Affiliation(s)
- Rui-Bin Yu
- Department of Otolaryngology-Head and Neck Surgery, Catholic Cardinal Tien Hospital, New Taipei City, Taiwan ROC
- Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei, Taiwan ROC
| | - Yi-Jia Chen
- Department of Otolaryngology-Head and Neck Surgery, Catholic Cardinal Tien Hospital, New Taipei City, Taiwan ROC
| | - Chun-Hsiang Chang
- Department of Otolaryngology-Head and Neck Surgery, Catholic Cardinal Tien Hospital, New Taipei City, Taiwan ROC
- Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei, Taiwan ROC
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan ROC
| | - Yen-Lin Chen
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan ROC
- Department of Pathology, Catholic Cardinal Tien Hospital, New Taipei City, Taiwan ROC
| | - Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Catholic Cardinal Tien Hospital, New Taipei City, Taiwan ROC
- Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei, Taiwan ROC
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan ROC
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3
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Sandakly N, El Koubayati G, Sarkis J, Naderi S, Sebaaly D, Haddad F. Kikuchi-Fujimoto disease associated with a flare-up of a leukocytoclastic vasculitis: A rare case report and review of literature. Medicine (Baltimore) 2024; 103:e37626. [PMID: 38552071 PMCID: PMC10977597 DOI: 10.1097/md.0000000000037626] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Kikuchi-Fujimoto disease (KFD) also known as histiocytic necrotizing lymphadenopathy is an exceedingly rare cause of cervical lymphadenopathy, commonly accompanied by systemic symptoms such as fever, fatigue, night sweats, myalgia, skin rash. PATIENT CONCERNS In this paper, we report the case of a 22-year-old female patient who experienced a flare-up of leukocytoclastic vasculitis that was complicated by the appearance of a cervical lymph node with dysphagia, fever and nausea. DIAGNOSIS Infectious and autoimmune workup came back negative. INTERVENTIONS Excisional lymph node biopsy was done and the pathology results were consistent with histiocytic necrotizing lymphadenitis in keeping with Kikuchi-Fujimoto disease. OUTCOMES Patient improved on intravenous corticosteroids and was discharged on per os prednisone. Six month follow-up shows complete resolution of her symptoms. LESSONS KFD should be ruled out in patients with autoimmune or inflammatory diseases who develop lymphadenopathies.
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Affiliation(s)
- Nicolas Sandakly
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Georgio El Koubayati
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Jeannette Sarkis
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Samah Naderi
- Department of Pathology, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Delivrance Sebaaly
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Pathology, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Fady Haddad
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
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4
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Lou D, Song Y. Clinical features of histiocytic necrotizing lymphadenitis in children. Eur J Pediatr 2024; 183:1333-1339. [PMID: 38141136 DOI: 10.1007/s00431-023-05391-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Due to its nonspecific clinical characteristics, histiocytic necrotizing lymphadenitis (HNL) is often misdiagnosed as a suppurative cervical lymphadenitis and lymphoma. Thus, this study aimed to investigate the clinical characteristics of HNL in pediatric patients. We retrospectively identified 61 patients with histopathologically confirmed HNL. Clinical and laboratory data, including age, sex, clinical manifestations, laboratory investigations, histological discoveries, treatment, and outcomes, were collected from the medical records to determine associations with extracervical lymph node (LN) involvement. The mean age of patients was 9.7 ± 2.8 years (range, 1.5-14.0 years), and the male-to-female ratio was 2.2:1. The most common systemic symptom was fever in all patients. The median pre-admission and total durations of fever were 13.0 (interquartile range [IQR]: 9.0-22.5 days) and 22.0 days (IQR: 17.0-33.0 days), respectively. Patients with temporary fever (< 2 weeks) had a higher peak temperature and were more likely to undergo LN biopsy after admission than those with a prolonged fever (≥ 2 weeks). Multivariate analysis revealed that peak temperature ≥ 40 °C was significantly associated with a longer fever duration (P = 0.023). Laboratory values showed leukopenia (68.9%), which presented more frequently in solitary cervical LNs than in extracervical LNs (82.4% vs. 52.9%, p = 0.027) in patients with prolonged fever. CONCLUSIONS HNL is often misdiagnosed in older children with persistent fever and lymphadenopathy, leading to unnecessary diagnostic tests and evaluations, inappropriate antibiotic administration, and mismanagement. A multidisciplinary team, including primary care providers, rheumatologists, and pathologists, can improve patient outcomes by increasing their awareness of this rare condition. WHAT IS KNOWN • Histiocytic necrotizing lymphadenitis (HNL) is characterized by fever, leukopenia, and neck lymphadenopathy with unknown etiology. • The lack of neutrophils or eosinophils in the histology, immunohistochemistry results help distinguish HNL from infectious causes. Although HNL is a self-limiting disease, antibiotics and steroid treatments were used inappropriately. WHAT IS NEW • A fever peak ≥ 40 °C was associated with a longer fever duration in HNL patients. Leukopenia presented more frequently in solitary cervical lymph node (LNs) than in extracervical LNs inpatients with prolonged fever. • Steroids are not recommended as a routine treatment, however, in some severe or relapsing cases with persistent symptoms, prednisolone (5 mg twice a day for 2 days) or other steroids (an equivalent dose of prednisolone) responded favorably.
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Affiliation(s)
- DanDan Lou
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Ye Song
- Department of Pediatrics, The First Affiliated Hospital of Air Force Medical University, No. 127 Changle West Road, Xincheng District, Xi'an, Shaanxi, 710032, People's Republic of China.
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Yu SC. Kikuchi disease and COVID-19 vaccination. Am J Clin Pathol 2024; 161:206-207. [PMID: 37824747 DOI: 10.1093/ajcp/aqad128] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
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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.
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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
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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.
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Affiliation(s)
- Evangelos Giannakos
- specialistläkare, reumatolog, kliniken för reumatologi samt hud- och könssjukdomar Sörmland, Mälarsjukhuset, Eskilstuna
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8
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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.
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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
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9
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Liu J, Jiang L, Yu G, Qu G, Cai L. A rare co-existence of histiocytic necrotizing lymphadenitis with metastatic papillary thyroid carcinoma and review of the literature. Diagn Pathol 2024; 19:14. [PMID: 38218846 PMCID: PMC10788022 DOI: 10.1186/s13000-024-01441-0] [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: 10/21/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
Histiocytic necrotizing lymphadenitis (HNL) is a benign, self-limiting disease that is rare clinically. The coexistence of HNL and tumor is rarer. We report a male patient who was preoperatively diagnosed with papillary thyroid carcinoma with cervical lymph nodes metastasis, and the postoperative pathological examination showed histiocytic necrotizing lymphadenitis combined with metastatic papillary thyroid carcinoma in the same single lymph node. More interestingly, Epstein‒Barr virus was positive in these lymph nodes by in situ hybridization. This may suggest a trigger for the coexistence of the two diseases.
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Affiliation(s)
- Jing Liu
- Weifang Medical University, Weifang, China
- Department of Pathology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Lei Jiang
- Department of Pathology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Guohua Yu
- Department of Pathology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Guimei Qu
- Department of Pathology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Li Cai
- Department of Pathology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
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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.
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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.
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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
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Asano S, Yamazaki K, Mori K, Hashimoto Y, Kawana S, Sato H, Naito H, Shikano K, Sogame Y, Kashimura M. C/EBP homogenous protein-induced Apoptosis in Endoplasmic Reticulum stress has been implicated in Kikuchi-Fujimoto Disease. J Clin Exp Hematop 2023; 63:270-274. [PMID: 37899238 PMCID: PMC10861369 DOI: 10.3960/jslrt.23034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 10/31/2023] Open
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13
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Falbo E. Kikuchi-Fujimoto's Disease: A Rare and Underdiagnosed Condition with Possible Renal Involvement. G Ital Nefrol 2023; 40:2023-vol6. [PMID: 38156536] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Kikuchi-Fujimoto disease (KFD), or Histiocytic Necrotizing Lymphadenitis, is a rare disease, with worldwide distribution but is best known in Japan and South Asia. The most common feature is cervical lymphadenopathy, accompanied by tenderness or high fever, with night sweats, but it can also be asymptomatic or with a very wide range of symptoms. The diagnosis is histopathological, on excisional biopsy. The Kikuchi-Fujmoto disease can mimic lymphoma but also tuberculosis and some autoimmune diseases, or be associated with them. Nephrologists need to be aware of it, considering the potential renal involvement. The association with systemic lupus erythematosus (SLE) is the most frequent but not the only one. Early diagnosis of this disease can prevent unnecessary investigations and aggressive therapies.
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Affiliation(s)
- Enrica Falbo
- Consultant Nephrologist at Healthbay Polyclinic Jumeirah ‒ 1-6 Al Wasl Rd ‒ Umm Al Sheif, Dubai, Emirati Arabi Uniti (UAE)
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14
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Yamaguchi H, Hagino N. Heliotrope rash and puffy fingers due to Kikuchi-Fujimoto disease. Joint Bone Spine 2023; 90:105606. [PMID: 37414136 DOI: 10.1016/j.jbspin.2023.105606] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Hiroyuki Yamaguchi
- Department of Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan.
| | - Noboru Hagino
- Department of Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan
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Nam KH, Choi Y. A rare encounter: Kikuchi-Fujimoto disease presenting atypically after BNT162b2 COVID-19 vaccination: a case report. Scand J Rheumatol 2023; 52:705-707. [PMID: 37606559 DOI: 10.1080/03009742.2023.2241760] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023]
Affiliation(s)
- K-H Nam
- Department of Dermatology, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea
| | - Y Choi
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea
- Department of Internal Medicine, Division of Rheumatology, Jeonbuk National University Medical School, Jeonju, South Korea
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16
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Wang Y, Chen C, Xie J, Chen H, Xu Y. Kikuchi-Fujimoto disease and membranous nephropathy. Int Urol Nephrol 2023; 55:3001-3002. [PMID: 37036572 DOI: 10.1007/s11255-023-03591-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Yujia Wang
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Caiming Chen
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Jingzhi Xie
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Hong Chen
- Department of Pathology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Yanfang Xu
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
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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.
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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.
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18
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Zhao Z, Li J, Yang L, Ren G, Zhang L, Wang T. Hemophagocytic lymphohistiocytosis and histiocytic necrotizing lymphadenitis secondary to hemodialysis catheter-related bloodstream infection caused by Corynebacterium Striatum. BMC Nephrol 2023; 24:294. [PMID: 37803308 PMCID: PMC10559591 DOI: 10.1186/s12882-023-03356-2] [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: 05/20/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND We herein described the coexistence of hemophagocytic lymphohistiocytosis (HLH) and histiocytic necrotizing lymphadenitis, alternatively known as the Kikuchi disease (KD), secondary to hemodialysis catheter-related bloodstream infection (BSI) caused by Corynebacterium striatum. CASE PRESENTATION A patient on maintenance hemodialysis had developed persistent fever and Corynebacterium striatum was subsequently identified from the culture of both catheter tip and peripheral blood. During mitigation of the BSI, however, his fever was unabated and ensuing workup further found thrombocytopenia, hyperferritinemia, hypertriglyceridemia, low NK cell activity and a surge in serum CD25 levels. Moreover, biopsy of the bone marrow and lymph node detected histopathological evidence of hemophagocytosis and KD, respectively. Upon these abnormalities, the title-bound diagnosis was considered and the patient was eventually recovered from the treatment of dexamethasone instead of antibiotics. Consistently, aberrations in his serum CD25 levels and NK cell activity had subsided two months after discharge. CONCLUSIONS Arguably, this encounter offered a unique chance to unravel the principal pathogenic cascade in immunobiology that made the three entities one disease continuum. As such, our work may add new understandings of HLH and/or KD secondary to severe infections in general and excessive release of cytokines in particular among patients with kidney diseases. The resultant early diagnosis is crucial to initiate appropriate treatment and improve the survival of patients with these challenging and potentially life-threatening disorders.
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Affiliation(s)
- ZhiPeng Zhao
- Graduate School of HeBei Medical University, No.361 East ZhongShan Boulevard, ShiJiaZhuang, 050011, China
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - Jing Li
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - Liu Yang
- Department of Hematology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - GuangWei Ren
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - LiHong Zhang
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China
| | - Tao Wang
- Department of Nephrology, the First Hospital of HeBei Medical University, No.89 DongGang Road, ShiJiaZhuang, 050030, China.
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Yamada R, Komohara Y, Yoshii H. Kikuchi-Fujimoto disease following COVID-19 in a 32-year-old woman. J Clin Exp Hematop 2023; 63:209-211. [PMID: 37518269 PMCID: PMC10628830 DOI: 10.3960/jslrt.23022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Rin Yamada
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshihiro Komohara
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Yoshii
- Department of General medicine, Izumi General Medical Center, Kagoshima, Japan
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20
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Choi S, Choi HS, Ryu YJ, Kim JY, Paik JH, Ahn S, Lee H. Characterization of Kikuchi-Fujimoto Disease in Children and Risk Factors Associated with Its Course. J Pediatr 2023; 260:113515. [PMID: 37244579 DOI: 10.1016/j.jpeds.2023.113515] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To outline the characteristics of Kikuchi-Fujimoto disease (KFD) in children and analyze factors associated with severe and recurring courses. METHODS Electronic medical records of children histopathologically diagnosed with KFD at Seoul National University Bundang Hospital from March 2015 to April 2021 were retrospectively reviewed. RESULTS A total of 114 cases (62 males) were identified. The mean patient age was 12.0 ± 3.5 years. Most patients came to medical attention with cervical lymph node enlargement (97.4%) and fever (85%); 62% had a high-grade fever (≥39°C). Prolonged fever (≥14 days) was seen in 44.3% and was associated with a high-grade fever (P = .004). Splenomegaly, oral ulcer, or rash was present in 10.5%, 9.6%, and 15.8%, respectively. Laboratory findings showed leukopenia, anemia, and thrombocytopenia in 74.1%, 49%, and 24%, respectively. Sixty percent of cases had a self-limited course. Antibiotics were initially prescribed in 20%. A corticosteroid was prescribed in 40% of patients and was associated with oral ulcer (P = .045) and anemia (P = .025). Twelve patients (10.5%) had a recurrence with a median interval of 19 months. No risk factor for recurrence was identified in multivariable analysis. Clinical characteristics of KFD were similar between our current and previous studies. However, antibiotics use decreased (P < .001); nonsteroidal anti-inflammatory drugs use increased (P < .001), and, although statistically not significant, corticosteroid treatment also increased. CONCLUSIONS Over a span of 18 years, the clinical characteristics of KFD did not change. Patients presenting with high-grade fever, oral ulcer, or anemia may benefit from corticosteroid intervention. All patients should be monitored for recurrence.
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Affiliation(s)
- Sujin Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Soo Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin Ho Paik
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soyeon Ahn
- Department of Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
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21
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He T, Shen Z, Ling J, Zhu X, Yang J. Elevated serum IFN-γand IFN-γ/IL-6 ratio in Kikuchi-Fujimoto disease. Pediatr Rheumatol Online J 2023; 21:88. [PMID: 37608293 PMCID: PMC10463342 DOI: 10.1186/s12969-023-00877-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease (KFD) is typically a benign, self-limiting inflammatory disease. The diagnosis of KFD can be challenging for nonspecific symptoms, laboratory or imaging findings. In this study, we aimed to describe the clinical manifestations of patients with KFD and to access the potential role of serum cytokines in the diagnosis of this disease. METHODS Patients with KFD were retrospectively enrolled from January 2015 to November 2021 at Shenzhen Children's Hospital. Clinical data were collected from inpatient or outpatient medical records. Serum cytokines were detected by the Flowcytomix technique. Serum levels of cytokines were compared between patients with KFD and SJIA, or patients with KFD and KD. The data of patients without MAS were further analyzed. A receiver operating characteristic (ROC) curve analysis was further performed to access the potential role of serum cytokines in the diagnosis of KFD. RESULTS Serum cytokines were detected in 25 (43.8%, 25/57) patients with a histological diagnosis of KFD. Compared to SJIA or KD patients, the KFD group had a significantly higher IFN-γ/IL-6 ratio and much lower levels of serum IL-6. The median level of serum IFN-γ in KFD was 41.65 pg/ml (range, 21.04-70.74 pg/ml), which was much higher than that in SJIA (median: 3.33 pg/ml, p = 0.16) or KD (median: 2.6 pg/ml, p = 0.01). After excluding patients with MAS, there was statistical significance in all comparisons of serum IFN-γ, IFN-γ/IL-6 ratio, and serum IL-6. The cutoff values of serum IFN-γ, IL-6, and IFN-γ/IL-6 ratio for differentiating KFD from SJIA were > 8.48 pg/ml, < 47.42 pg/ml, and > 0.45, respectively. The cutoff values of serum IFN-γ, IL-6, and IFN-γ/IL-6 ratio for differentiating KFD from KD were > 8.56 pg/ml, < 50.45 pg/ml, and > 0.45, respectively. The specificity of all those cutoff values for differentiating KFD from SJIA or KD was ≥ 94.7%. CONCLUSIONS For patients with fever of unknown etiology and lymphadenopathy, after excluding HLH or MAS, serum IFN-γ > 8.56 pg/mL and IFN-γ/IL-6 ratio > 0.45 may highly suggest the diagnosis of KFD; serum IL-6 > 50.45 pg/mL indicates that the probability of KFD may be small, and sJIA, KD, and acute infection should be excluded first.
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Affiliation(s)
- Tingyan He
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518038, China.
| | - Zixuan Shen
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518038, China
| | - Jiayun Ling
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518038, China
| | - Xiaona Zhu
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518038, China
| | - Jun Yang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518038, China
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22
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Hartmann S, Melle F, Motta G, Agostinelli C, Sabattini E, Pileri S, Hansmann ML. Clonal T-cell proliferations occasionally occur in Kikuchi-Fujimoto disease. Hum Pathol 2023; 138:103-111. [PMID: 37331528 DOI: 10.1016/j.humpath.2023.06.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
Kikuchi-Fujimoto disease (KFD) is a benign self-limiting disorder that frequently leads to swelling of cervical lymph nodes in young women. It has a characteristic histologic appearance with sharply demarcated foci containing apoptotic debris, histiocytes, and proliferating large T-cells. Since in the past years, core needle biopsies have been increasingly used for diagnostic work-up, a small biopsy of the pathognomonic proliferating T-cell foci may lead to misinterpretation as a large T-cell neoplasia. The aim of the present study therefore was to analyze how frequently clonal T-cell receptor (TCR) amplificates may be obtained in KFD using a commonly used TCR gamma rearrangement clonality assay. In 88 KFD cases, TCR gamma clonality assays could be successfully applied. Clonal peaks of TCR gamma in front of a polyclonal background were observed in 15 cases (18%). The investigated clinical parameters (age, gender, extent of infiltration of the lymph node, percentage of proliferative compartment) did not differ between patients with detectable TCR gamma clones from those patients who had polyclonal TCR gamma results. Our study therefore demonstrates that clonal TCR gamma amplificates may be obtained in any type of KFD and that an over-interpretation of clonal T-cell proliferates in diagnostically equivocal material should be avoided.
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Affiliation(s)
- Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt Am Main, D-60590 Frankfurt am Main, Germany.
| | - Federica Melle
- Division of Haematopathology, Haematology Programme, IEO European Institute of Oncology IRCCS, 20121 Milan, Italy
| | - Giovanna Motta
- Division of Haematopathology, Haematology Programme, IEO European Institute of Oncology IRCCS, 20121 Milan, Italy
| | - Claudio Agostinelli
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy
| | - Stefano Pileri
- Division of Haematopathology, Haematology Programme, IEO European Institute of Oncology IRCCS, 20121 Milan, Italy
| | - Martin-Leo Hansmann
- Frankfurt Institute for Advanced Studies, 60438 Frankfurt am Main, Germany; Institute of General Pharmacology and Toxicology, Goethe University Frankfurt am Main, D-60590 Frankfurt am Main, Germany
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23
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Rodríguez-Ferreras A, Maray I, Coya-Fernández C, Octavio-Bocigas MM, Fernández-Del Río MF, Casares-López S, Ruiz-Salazar J. Kikuchi-Fujimoto Disease: a rare type of lymphadenopathy and its plausible relationship with human papillomavirus vaccines. Rev Esp Quimioter 2023; 36:429-431. [PMID: 37130334 PMCID: PMC10336308 DOI: 10.37201/req/140.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 05/04/2023]
Affiliation(s)
- A Rodríguez-Ferreras
- Adrián Rodríguez Ferreras, Pharmacovigilance Division, Department of Pharmacy, Directorate General of Health Policy and Planning, Regional Ministry of Health of the Principality of Asturias, Spain.
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24
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Fujita Y, Kurasawa K, Kuwashima S, Yoshihara S. Polyarthritis Associated with Kikuchi-Fujimoto Disease in a Child. Indian J Pediatr 2023; 90:199. [PMID: 36480129 DOI: 10.1007/s12098-022-04425-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Kazuhiro Kurasawa
- Department of Rheumatology, Dokkyo Medical University, Tochigi, Japan
| | | | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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25
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Kumar A, Aggarwal V, Sharma S, Singhal A, Jain S, Thakur S. Kikuchi Fujimoto Disease and Post-SARS-COVID-19 Association. Indian J Pediatr 2023; 90:208. [PMID: 36572819 PMCID: PMC9792312 DOI: 10.1007/s12098-022-04440-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/01/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Arvind Kumar
- Department of Pediatrics, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Vani Aggarwal
- Department of Pediatrics, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Shobhna Sharma
- Department of Pathology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Abhishek Singhal
- Department of Pediatrics, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Sachin Jain
- Department of Nuclear Medicine, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Seema Thakur
- Department of Genetics and Fetal Diagnosis, Fortis Hospital, AA Block, Shalimar Bagh, New Delhi, India.
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26
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Takahashi K, Okura Y, Shimomura M, Taniguchi K, Nawate M, Takahashi Y, Kobayashi I. Development of Sjögren's syndrome following Kikuchi-Fujimoto disease - A sibling case. Pediatr Int 2023; 65:e15524. [PMID: 36897118 DOI: 10.1111/ped.15524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Kazuki Takahashi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Yuka Okura
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Masaki Shimomura
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Kota Taniguchi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Mitsuru Nawate
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Yutaka Takahashi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Ichiro Kobayashi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
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27
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Abstract
A previously healthy Japanese woman in her 20s was admitted to our hospital with a 2-week history of fever (39.0°C) and a 1-week history of painful cervical lymphadenopathy. The day before fever onset, she had received her first Pfizer-BioNTech SARS-CoV-2 vaccine in her left arm. She had previously been treated with empirical antibiotics with no improvement. Physical examination revealed painful lymphadenopathy in both posterior cervical regions. CT showed symmetrical lymphadenopathies in the neck, supraclavicular, axillary and inguinal regions as well as hepatosplenomegaly. We suspected lymphoma and performed a lymph node biopsy in the right inguinal region, which revealed necrotising histiocytic lymphadenitis. The patient was, therefore, diagnosed with Kikuchi-Fujimoto disease (KFD). She improved after the corticosteroid therapy. This report highlights the importance of including KFD as a differential diagnosis of lymphadenopathy after SARS-CoV-2 vaccination. Additionally, lymph node biopsy is helpful for diagnosing KFD because it rules out other entities.
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Affiliation(s)
- Kohsuke Ikeda
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Seiji Adachi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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28
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Mallick A, Mohapatra MM, Babu VM, Rajaram M, Gocchait D, Surendranath Warrier L. All necrotizing nodes are not tuberculosis - A report of two cases. Indian J Tuberc 2022; 69:695-698. [PMID: 36460410 DOI: 10.1016/j.ijtb.2021.08.005] [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: 01/22/2021] [Accepted: 08/04/2021] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Kikuchi-Fujimoto disease is a benign and self-limiting systemic disorder of unknown aetiology characterised by fever, superficial lymphadenopathy and leukopenia. In highly endemic & low-resource country like India, it is frequently misdiagnosed as tuberculosis. CASE REPORT Both the cases were diagnosed as necrotizing lymphadenitis by fine-needle aspiration cytology. Tuberculin skin prick test (TST) was positive for one case and negative for the other case. Cartridge based nucleic acid amplification test (CBNAAT) from lymph node aspirate was negative for mycobacterium tuberculosis in both the cases, later on histopathology of lymph node showed diagnosis of Kikuchi-Fujimoto disease. CONCLUSION Kikuchi Fujimoto is a self-limiting disease systemic disease of unknown aetiology. A definite diagnosis can be established by incisional/excisional biopsy of the lymph node. When dealing with cases of tubercular lymphadenitis, Kikuchi-Fujimoto disease should be kept as differential diagnosis.
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Iwamoto N, Funahashi M, Shinohara K, Nakaya Y, Motobayashi H, Tochitani K, Yamamoto S, Shimizu T. Two Cases of Kikuchi Disease Presenting with Aseptic Meningitis and Encephalitis. Intern Med 2022; 61:2687-2689. [PMID: 35185045 PMCID: PMC9492496 DOI: 10.2169/internalmedicine.7724-21] [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] [Indexed: 11/17/2022] Open
Abstract
Kikuchi disease, also called histiocytic necrotizing lymphadenitis, is an idiopathic and generally self-limiting disease affecting young adults and children. Kikuchi disease does not commonly manifest neurological complications at its initial presentation. We herein report two cases of Kikuchi disease that initially presented with aseptic meningitis and encephalitis rather than the more common signs of lymphadenopathy, rash, and arthritis. A 15-year-old boy presented with aseptic meningitis with an extremely high intracranial pressure. A 28-year-old man presented with dysesthesia of the right lower extremity, coinciding with abnormal magnetic resonance imaging findings. In both cases, painful cervical lymphadenopathy was observed following the central nervous system symptoms. Both patients improved after treatment with steroids. Kikuchi disease occasionally affects the central nervous system, to which lymphadenitis may be observed subsequently. A repeated, careful physical examination of the cervical lymph nodes may be helpful for the diagnosis.
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Affiliation(s)
- Nobuki Iwamoto
- Department of Infectious Diseases, Kyoto City Hospital, Japan
| | | | - Koh Shinohara
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Japan
| | | | | | | | - Shungo Yamamoto
- Department of Infectious Diseases, Kyoto City Hospital, Japan
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30
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Kashihara E, Doi K, Fujita K. Multisystem Inflammatory Syndrome in Adults Accompanied with Kikuchi-Fujimoto Disease. Intern Med 2022; 61:2527-2532. [PMID: 35705268 PMCID: PMC9449605 DOI: 10.2169/internalmedicine.9384-22] [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] [Indexed: 11/18/2022] Open
Abstract
We herein report a case of multisystem inflammatory syndrome in adults (MIS-A) complicated with Kikuchi-Fujimoto disease (KFD). A previously healthy 41-year-old man presented with painful swelling of the cervical lymph nodes, fever, diarrhea, conjunctivitis, edema, and hypotension one month after the onset of asymptomatic coronavirus disease 2019. Laboratory investigations revealed an elevation of CRP, and echocardiography indicated diastolic dysfunction. We diagnosed the patient to have MIS-A. Histopathology of the lymph nodes showed necrotizing lymphadenitis. After the initiation of hydrocortisone and diuretics, his symptoms resolved immediately. This case suggested that post-viral immune dysregulation in MIS-A could play a role in the etiology of KFD.
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Affiliation(s)
- Eriko Kashihara
- Department of Infectious Diseases, National Hospital Organization Kyoto Medical Center, Japan
- Department of General Medicine, National Hospital Organization Kyoto Medical Center, Japan
- Department of General Internal Medicine, Tenri Hospital, Japan
| | - Kosuke Doi
- Department of Infectious Diseases, National Hospital Organization Kyoto Medical Center, Japan
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan
| | - Kohei Fujita
- Department of Infectious Diseases, National Hospital Organization Kyoto Medical Center, Japan
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Japan
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31
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Achappa B, Herath NC, Sebastian B, Dsouza NV, RAGHURAM PAVANMANIBETTU, Holla R, Chowta N, Kini JR. Kikuchi-Fujimoto disease in a tertiary care teaching hospital in Coastal South India: A 8-year retrospective study. F1000Res 2022; 11:492. [PMID: 35811790 PMCID: PMC9226704 DOI: 10.12688/f1000research.109832.1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Kikuchi-Fujimoto disease (KFD) is a rare, benign condition of unknown etiology, presenting as cervical lymphadenitis. Lymphadenopathy is usually tender and maybe associated with systemic symptoms. Despite the extensive literature on this disease, it continues to be misdiagnosed owing to its misleading clinical presentation.
Methods:
A retrospective hospital-based descriptive cross-sectional study was conducted in tertiary care hospitals from 2011 to 2019. All patients with confirmed KFD diagnosis were included and after ethics committee approval the clinical details and histopathological data was retrieved from the medical records department and analyzed.
Results:
A total of 67 cases were included. The mean age was 26.9±11.3 years with a female: male ratio of 1.9:1. There were 50 patients with tender cervical lymphadenopathy which was the most common clinical presentation. The mean length and width of palpable lymph nodes were 2.3±1.0 cm and 2.2±0.7 cm respectively. Histology revealed proliferative stage in majority of patients (
n=40, 59.7%). Lymphadenopathy resolved in 83.6% within 2 months. There were 42 patients who had complete recovery with symptomatic treatment within a period of 9 months.
Conclusions:
KFD is prevalent in young, female patients of Asian descent and often presents as tender cervical lymphadenopathy. Early diagnosis with excisional lymph node biopsy is crucial to avoid unnecessary investigations and treatment. Treatment is symptomatic unless complicated, where steroid therapy is considered. KFD has an excellent prognosis with almost no risk of fatality.
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Affiliation(s)
- Basavaprabhu Achappa
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nipuni Chamathka Herath
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Bodhi Sebastian
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nikhil Victor Dsouza
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - PAVAN MANIBETTU RAGHURAM
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nithyananda Chowta
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Jyoti Ramanath Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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32
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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.
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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
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33
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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.
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Affiliation(s)
- Marco Fiori
- Internal Medicine, EOC, Bellinzona, Switzerland
| | - Paolo Spina
- Cantonal Institute of Pathology, EOC, Bellinzona, Switzerland
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34
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Maffei S, De Guzman M, Rochat R, Tran J, Risen S, Dean A, Coleman N. From Telemedicine to the ICU-Fever and Rash in a 9-Year-Old Girl. Pediatrics 2022; 149:183833. [PMID: 34972223 DOI: 10.1542/peds.2021-051501] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
A 9-year-old girl presented to her primary care pediatrician via telemedicine during the initial months of the coronavirus disease 2019 pandemic because of 4 days of warmth perceived by her mother, decreased energy, and a new rash on her upper extremities. After 10 additional days of documented fever >38°C, worsening fatigue, and 1 day of nausea, vomiting, and diarrhea, she was allowed to schedule an in-person visit with her pediatrician after testing negative for severe acute respiratory syndrome coronavirus 2. She appeared ill on arrival to clinic, and her pediatrician recommended evaluation in an emergency department. Her initial laboratory testing revealed nonspecific elevation in several inflammatory markers and leukopenia, and she responded well to intravenous hydration. Over the next 2 weeks, her fever persisted, constitutional symptoms worsened, and she developed progressively painful cervical lymphadenopathy and pancytopenia. She was evaluated in clinic by several specialists and eventually was urged to present to the emergency department again, at which time she was admitted to the PICU. After consulting additional specialists and waiting for laboratory results, the team reached a definitive diagnosis and initiated therapy; however, she experienced rapid clinical decline shortly thereafter. The specialists who assisted with identification of the underlying etiology of her symptoms were able to work together to manage the subsequent complications.
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35
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Caocci G, Fanni D, Porru M, Greco M, Nemolato S, Firinu D, Faa G, Scuteri A, La Nasa G. Kikuchi-Fujimoto disease associated with hemophagocytic lymphohistiocytosis following the BNT162b2 mRNA COVID-19 vaccination. Haematologica 2021; 107:1222-1225. [PMID: 34965702 PMCID: PMC9052929 DOI: 10.3324/haematol.2021.280239] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- Giovanni Caocci
- Department of Medical Sciences and Public Health, Haematology, University of Cagliari, Businco Hospital, Cagliari.
| | - Daniela Fanni
- Department of Medical Sciences and Public Health, Pathology, University of Cagliari, S.Giovanni di Dio and Businco Hospital, Cagliari
| | - Mariagrazia Porru
- Department of Medical Sciences and Public Health, Internal Medicine, University of Cagliari, Policlinico Hospital, Cagliari
| | - Marianna Greco
- Department of Medical Sciences and Public Health, Haematology, University of Cagliari, Businco Hospital, Cagliari
| | - Sonia Nemolato
- Department of Medical Sciences and Public Health, Pathology, University of Cagliari, S.Giovanni di Dio and Businco Hospital, Cagliari
| | - Davide Firinu
- Department of Medical Sciences and Public Health, Internal Medicine, University of Cagliari, Policlinico Hospital, Cagliari
| | - Gavino Faa
- Department of Medical Sciences and Public Health, Pathology, University of Cagliari, S.Giovanni di Dio and Businco Hospital, Cagliari
| | - Angelo Scuteri
- Department of Medical Sciences and Public Health, Internal Medicine, University of Cagliari, Policlinico Hospital, Cagliari
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, Haematology, University of Cagliari, Businco Hospital, Cagliari
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36
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Fernandes BM, Bernardes M, Barroca H, Costa L. Kikuchi-Fujimoto Disease Associated With Mixed Connective Tissue Disease: A Late Recurrence Case. J Clin Rheumatol 2021; 27:S779-S780. [PMID: 32694354 DOI: 10.1097/rhu.0000000000001488] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Helena Barroca
- Pathology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
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37
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Gates GA, Li Y, Magyar C, Sarantopoulos GP. Kikuchi-Fujimoto Disease With Unusual Cutaneous Findings. Am J Dermatopathol 2021; 43:e213-e217. [PMID: 34132662 DOI: 10.1097/dad.0000000000001965] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT We present a case of the rare Kikuchi-Fujimoto disease (KFD) in a 14-year-old patient admitted to UCLA Medical Center with fever, weight loss, and pancytopenia. Physical examination revealed tender subcutaneous nodules and cervical lymphadenopathy. A lymph node biopsy showed findings consistent with KFD. The skin biopsy showed mild superficial dermal edema with neutrophil-predominant inflammation. In addition, rare atypical monocytoid cells were seen. This histologic finding of a Sweet-like morphology has not been reported previously in the literature in association with KFD. The differential diagnosis included Sweet syndrome arising in association with KFD, underlying connective tissue, and an infectious etiology.
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Affiliation(s)
- Gregory A Gates
- Division of Dermatopathology, UCLA Medical Center, Department of Pathology & Lab Medicine, Los Angeles, CA
| | - Yunfeng Li
- Translational Pathology Core Laboratory UCLA Medical School, Department of Pathology and Laboratory Medicine, Los Angeles, CA; and
| | - Clara Magyar
- Translational Pathology Core Laboratory UCLA Medical School, Department of Pathology and Laboratory Medicine, Los Angeles, CA; and
| | - G Peter Sarantopoulos
- Division of Dermatopathology, UCLA Department of Pathology & Lab Medicine, Los Angeles, CA
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38
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Dragan M, Nandan A. Kikuchi-Fujimoto Disease in a Young Hispanic Man. J Clin Rheumatol 2021; 27:S808-S809. [PMID: 32568950 DOI: 10.1097/rhu.0000000000001452] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Abhishek Nandan
- Rheumatology, Allergy and Immunology, Virginia Commonwealth University, Richmond, VA
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39
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Dao QL, Hottenstein B, Selvaraj V. An Unusual Presentation of Kikuchi-Fujimoto Disease with Recurrent Fever and Syncope. R I Med J (2013) 2021; 104:73-75. [PMID: 34705915] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Kikuchi-Fujimoto (KF) disease, also known as necrotizing histiocytic lymphadenopathy, is a rare, benign disorder of the lymph nodes of young adults, predominantly young females. The exact cause of KF disease is unknown. Here, we report a young female with recurrent fever and syncopal episodes diagnosed with KF disease on lymph node biopsy.
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Affiliation(s)
- Quynh-Lan Dao
- Division of Hospital Medicine, The Miriam Hospital, Providence, RI
| | - Bridget Hottenstein
- Division of Hospital Medicine, The Miriam Hospital; Warren Alpert Medical School of Brown University, Providence, RI
| | - Vijairam Selvaraj
- Division of Hospital Medicine, The Miriam Hospital; Warren Alpert Medical School of Brown University, Providence, RI
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40
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Anuntakarun S, Larbcharoensub N, Payungporn S, Reamtong O. Identification of genes associated with Kikuchi-Fujimoto disease using RNA and exome sequencing. Mol Cell Probes 2021; 57:101728. [PMID: 33819568 DOI: 10.1016/j.mcp.2021.101728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/28/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022]
Abstract
Kikuchi-Fujimoto disease (KFD) is an extremely rare disease, and although it is reported to have a worldwide distribution, young Asian women are most likely to be affected. Although this disease is generally benign and self-limiting, distinguishing it from other diseases that cause lymphadenopathy (e.g., leukemia, lymphoma, and infectious diseases) is challenging. A lymph node biopsy is a definitive diagnostic technique for KFD and only requires skillful pathologists. There are no specific symptoms or laboratory tests for KFD, and more than 50% of KFD patients have suffered from being misdiagnosed with lymphoma, which leads to improper treatment. In this study, lymph node tissue samples from KFD patients were used to reveal their exomes and transcriptomes using a high-throughput nucleotide sequencer. Fourteen single nucleotide polymorphisms (SNPs) were identified as candidate KFD markers and were compared with a healthy lymph node exome dataset. The mutation of these genes caused disruptive impact in the proteins. Several SNPs associated with KFD involve genes related to human cancers, olfaction, and osteoblast differentiation. According to the transcriptome data, there were 238 up-regulated and 1,519 down-regulated genes. RANBP2-like and ribosomal protein L13 were the most up-regulated and down-regulated genes in KFD patients, respectively. The altered gene expression involved in the human immune system, chromatin remodeling, and gene transcription. A comparison of KFD and healthy datasets of exomes and transcriptomes may allow further insights into the KFD phenotype. The results may also facilitate future KFD diagnosis and treatment.
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Affiliation(s)
- Songtham Anuntakarun
- Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sunchai Payungporn
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand; Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Onrapak Reamtong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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41
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Sekiguchi S, Yamamoto Y, Hatakeyama S, Matsumura M. Recurrent Aseptic Meningitis Associated with Kikuchi's Disease (Histiocytic Necrotizing Lymphadenitis): A Case Report and Literature Review. Intern Med 2021; 60:1779-1784. [PMID: 33431735 PMCID: PMC8222115 DOI: 10.2169/internalmedicine.6494-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/23/2022] Open
Abstract
We herein report a 31-year-old man with recurrent aseptic meningitis associated with Kikuchi's disease. Although aseptic meningitis is the most common neurological complication of Kikuchi's disease, its characteristics remain unclear, especially in recurrent cases. A literature review revealed that aseptic meningitis associated with Kikuchi's disease was more likely to occur in men and was associated with a low cerebrospinal fluid (CSF)/serum glucose ratio. Lymphadenopathy tended to occur simultaneously or after the onset of meningitis. When encountering a patient with aseptic meningitis of unknown etiology, it may be worthwhile to focus on the CSF/serum glucose ratio and lymphadenopathy with a careful examination.
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Affiliation(s)
- Shiori Sekiguchi
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Shuji Hatakeyama
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Masami Matsumura
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
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42
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Ghantous N, Hershkovic S, Poran I, Benninger F, Molad Y, Eliakim-Raz N. [NEUROLOGIC COMPLICATIONS AROUND THE DIAGNOSIS OF KIKUCHI-FUJIMOTO DISEASE: A RARE PRESENTATION OF THE DISEASE OR A HINT OF AN ADDITIONAL DIAGNOSIS?]. Harefuah 2021; 160:307-310. [PMID: 34028223] [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: 06/12/2023]
Abstract
Neurologic symptoms are an extremely rare presentation of Kikuchi-Fujimoto disease. We report a case of a young female patient diagnosed with Kikuchi-Fujimoto disease, presenting with neurologic symptoms compatible with aseptic meningitis, along with radiographic findings which improved with steroidal treatment. Despite the rarity of these findings, they were reported as part of the disease manifestation, however, since Kikuchi-Fujimoto disease is associated with other diseases, such as systemic lupus erythematosus (SLE), other diagnoses cannot be ruled out.
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Affiliation(s)
- Nassem Ghantous
- Department of Medicine E, Rabin Medical Center- Beilinson, Petah Tikva, Israel
| | - Shimrit Hershkovic
- Department of Medicine E, Rabin Medical Center- Beilinson, Petah Tikva, Israel
| | - Itamar Poran
- Department of Medicine E, Rabin Medical Center- Beilinson, Petah Tikva, Israel
| | - Felix Benninger
- Department of Neurology, Rabin Medical Center- Beilinson, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Molad
- Department of Rheumatology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center- Beilinson, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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43
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Cao NT, Nguyen HT, Pham VHT, Doan TTP, Le LB, Bui KD, Tran TH, Vu TT, Nguyen CTH. Reactive Hemophagocytic Lymphohistiocytosis-Associated Kikuchi-Fujimoto Disease After a Staphylococcus epidermidis Cutaneous Infection: The First Case Report. J Clin Rheumatol 2021; 27:e96-e97. [PMID: 31804253 PMCID: PMC7996236 DOI: 10.1097/rhu.0000000000001279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ngoc Thanh Cao
- From the Department of Geriatric and Gerontology, University of Medicine and Pharmacy
- Department of Rheumatology, University Medical Center
| | - Huan Thanh Nguyen
- From the Department of Geriatric and Gerontology, University of Medicine and Pharmacy
| | | | - Thao Thi Phuong Doan
- Department of Pathology, University of Medicine and Pharmacy
- Department of Pathology, University Medical Center
| | - Le Bao Le
- Department of Rheumatology, University Medical Center
| | - Khoa Dang Bui
- Department of Rheumatology, University Medical Center
| | | | - Thanh Tri Vu
- Department of Rheumatology, University Medical Center
| | - Chuyen Thi Hong Nguyen
- Department of Dermatology, University of Medicine and Pharmacy
- Department of Dermatology and Skin Aesthetics, University Medical Center, Ho Chi Minh City, Viet Nam
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44
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Danai MM, Kaye SP, Gong R, McKnight H. A Rare Pediatric Case of Persistent Kikuchi-Fujimoto Disease and Underlying Systemic Lupus Erythematosus. J Clin Rheumatol 2021; 27:e111-e112. [PMID: 31972742 DOI: 10.1097/rhu.0000000000001287] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mahtab M Danai
- From the School of Medicine, University of California, Davis
| | - Shaina P Kaye
- University of California, Davis, Children's Hospital
| | - Raymond Gong
- Department of Pathology, University of California, Davis, Medical Center, Sacramento, CA
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Müller CSL, Vogt T, Becker SL. Kikuchi-Fujimoto Disease Triggered by Systemic Lupus Erythematosus and Mycoplasma pneumoniae Infection-A Report of a Case and a Review of the Literature. Am J Dermatopathol 2021; 43:202-208. [PMID: 32809980 DOI: 10.1097/dad.0000000000001764] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT Kikuchi-Fujimoto disease (KFD) is a necrotizing histiocytic lymphadenitis that was described for the first time in 1972 in Japan. Its etiology is still not fully understood. It has been reported in association with many different agents, diseases, and triggering factors without any conclusive result. To the best of our knowledge, we report for the first time a case of KFD with systemic lupus erythematosus in a child in association with a polymerase chain reaction (PCR)-positive throat swab for Mycoplasma pneumoniae. Although difficult to prove, the acute M. pneumoniae infection might have served as a triggering event for the development of KFD in our case. We encourage further studies to investigate a potential relationship between KFD and M. pneumoniae, which should also use PCR-based testing for this pathogen in patients with KFD.
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Affiliation(s)
- Cornelia S L Müller
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg/Saar, Germany
- Swiss Tropical and Public Health Institute, Basel, Switzerland; and
- University of Basel, Basel, Switzerland
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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.
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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
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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.
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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
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Pham AK, Castillo SA, Barton DT, Rigby WF, Guill MA, Lucas R, LeBlanc RE. Kikuchi-Fujimoto disease preceded by lupus erythematosus panniculitis: do these findings together herald the onset of systemic lupus erythematosus? Dermatol Online J 2020; 26:13030/qt6tx957m2. [PMID: 32941714] [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] [Received: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare disorder that must be distinguished from systemic lupus erythematosus (SLE). Although a minority of patients with KFD develop SLE, most patients have a self-limited disease. Importantly, KFD can have skin manifestations resembling cutaneous lupus. Therefore, the diagnosis of SLE should be predicated on a complete rheumatologic workup and not on the constellation of skin disease and lymphadenitis. Nonetheless, as our exceedingly rare case illustrates, patients who do not initially meet diagnostic criteria for SLE require dermatologic follow-up. We present a young adult woman who had a remote history of KFD and later presented with combined features of discoid lupus and lupus erythematosus panniculitis (LEP). On subsequent rheumatologic workup, she fulfilled criteria for SLE. We discuss the differential diagnosis of both KFD and LEP and emphasize how strong communication among dermatologists and other healthcare providers is essential in the management of patients with KFD.
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Affiliation(s)
| | | | | | | | | | | | - Robert E LeBlanc
- Geisel School of Medicine at Dartmouth College, NH Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, NH.
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Kaur M, King S, Fotouhie A, Zangeneh TT. Unusual Presentations of Coccidioidomycosis in Conjunction With Autoimmune Syndromes: A Literature Review and Case Series. J Clin Rheumatol 2020; 26:e43-e47. [PMID: 32073532 DOI: 10.1097/rhu.0000000000000825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Manjinder Kaur
- Division of Rheumatology, Department of Internal Medicine, University of Arizona, Tucson, AZ Department of Internal Medicine, College of Medicine, University of Arizona, Tucson, AZ Department of Internal Medicine, College of Medicine, University of Arizona, Tucson, AZ; Division of Infectious Disease, The Valley Fever Center for Excellence, Department of Internal Medicine, University of Arizona, Tucson, AZ
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50
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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.
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