Q J Med 2014; 107:931–932 doi:10.1093/qjmed/hcu065 Advance Access Publication 25 March 2014
Clinical picture Kikuchi-Fujimoto disease
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A 23-year-old man with morbid obesity with recent body weight loss about 50 kg (from 158 to 108kg) in recent 3 months presented with a 1-week history of sore throat and fever and right neck mass. Physical examination revealed a low grade fever of 37.58C, mildly enlarged inflamed tonsils and right tender cervical lymphadenopathy. Remarkable laboratory examination showed leukocyte of 4.7 103/ml with monocyte predominat (17.7%; normal: 0–10%); serology survey for virus, autoimmune and malignacy showed negative results. Neck computed tomography revealed numberous enlarged lymph node in the right caroid space (levels II, III and IV) (Figure 1a). Excision biopsy was done due to suspicious lymphoma and finally diagnosed as Kikuchi-Fujimoto disease (KPD) by histopathology finding (Figure 1b). He was treated with NSAIDs and recovered spontaneously. KPD or histiocytic necrotizing lymphadenitis is a benigh, self limited condition with higher prevalence among Japanese and Asiatic people and a slight female predominance. The cause of the disease been related to some microorganisms (Yersinia enterocolitica, Toxoplasma gondii), viral cause (EBV, HTLV-1 and parvovirus B19) and autoimmune disease such as systemic lupus erythematosus (SLE). Cervical lymphadenopathy is usually characterized by unilateral tender, and involves mainly the juglar carotid chain and posterior triangle. Diagnosis is made by excisional biopsy with the histopathological finding of irregular paracortical areas of coagulative necrosis with abundant karyorrhectic debris, and large number of different types of histiocytes and the margin of the necrotic areas with the absence of neutrophils, eosinophils and plasma cells. The differential diagnoses of neck lymphadenopathy include lymphoma, SLE, toxoplasmosis, tuberculosis, myeloid tumor and even metastatic adenocarcinoma. Once diagnosis confirmed, KFD is usually a
Figure 1. (a) Neck computated tomography revealed numberous enlarged lymph node in the right caroid space (levels II, III and IV). (b) Lymph node bipsy showed apoptic necrosis with abundant karyorrhectic debris and large number of histiocyte.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
932
Clinical picture
self-limiting diease with good outcome and low recurrence rate.1,2
email: [email protected]
Photographs and text from: C.-Y. Liao, Internal Medicine Department, Kaohsiung Armed Forces General Hospital, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan, ROC; S.-T. Chien, Pathology Department, Kaohsiung Armed Forces General Hospital, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan, ROC; C.-C. Wang, Internal Medicine Department, Kaohsiung Armed Forces General Hospital, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan, ROC.
Conflict of interest: None declared.
References 1. Deaver D, Naghashpour M, Sokol L. Kikuchi-Fujimoto disease in the Unites States: three case reports and review of the literature. Mediterr J Hematol Infect Dis 2014; 6:e2014001. 2. Bosch X, Guilabert A, Miquel R, Campo E. Enigmatic Kikuchi-Fujimoto disease: a comprehensive review. Am J Clin Pathol 2004; 122:141–52.
Downloaded from by guest on November 16, 2015
Clinical picture Kikuchi-Fujimoto disease
Downloaded from by guest on November 16, 2015
A 23-year-old man with morbid obesity with recent body weight loss about 50 kg (from 158 to 108kg) in recent 3 months presented with a 1-week history of sore throat and fever and right neck mass. Physical examination revealed a low grade fever of 37.58C, mildly enlarged inflamed tonsils and right tender cervical lymphadenopathy. Remarkable laboratory examination showed leukocyte of 4.7 103/ml with monocyte predominat (17.7%; normal: 0–10%); serology survey for virus, autoimmune and malignacy showed negative results. Neck computed tomography revealed numberous enlarged lymph node in the right caroid space (levels II, III and IV) (Figure 1a). Excision biopsy was done due to suspicious lymphoma and finally diagnosed as Kikuchi-Fujimoto disease (KPD) by histopathology finding (Figure 1b). He was treated with NSAIDs and recovered spontaneously. KPD or histiocytic necrotizing lymphadenitis is a benigh, self limited condition with higher prevalence among Japanese and Asiatic people and a slight female predominance. The cause of the disease been related to some microorganisms (Yersinia enterocolitica, Toxoplasma gondii), viral cause (EBV, HTLV-1 and parvovirus B19) and autoimmune disease such as systemic lupus erythematosus (SLE). Cervical lymphadenopathy is usually characterized by unilateral tender, and involves mainly the juglar carotid chain and posterior triangle. Diagnosis is made by excisional biopsy with the histopathological finding of irregular paracortical areas of coagulative necrosis with abundant karyorrhectic debris, and large number of different types of histiocytes and the margin of the necrotic areas with the absence of neutrophils, eosinophils and plasma cells. The differential diagnoses of neck lymphadenopathy include lymphoma, SLE, toxoplasmosis, tuberculosis, myeloid tumor and even metastatic adenocarcinoma. Once diagnosis confirmed, KFD is usually a
Figure 1. (a) Neck computated tomography revealed numberous enlarged lymph node in the right caroid space (levels II, III and IV). (b) Lymph node bipsy showed apoptic necrosis with abundant karyorrhectic debris and large number of histiocyte.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
932
Clinical picture
self-limiting diease with good outcome and low recurrence rate.1,2
email: [email protected]
Photographs and text from: C.-Y. Liao, Internal Medicine Department, Kaohsiung Armed Forces General Hospital, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan, ROC; S.-T. Chien, Pathology Department, Kaohsiung Armed Forces General Hospital, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan, ROC; C.-C. Wang, Internal Medicine Department, Kaohsiung Armed Forces General Hospital, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan, ROC.
Conflict of interest: None declared.
References 1. Deaver D, Naghashpour M, Sokol L. Kikuchi-Fujimoto disease in the Unites States: three case reports and review of the literature. Mediterr J Hematol Infect Dis 2014; 6:e2014001. 2. Bosch X, Guilabert A, Miquel R, Campo E. Enigmatic Kikuchi-Fujimoto disease: a comprehensive review. Am J Clin Pathol 2004; 122:141–52.
Downloaded from by guest on November 16, 2015
