|Year : 2021 | Volume
| Issue : 2 | Page : 165-167
Kikuchi Disease: Masquerading as Tubercular Cervical Lymphadenopathy
Ankur Garg1, Prashant Choudhary1, Mithilesh Chandra2, Devendra Kumar Singh1
1 Department of Respiratory Medicine, School of Medical Sciences & Research, Gautam Budh Nagar, Uttar Pradesh, India
2 Pathology Consultancy Services, Noida, Uttar Pradesh, India
|Date of Submission||08-Dec-2020|
|Date of Decision||20-Apr-2021|
|Date of Acceptance||14-Jun-2021|
|Date of Web Publication||22-Jul-2021|
Dr. Devendra Kumar Singh
Department of Respiratory Medicine, School of Medical Sciences & Research, 52 Karma Cottage, Allipur, Mandola, Ghaziabad, Uttar Pradesh 201102
Source of Support: None, Conflict of Interest: None
Kikuchi–Fujimoto disease, also known as “histiocytic necrotizing lymphadenitis,” is a rare, benign disease that commonly affects young females. Patient usually presents with swollen lymph nodes in neck (cervical lymphadenopathy), fever, night sweats, weight loss, nausea, and vomiting. Due to the similar symptomatology, the disease is often confused with tuberculosis and lymphomas. The exact cause remains unknown with no evidence of inheritance. The diagnosis is confirmed by histopathologic examination of lymph node biopsy, which reveals necrosis (that varies considerably from one case to another), histiocytes (contains phagocytosed debris), crescentic nuclei, karyorrhexis, and plasmacytoid monocytes. The disease is self-remitting within 1 to 4 months. However, nonsteroidal anti-inflammatory drugs (NSAIDs), oral corticosteroids, and hydroxychloroquine may be used for symptomatic relief.
Keywords: Cervical lymphadenopathy, Kikuchi disease, tuberculosis
|How to cite this article:|
Garg A, Choudhary P, Chandra M, Singh DK. Kikuchi Disease: Masquerading as Tubercular Cervical Lymphadenopathy. MAMC J Med Sci 2021;7:165-7
|How to cite this URL:|
Garg A, Choudhary P, Chandra M, Singh DK. Kikuchi Disease: Masquerading as Tubercular Cervical Lymphadenopathy. MAMC J Med Sci [serial online] 2021 [cited 2021 Dec 6];7:165-7. Available from: https://www.mamcjms.in/text.asp?2021/7/2/165/322142
| Case Report|| |
A 16-year-old female presented to tertiary care health center in North India with complains of multiple small swellings in infra-auricular region on right side of neck for 2 months. Swellings were accompanied by localized pain, tenderness, and fever. Fever was low grade, intermittent, and relieved on taking antipyretic medications.,,,
Patient consulted a near-by physician, who advised Mantoux test and fine-needle aspiration cytology (FNAC) of the swollen lymph node and started antitubercular treatment (ATT) on empirical basis. Mantoux test revealed induration of 12 mm, whereas FNAC revealed lymphoid cells in various stages of maturation along with occasional neutrophils and scattered epitheloid cells. Patient took ATT for 15 days but was not relieved symptomatically and was referred to tertiary health center.
On local examination, multiple small discrete, rounded swellings were palpable in neck on right side, of 1 to 2 cm in size. Swellings were firm in consistency with signs of local inflammation (tenderness and local temperature was raised) present.
Contrast-enhanced commuted tomography for neck and chest was performed, which revealed multiple, heterogeneously enhancing lymph nodes in various stations of cervical lymph nodes (Ib, II, III, IV, and V) with largest measuring 2 cm in short axis. However, no evidence of necrosis or calcification was noticed [Figure 1].
|Figure 1 Contrast-enhanced commuted tomography scan showing coronal section of head, neck, and chest. Red arrow showing enlarged lymph node in the neck.|
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Patient was then advised repeat FNAC of the lymph node, and the FNAC smears showed mixed population of histiocytes with crescent-shaped nuclei and phagocytes, along with plasmacytoid monocytic cells, and few plasma cells. Background shows nuclear karyorrhexis. No well-defined granuloma formation was identified [Figure 2] and [Figure 3].
|Figure 2 Kikuchi disease: fine-needle aspiration cytology smear is very cellular and shows histiocytes, plasmacytoid monocytes, and extracellular (karyorrhectic) debris. Hematoxylin and eosin, ×100.|
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|Figure 3 Fine-needle aspiration cytology of the node: crescentic histiocytes, plasmacytoid monocytes, extracellular (karyorrhectic) debris, and necrosis. Hematoxylin and eosin, ×400.|
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The diagnosis of Kikuchi–Fujimoto disease was confirmed histopathologically and patient was started on NSAIDs (aceclofenac and paracetamol combination). Patient was followed up every 2 weekly. The local inflammation subsided after 2 weeks and the size of lymph node also became subcentimetric. After 6 weeks of therapy, swellings were almost nonpalpable.
| Discussion and Conclusion|| |
In India, though tuberculosis being the most common cause of cervical lymphadenopathy, every clinician must try to obtain the evidence of tuberculosis, before starting the ATT. The other causes of cervical lymphadenopathy, such as lymphomas, Kikuchi–Fujimoto disease, and sarcoidosis, though rare must be ruled out.
The authors acknowledge the valuable contribution of Dr Deepti Agarwal (consultant pathologist).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Rakesh P, Alex RG, Varghese GM et al.
Kikuchi–Fujimoto disease: clinical and laboratory characteristics and outcome. J Glob Infect Dis 2014;6:147-50.
Hassan M, Aees A, Zaheer S. Kikuchi-Fujimoto disease: diagnostic dilemma and the role of immunohistochemistry. J Clin Med Res 2009;1:244-6.
Chaitanya BN, Sindura C. Kikuchi’s disease. J Oral Maxillofac Pathol 2010;14:6-9.
[Figure 1], [Figure 2], [Figure 3]