Authors :
Vedant Shah; Joy Chaudhari; Urvi Zala; Rushi Patel; Harmin Goklani; Urvashi Rathod; Mohmed Junaid Hingora; Viraj Panchal; Maitri Shah; Dr. Prahlad Gadhavi; Abhi Shah
Volume/Issue :
Volume 8 - 2023, Issue 8 - August
Google Scholar :
https://bit.ly/3TmGbDi
Scribd :
https://tinyurl.com/mrxb7auc
DOI :
https://doi.org/10.5281/zenodo.8323431
Abstract :
Kikuchi-Fujimoto disease is a form of benign
necrotizing lymphadenitis also known as histiocytic
necrotizing lymphadenitis. While Kikuchi disease is a
globally prevalent disease, it is predominantly seen in the
Asian population. Etiology can be traced back to
dysregulated immune responses triggered by viral or
autoimmune factors. Here we present a case report to
emphasize the importance of considering Kikuchi disease
and possible etiologies, highlighting the need for increased
awareness and recognition of this rare condition. A 28-year-
old female with a history of hypothyroidism, IBS, and
GERD complained of sore throat, intermittent epigastric
pain, mild heartburn, and fever and was taking PPIs
without any improvement. Abdominal USG was negative
for any pathology. She presented with bilateral enlarged
cervical lymph nodes and worsening of symptoms 1.5
months later. Ciprofloxacin was prescribed which failed to
improve the symptoms. CT scan of the neck showed an
enlarged thyroid gland with diffuse lymphadenopathy.
Labs showed elevated TSH, for which the levothyroxine
dose was increased, despite that she still continued to have
symptoms. LDH and CRP were normal. Rheumatology,
oncology, and infectious disease specialists were called upon
for further evaluation. Excisional Lymph node biopsy
showed areas of extensive necrosis with karyorrhectic
debris, surrounded by histiocytes and small lymphocytes,
suggestive of necrotizing lymphadenitis, specifically
consistent with Kikuchi disease. Immunophenotyping byflow cytometry demonstrated normal CD4+ and CD8+ T
cell populations without any evidence of clonal lymphoid
expansion. AFB and GMS stains were negative for
infection. Hydroxychloroquine 200 mg twice daily was
given, which resulted in the resolution of her
symptoms. Kikuchi disease’s origins can be traced back to
Japan, where it was initially documented. More prevalent
in the young female Asian population under the age of 30.
It presents as tender, enlarged nodes, primarily in the
cervical region along with lymphadenopathy, fever,
erythematous rash, joint pain, fatigue, arthritis, and
hepatosplenomegaly. It becomes important to consider
Kikuchi disease in patients presenting with symptoms that
can be attributed to sore throat related to GERD, followed
by the development of fever with cervical lymph node
enlargement.
Keywords :
Kikuchi-Fujimoto disease, benign necrotizing lymphadenitis, Asian population, dysregulated immune response, cervical lymphadenopathy.
Kikuchi-Fujimoto disease is a form of benign
necrotizing lymphadenitis also known as histiocytic
necrotizing lymphadenitis. While Kikuchi disease is a
globally prevalent disease, it is predominantly seen in the
Asian population. Etiology can be traced back to
dysregulated immune responses triggered by viral or
autoimmune factors. Here we present a case report to
emphasize the importance of considering Kikuchi disease
and possible etiologies, highlighting the need for increased
awareness and recognition of this rare condition. A 28-year-
old female with a history of hypothyroidism, IBS, and
GERD complained of sore throat, intermittent epigastric
pain, mild heartburn, and fever and was taking PPIs
without any improvement. Abdominal USG was negative
for any pathology. She presented with bilateral enlarged
cervical lymph nodes and worsening of symptoms 1.5
months later. Ciprofloxacin was prescribed which failed to
improve the symptoms. CT scan of the neck showed an
enlarged thyroid gland with diffuse lymphadenopathy.
Labs showed elevated TSH, for which the levothyroxine
dose was increased, despite that she still continued to have
symptoms. LDH and CRP were normal. Rheumatology,
oncology, and infectious disease specialists were called upon
for further evaluation. Excisional Lymph node biopsy
showed areas of extensive necrosis with karyorrhectic
debris, surrounded by histiocytes and small lymphocytes,
suggestive of necrotizing lymphadenitis, specifically
consistent with Kikuchi disease. Immunophenotyping byflow cytometry demonstrated normal CD4+ and CD8+ T
cell populations without any evidence of clonal lymphoid
expansion. AFB and GMS stains were negative for
infection. Hydroxychloroquine 200 mg twice daily was
given, which resulted in the resolution of her
symptoms. Kikuchi disease’s origins can be traced back to
Japan, where it was initially documented. More prevalent
in the young female Asian population under the age of 30.
It presents as tender, enlarged nodes, primarily in the
cervical region along with lymphadenopathy, fever,
erythematous rash, joint pain, fatigue, arthritis, and
hepatosplenomegaly. It becomes important to consider
Kikuchi disease in patients presenting with symptoms that
can be attributed to sore throat related to GERD, followed
by the development of fever with cervical lymph node
enlargement.
Keywords :
Kikuchi-Fujimoto disease, benign necrotizing lymphadenitis, Asian population, dysregulated immune response, cervical lymphadenopathy.
