Kikuchi–Fujimoto's Disease in a Pediatric Patient with Mycobacterium tuberculosis Infection

Muayad Alali; Jefree J. Schulte; Barbara A. Hendrickson

doi:10.1055/s-0037-1608923

Journal of Pediatric Infectious Diseases, Table of Contents

J Pediatr Infect Dis 2019; 14(05): 260-263
DOI: 10.1055/s-0037-1608923

Case Report

Georg Thieme Verlag KG Stuttgart · New York

Kikuchi–Fujimoto's Disease in a Pediatric Patient with Mycobacterium tuberculosis Infection

Authors

Muayad Alali

¹Division of Infectious Diseases, Department of Pediatrics, Comer Children's Hospital, University of Chicago Medicine, Chicago, Illinois, United States
Jefree J. Schulte

²Department of Pathology, University of Chicago, Chicago, Illinois, United States
Barbara A. Hendrickson

¹Division of Infectious Diseases, Department of Pediatrics, Comer Children's Hospital, University of Chicago Medicine, Chicago, Illinois, United States

Abstract

Kikuchi–Fujimoto's disease (KFD), alternatively termed histiocytic necrotizing lymphadenitis, was first described in 1972. KFD is rare in children, with most of the cases occurring between the ages of 20 and 30 years with a female-to-male ratio of 4:1. The etiology is unknown, although infectious and autoimmune mechanisms have been proposed. KFD manifests with a spectrum of nonspecific clinical symptoms and laboratory findings. KFD is without a definitive diagnostic test and is a diagnosis of exclusion, which must be differentiated from other disease processes with associated lymphadenopathy. Significant overlap in both clinical presentation and histological features with other diseases, such as non-Hodgkin lymphoma, systemic lupus erythematosus, and active tuberculosis (TB), presents challenges in diagnosis. A small number of case reports have been published describing the coexistence of KFD and active TB. Most reported cases occur in TB endemic areas. In the largest analysis of KFD, TB infection was concurrent in 2% of cases. Most of the cases occurred in adult patients. To our knowledge, there have been no pediatric cases of KFD with concurrent TB infection reported in the United States. This study describes a case of KFD with concurrent Mycobacterium tuberculosis infection in a young male from the United States.

Keywords

lymphadenopathy - tuberculosis - Kikuchi

Full Text

References

References
1 Koybasi S, Saydam L, Gungen Y. Histiocytic necrotizing lymphadenitis of the neck. Am J Otolaryngol 2003; 24 (05) 344-347
2 Kucukardali Y, Solmazgul E, Kunter E, Oncul O, Yildirim S, Kaplan M. Kikuchi-Fujimoto disease: analysis of 244 cases. Clin Rheumatol 2007; 26 (01) 50-54
3 Norris AH, Krasinskas AM, Salhany KE, Gluckman SJ. Kikuchi-Fujimoto disease: a benign cause of fever and lymphadenopathy. Am J Med 1996; 101 (04) 401-405
4 Dorfman RF, Berry GJ. Kikuchi's histiocytic necrotizing lymphadenitis: an analysis of 108 cases with emphasis on differential diagnosis. Semin Diagn Pathol 1988; 5 (04) 329-345
5 Elendu S, Rahman HM, Fleischman JK. Histiocytic necrotizing lymphadenitis and tuberculosis infection in the same cervical lymph node. Hospital Physician 2003; 39 (12) 53-56
6 Seo JH, Shim HS, Park JJ. , et al. A clinical study of histiocytic necrotizing lymphadenitis (Kikuchi's disease) in children. Int J Pediatr Otorhinolaryngol 2008; 72 (11) 1637-1642
7 Jamal AB. Kikuchi Fujimoto disease. Clin Med Insights Arthritis Musculoskelet Disord 2012; 5: 63-66
8 Piccirillo JF, Lanza DC, Stasio EA, Moloy PJ. Histiocytic necrotizing lymphadenitis (Kikuchi's disease). Arch Otolaryngol Head Neck Surg 1991; 117 (07) 800-802
9 Jang YJ, Park KH, Seok HJ. Management of Kikuchi's disease using glucocorticoid. J Laryngol Otol 2000; 114 (09) 709-711
10 Jayaraj SM, Lloyd J, Frosh AC, Patel KS. Kikuchi-Fujimoto's syndrome masquerading as tuberculosis. J Laryngol Otol 1999; 113 (01) 82-84
11 Lee S, Yoo JH, Lee SW. Kikuchi disease: differentiation from tuberculous lymphadenitis based on patterns of nodal necrosis on CT. AJNR Am J Neuroradiol 2012; 33 (01) 135-140
12 Mahmood S, Saif T, Khurram M, Khan MU. Kikuchi-Fujimoto disease complicated by tuberculosis. J Rawal Med Coll 2015; 19 (01) 102-104
13 Nayak HK, Mohanty PK, Mallick S, Bagchi A. Diagnostic dilemma: Kikuchi's disease or tuberculosis?. BMJ Case Rep 2013; 2013: bcr2012008026
14 Kwon HH, Kim SK. Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease) preceding tuberculous pleurisy. Int J Rheum Dis 2014; 17 (02) 223-225
15 Tsang WY, Chan JK, Ng CS. Kikuchi's lymphadenitis. A morphologic analysis of 75 cases with special reference to unusual features. Am J Surg Pathol 1994; 18 (03) 219-231
16 Song JY, Lee J, Park DW. , et al. Clinical outcome and predictive factors of recurrence among patients with Kikuchi's disease. Int J Infect Dis 2009; 13 (03) 322-326
17 Melikoglu MA, Melikoglu M. The clinical importance of lymphadenopathy in systemic lupus erythematous. Acta Reumatol Port 2008; 33 (04) 402-406