English

Abstract

Kikuchi-Fujimoto disease is a rare benign, condition of necrotizing histiocytic lymphadenitis. A case of a 21 year old gentleman is described here. He presented with fever, weight loss and non-tender cervical lymph nodes. Kikuchi-Fujimoto disease was diagnosed after cervical lymph node biopsy. Symptomatic treatment was provided and an uneventful full recovery was made. BACKGROUND: The presenting complaint of neck masses in association with non-specific systemic signs and symptoms prompt investigation towards the more common diagnoses. However, rarer conditions like Kikuchi-Fujimoto disease must be included in the differential diagnosis of necrotizing lymphadenopathies such as tuberculosis, lupus erythematosus and lymphoma as its course and treatment are entirely different. (1) Here in we discuss a case of male patient who presented with a CASE PRESENTATION: A 21 year old male patient presented with a two week history of fever, anorexia and weight loss. There were no other complaints. He had been previously fit and well and was on no medication. On examination, he was lethargic, but otherwise looked well. He was afebrile and hemodynamically stable. Significant findings were generalized lymphadenopathy, palpable in the cervical and axillary regions. There was no evidence of hepatosplenomegaly. Blood tests revealed neutropenia, hyponatraemia, raised alkaline phosphate and C-reactive protein. Electrocardiogram and chest radiographs were normal. His initial management consisted of fluid restriction and regular paracetamol, whilst results of further tests were awaited. These included blood and sputum cultures, autoimmune and viral screens. Subsequently there was a reduction in size and tenderness of the cervical lymph nodes. There were persistent intermittent temperature spikes and a two day episode of self-resolved diarrhea. Blood, urine and stool cultures were negative. Sputum cultures grew respiratory tract flora and were negative for acid-fast bacilli. The autoimmune screen was negative, as was toxoplasma and cytomegalovirus screens. Computerized tomography demonstrated cervical and axillary lymphadenopathy The abdominal viscera were normal. Excisional biopsy of a cervical lymph node confirmed a diagnosis of Kikuchi-Fujimoto disease (KFD). Histological analysis showed histiocytic granulomatous infiltration with widespread paracortical necrosis of the lymph node, extensive karyorrhectic debris and scattered fibrin deposits and sheets of foam cells. Special stains for acid fast bacilli (Ziehl-Neelsen) and fungi (Gomori's methanamine silver and periodic acid Schiff with diastase) did not reveal any micro-organisms.