Kikuchi-Fujimoto Disease: Diagnosis in a Relapsing Case

Area of Science:

• Internal Medicine
• Pathology
• Oncology

Background:

• Cervical lymphadenopathy presents a diverse differential diagnosis, necessitating age-specific evaluation.
• Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis) is a rare but significant consideration, particularly after excluding common causes.

Observation:

• A 21-year-old female presented with painful left cervical swelling and multiple tender lymphadenopathies.
• Initial investigations including serologies for common viral infections and an interferon-gamma release assay were negative.
• Neck CT revealed round lymphadenopathies with necrosis and extracapsular extension, initially suggestive of tuberculous lymphadenitis.

Findings:

• Despite initial suspicion for tuberculosis, the diagnosis was confirmed as Kikuchi-Fujimoto disease via excisional biopsy following a relapse.
• The case illustrates a relapsing pattern of histiocytic necrotizing lymphadenitis.

Implications:

• Accurate diagnosis of Kikuchi-Fujimoto disease relies on high clinical suspicion and definitive histological confirmation.
• This case underscores the importance of considering rare diagnoses in the differential of cervical lymphadenopathy, especially with atypical or relapsing presentations.