Kikuchi-Fujimoto Disease - A Case Report in a Middle-aged Adult

Kikuchi-Fujimoto disease (KFD) is a rare, benign, self-limiting condition characterized by histiocytic necrotizing lymphadenitis that predominantly affects young adults. The clinical presentation often mimics more serious conditions such as tuberculosis and lymphoma, posing a significant diagnostic challenge. We report a case of KFD in a middle-aged adult. A 46-year-old female presented with left posterior cervical lymphadenopathy and fever of 2 weeks' duration. Extensive workup, including tuberculosis screening with GeneXpert, Mantoux test, and culture, was all negative. Ultrasonography and computed tomography revealed multiple necrotic cervical lymph nodes with bilateral involvement. Excisional lymph node biopsy was done, and histopathology revealed patchy areas of necrosis with karyorrhectic debris, proliferation of histiocytes and immunoblasts, and absence of neutrophilic infiltration suggestive of KFD. The patient was given symptomatic treatment and showed complete resolution of symptoms at follow-up. This case emphasizes the importance of considering KFD in the differential diagnosis of cervical lymphadenopathy, particularly when routine investigations for tuberculosis and malignancy are negative. Excisional lymph node biopsy remains the gold standard for diagnosis.