Case Report of Kikuchi-Fujimoto Disease from Sub-Saharan Africa: An Important Mimic of Tuberculous Lymphadenitis

Abstract

Kikuchi-Fujimoto disease (KFD) is a rare form of painful lymphadenopathy, usually cervical, which is more common in Southeast Asia and rarely reported from Africa. Symptoms are usually nonspecific (fever, night sweats, etc.), and can mimic more common diseases such as tuberculosis (TB) in endemic areas. We report a case of a 29-year-old black African woman who was admitted with headache, neck pain, fever, and lymphadenopathy. She was found to have aseptic meningitis, eventually attributed to TB based on cervical node biopsy, although further histology suggested KFD. Blood tests for systemic lupus erythematosus (SLE) were negative; she had already been commenced on anti-TB treatment and had responded well and so was continued with this therapy. She was also later diagnosed with Hashimoto's thyroiditis 3 months after her diagnosis of KFD. Five months after stopping TB treatment, she was readmitted with the same symptoms and associated painless lymphadenopathy. Repeat biopsy was morphologically similar to that of 2017, and repeat evaluation confirmed SLE. She has since been managed by a rheumatologist and continues to do well.

Case Report: Histiocytic Necrotizing Lymphadenitis (Kikuchi–Fujimoto Disease) Concurrent With Aseptic Meningitis

“…KFD is a benign, self-limiting disease, and most patients do not need special treatment (3). Moreover, it has a low recurrence rate (3 to 4%), and only several fatal cases have been reported (3,5,18). In the retrospective analysis of 11 cases (Table 2: cases 28 and 32-41) of KFD patients with meningitis, Sato et al found that meningitis symptoms would spontaneously recede within 2-6 weeks without special treatment (26).…”

Kikuchi-Fujimoto disease: State of the art

“…The first is viral infection and the second theory explains the appearance of KFD in the course of autoimmune disease. 2,6,7 The confirmation of the 'viral disease' theory in the course of KFD. The large number of histiocytes and CD8 + lymphocytes in the affected lymph nodes seems to confirm the viral infection etiology of KFD.…”

“…In most cases, Hashimoto's disease manifested itself at the same time as KFD. 3,6 KFD may cooccur before, during or after the onset of SLE. Therefore, the diagnosis of KFD requires longterm monitoring for the development of SLE.…”

“…Skin lesions most often appear in the form of urticaria, purpura, papules resembling measles, rubella or a drug rash. 5,6 Symptoms of central nervous system involvement in KFD are rare and include encephalitis, meningitis, and cerebellar ataxia. 5,6,12 Individual cases of patients in whom KFD was manifested by optic neuritis were also reported in the literature.…”

“…5,6 Symptoms of central nervous system involvement in KFD are rare and include encephalitis, meningitis, and cerebellar ataxia. 5,6,12 Individual cases of patients in whom KFD was manifested by optic neuritis were also reported in the literature. 9 In most cases, the course of the disease is mild.…”