Kikuchi- Fujimoto Disease of Mesenteric Lymph Nodes Mimicking Acute Appendicitis

Abstract

Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenopathy of unknown aetiology, is a rare, benign and self-limiting cause of lymphadenopathy often involving the cervical nodes, and rarely presenting with mesenteric lymphadenopathy. We present a 26-year-old Caucasian male, who presented with right iliac fossa pain and low grade pyrexia, mimicking acute appendicitis. He underwent a laparatomy and an extended right hemi-colectomy for a caecal mass. Histology of the specimen showed lymph nodes with extensive areas of necrosis, with abnormal architecture suggesting Kikuchi-Fujimoto lymphadenopathy. This was further confirmed by immunohistochemistry. In this context maintenance of a high index of suspicion of this condition can avoid major surgical interventions. We describe the management of our case of Kikuchi-Fujimoto’s disease involving the mesenteric nodes and provide an up to date review of the pertinent literature on this subject. 
 Keywords: abdominal mass; Kikuchi- Fujimoto disease; mesenteric lymphadenopathy; necrotising lymphadenitis.

Histiocytic Necrotizing Lymphadenitis Mimicking Acute Appendicitis in a Child: A Case Report

“…If there was no manifestation of an acute abdominal pain, the affected lymph node might not be excised through surgery in time, and the diagnosis process of KFD might be more tortuous. Three KFD cases involving mesenteric lymph nodes and causing acute-appendicitis-like symptoms were reported, and the patients were adults who underwent appendectomy with excision of an enlarged mesenteric lymph node and were diagnosed as KFD based on histopathological findings (16)(17)(18). The pathological features showed lymph node has architecture with partial follicular hyperplasia.…”

Kikuchi-Fujimoto disease: A comprehensive review

“…Extracervical disease especially with bilateral cervical adenopathy and leukopenia in a review of 60 patients (mean age of 21years) with confirmed KFD manifested with abdominal in 52%, pelvic in 47%, inguinal in 41%, and axillary lymph nodes in 30% of patients, respectively[ 78 ]. Mediastinum lymphadenopathy can occur more often while the involvement of mesenteric lymphadenitis is rare and often mimic appendicitis[ 79 - 82 ]. However, nodal enlargement may be minimal or remain limited to mediastinal or retroperitoneal nodes only[ 83 , 84 ].…”