Case & review
Kikuchi's disease: Case report and systematic review of cutaneous and histopathologic presentations

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Kikuchi's disease, also known as histiocytic necrotizing lymphadenitis, is a systemic illness with classic clinical findings of cervical lymphadenopathy and fever. Diagnosis is confirmed by lymph node histology, which reveals paracortical foci of necrosis and a histiocytic infiltrate. Kikuchi's disease has been associated with a number of infections, but no single source has been identified. Diverse, often nonspecific, cutaneous findings have been described in up to 40% of cases. Description of the histopathologic findings of skin lesions is limited to single case reports and one case series. We describe a 24-year-old woman with fevers, lymphadenopathy, hepatic and hematologic abnormalities, and a skin eruption involving the face, neck, trunk, and extremities with characteristic lymph node and cutaneous histopathologic findings. We completed a systematic review of the clinical presentations and histopathology of Kikuchi's disease.

Section snippets

Case report

A white woman, 24 years old, was evaluated for fevers and lymphadenopathy of 6 weeks' duration and 8 days of a pruritic, burning skin eruption on the cheeks, neck, trunk, and extremities. She reported headache, ear pain, tinnitus, sore throat, cough, loose stools, and vomiting. Her medical history included chronic back pain, tonsillectomy, adenoidectomy, repair of a nasal fracture, and nonsteroidal anti-inflammatory drug–induced ulcers and gastritis. Her medications included hydroxyzine,

Methods

A systematic search of the scientific literature from 1966 through January 2007 was conducted to identify all case reports and case series describing Kikuchi's disease. Cases were identified by searches of PubMed/MEDLINE with the MeSH term Histiocytic Necrotizing Lymphadenitis and the entry terms Kikuchi-Fujimoto Disease; Disease, Kikuchi-Fujimoto; Kikuchi Fujimoto Disease; Kikuchi's Disease; Disease, Kikuchi's; Kikuchis Disease; Kikuchi Disease; Disease, Kikuchi; Lymphadenitis, Histiocytic

Discussion

The classic findings of Kikuchi's disease are lymphadenopathy and fever.103, 104. The etiology is unknown. Infections have been implicated, including Epstein-Barr virus,61, 67, 83, 105 human herpesvirus,6, 23, 106 human herpesvirus 8,107 HIV,108 HTLV1,5 dengue virus,21 parvovirus B19,93Yersinia enterocolitica,109Bartonella,110Brucella,111 and Toxoplasma organisms.90 Kikuchi's disease affects all ethnic groups and is more common in women.74, 80 Most affected patients are younger than 40 years.112

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  • Cited by (0)

    Funding sources: None.

    Conflicts of interest: None declared.

    Presented in poster format at the annual meeting of the American Academy of Dermatology, Washington, DC, February 2-6, 2007.

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