Kikuchi’s Disease: A Case Report

A 30-year-old female attended in August 2019, presented with painful swelling in right upper neck and fever for 20 days. Biochemical and microbiological tests, and imaging studies were all inconclusive. Histopathology of the affected lymph nodes revealed consistent with Kikuchi’s disease. The Patient was treated properly and complete remission occurred within few weeks. It is a self-limiting idiopathic disease which can mimic several serious conditions such as TB, lymphoma, infectious mononucleosis and others.

about only 3%. 3 Mortality is extremely rare. Awareness of this disorder will help to prevent misdiagnosis and inappropriate treatment as it is strongly associated with autoimmune disorders like hashimoto's thyroiditis or systemic lupus erythematous (SLE) and mimic lymphoma, TB etc. 4

Case presentation:
A 30-year-old female presented with painful swelling in right neck and fever for 20 days in the ENT department in August 2019. There was no weight loss, no previous history of tuberculosis or contact with tuberculosis. Clinical Examinations revealed right sided palpable, oval, mobile and tendercervical lymphadenopathy, larger node being the right anterior triangle of neck which was measured about 4 x 3 cm, other enlarged nodes were on right posterior cervical region. Lymph nodes were not palpable in other parts of the body. On admission, the patient was febrile to 102° F. She was normotensive, nondiabetic. Routine hematological parameters like complete blood count, hemoglobin, peripheral blood film was within normal limits. X-ray chest revealed no abnormalities. Day after admission, the patient underwent excisional cervical lymph node biopsy under general anesthesia. Lymph nodes from right anterior and posterior chain of cervical group were completely removed and sent for histopathology. The histopathology revealed area of karyorrhectic debris and focal proliferation of histiocytes, small focus of necrosis and scattered fibrin deposits are presents concluding acute necrotizing lymphadenitis or Kikuchi's disease (Figure 1).
previously healthy young female. Less frequent presentations are malaise, weight loss, rash, arthritis, fatigue and hepatosplenomegaly, although there are case reports in the literature of more serious presentations such as meningitis, polymyositis and acute cerebellar syndromes 5 . In our case there was only fever and cervical lymphadenopathy.
The clinical presentation and the usually selflimited course suggest an immune response to an infectious agent. Numerous inciting infectious agents have been proposed, including EBV, HHV 6 and 8, HIV and parvovirus B19. 6 We didn't do any virological tests because of patient's poor financial condition.
Histopathological examination of involved lymph nodes is necessary to make a definitive diagnosis and to exclude other such as lymphoma and hematologic malignancies. Microscopic examination of the node revealed area of karyorrhectic debris and focal proliferation of histiocytes, small focus of necrosis and scattered fibrin deposits.
Laboratory studies are mostly non-specific. Leukopenia is common; however, the majority of the patient have a normal Complete Blood Cell count. Erythrocyte sedimentation Rate (ESR) also tends to be elevated in most patients and there may also be abnormalities in liver enzymes and an elevated LDH. In our case, only ESR was elevated and other hematological reports were normal.
Symptomatic and supportive treatment is usually adequate. 7 If the lymph nodes are large and painful, its better to excise the lymph nodes and sent for histopathology.
A complete history, physical examinations and appropriate investigations are necessary for the diagnosis of Kikuchi's disease. Patient was discharged with advices and follow up schedule.
At last follow-up she reports no symptoms, remains well and there are no abnormalities on clinical examination.

Discussion:
Kikuchi's disease, known as necrotizing histiocytic lymphadenitis is a rare, idiopathic cause of lymphadenopathy that may be difficult to differentiate from other causes of lymphadenopathy such as mononucleosis, tuberculosis and lymphoma.
The most common clinical presentation is fever and cervical lymphadenopathy in a