Doença de Kikuchi-Fujimoto

Abstract

Kikuchi-Fujimoto disease is characterized by fever and lymphadenopathy, usually localized in the cervical region. This disease principally affects young females. It can be confused with lymphoma, adenocarcinoma metastasis and tuberculosis. We report two cases of Kikuchi-Fujimoto disease. In the first case, a 28-year-old female had been treated for tuberculosis one year prior and presented with a clinical and histological profile compatible with Kikuchi-Fujimoto disease. The second patient, a 58-year-old female, initially received treatment for Wegener's granulomatosis and, subsequently, for tuberculosis. Histopathological examination followed by immunohistochemical analysis confirmed the diagnosis of Kikuchi-Fujimoto disease in both cases. After the definitive diagnosis had been made, both patients were treated symptomatically, and both presented clinical improvement within one month. Subsequently, the latter patient developed systemic lupus erythematosus.

Kikuchi-Fujimoto disease: an unusual association with acute renal failure

“…Patients with more severe or persistent symptoms have been treated with corticosteroids. 8 In our case, corticoid therapy with prednisone has had signifi cant importance, for it revealed transitory relation with symptom reduction. With the remission of prednisone, the patient has shown a worse KFD picture and has presented an atypical systemic manifestation, which has not been reported in the literature for this disease: acute kidney failure (AKF).…”

“…Generalized lymphadenopathy occurs in a minority (5%) of cases. 8 The disease courses with fever from 30% to 50% of cases, usually of low-grade, associated with symptoms of upper respiratory tract. Symptoms such as weight loss, nausea, vomiting, sore throat, and night sweat are not common, and when they occur, they are related to extranodal involvement.…”

“…8 There are atypical systemic manifestations such as panuveitis with impairment of visual acuity, 10 arthritis, 11 four cases of aseptic meningitis, amigdalitis 12 and cryptogenic organizing pneumonia. 13 Mortality is rarely found in KFD, but there have been three cases due to the disease, such as a 38-year-old woman with acute heart failure, in whose necropsy multiple focuses of cardiac necrosis were found; there has been another case of a 19-month-old child who died of febrile syndrome, and whose necropsy revealed a clinical picture compatible with extranodal and nodal KFD; 14 fi nally, there has been a case of KFD death in a patient who had received a transplant.…”

“…Other autoimmune conditions, such as antiphospholipid antibody syndrome, polymyositis, Still's disease, uveitis, scleroderma, thyroiditis, pulmonary hemorrhage and interstitial lung disease, can be associated with KFD. 8 KFD and lymph nodal tuberculosis (LTB) are commonly mistaken. There are cases in the literature described with LTB diagnosis before the anatomopathological examination.…”

“…12 There is also another case in which the patient received treatment for Wegener's granulomatosis. 8 That is why the etiologic diagnosis is important, in order to avoid long and expensive treatment.…”