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

Abstract

Background: Histiocytic necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease (KFD), is a self-limiting inflammatory disease with low incidence and high misdiagnosis rate in children. Furthermore, cases where the clinical presentation resembles acute appendicitis are very rare.Case Presentation: A 14-year-old boy was misdiagnosed as acute appendicitis and received operative treatment at his early visit. He suffered from abdominal pain, vomiting, diarrhea, fever, and lymphadenitis at the ileocecal junction, which were found by B-ultrasonography examination and surgery. Lymphadenectomy, as well as appendectomy, was performed, and KFD was identified by pathological examination. The patient was transferred to our hospital for further therapy because of recurrent fever and abdominal pain after the appendectomy. His temperature became normal after methylprednisolone was administered, and no recurrence was observed till now during follow-up.Conclusions: Necrotizing lymphadenitis involving mesenteric lymph nodes may cause acute-appendicitis-like symptom; KFD should be a diagnostic consideration for mesenteric lymphadenitis.

Case Report: Acute abdomen and large mesenteric mass as another face of multisystem inflammatory syndrome in an adolescent child: measure twice, act once!

“…Viral lymphadenitis can sometimes mimic KFD, sharing histologic features like paracortical expansion, necrosis, and histiocytic infiltrate. However, viral lymphadenitis typically displays less prominent histiocytic infiltrate, more neutrophils, plasma cells, and a predominant CD4 T cell population (35).…”

“…In contrast, lymph node involvement in MIS-C is less common and is primarily observed as cervical lymphadenopathy (33). In both KFD and MIS-C, mesenteric lymphadenopathy is rare, with only a few reported cases documented in the literature (35,37).…”

“…This underscores the diverse clinical manifestations of adenovirus and its potential to mimic other gastrointestinal conditions. Nevertheless, there is a notable absence of case reports in the English literature documenting giant abdominal lymph node in association with adenovirus gastroenteritis and pathologic feature of lymph node is different than post-infectious inflammatory disorders (35).…”

Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS) — A mimic of intra-abdominal malignancy

“…It is thought to be triggered by viral infection, but this is not proven. While mesenteric lymph node involvement has been described in children presenting with abdominal pain, 3 it is rare. This, together with the extent of the necrosis and the prominent mesenteric fat involvement, prevented a definite diagnosis of Kikuchi’s disease.…”