Kikuchi-Fujimoto's disease involving mesenteric nodes: a report and review of literature

Abstract

An adolescent boy underwent laparoscopic evaluation with persisting fever associated with colicky abdominal pain of about 3 weeks duration after a CT study of his abdomen revealed mesenteric adenopathy. Histopathological evaluation of the excised mesenteric nodes showed features of histiocytic necrotising lymphadenopathy suggestive of Kikuchi-Fujimoto lymphadenopathy which was confirmed on immunehistochemistry staining. Kikuchi-Fujimoto's disease involving the mesenteric nodes is extremely unusual and can be confounding with a mistaken diagnosis of and prolonged treatment for tuberculosis. The authors present a case of Kikuchi-Fujimoto's disease involving the mesenteric lymph nodes and discuss the various aspects of diagnosis and management of the case along with a review of published literature.

Kikuchi-Fujimoto disease and acute appendicitis

“…In a recent case report and literature review, Vijayaraghavan et al 14 identified 17 cases of KFD and mesenteric lymphadenopathy, 5 of which presented as acute appendicitis similar to our patient 4 8 9 12. The constellation referred to as pseudoappendicitis includes the classic signs of right lower quadrant abdominal pain, positive McBurney's sign and rebound tenderness and may be found in KFD when mesenteric lymphadenitis is exceptionally prominent.…”

“…In one instance, the patient declined surgery and underwent a percutaneous transabdominal lymph node biopsy 11. CT scan imaging, known to be performed preoperatively in 11 of the 15 cases, demonstrated isolated mesenteric lymphadenopathy5–10 13 14; none of the patients had PET scan imaging.…”

“…Even if KFD is suspected clinically, abdominal surgery may be necessary to obtain a biopsy sample. Indeed, of the 15 reported cases presenting as acute appendicitis, abdominal surgery was performed in 14: via laparoscopy (3 cases)10 14 or laparotomy (11 cases) 4–9 13 15. In one instance, the patient declined surgery and underwent a percutaneous transabdominal lymph node biopsy 11.…”

Systemic Kikuchi-Fujimoto disease bordering lupus lymphadenitis: A fresh look?

“…Kikuchi-Fujimoto's necrotizing lymphadenitis is a predominantly benign disease characterized by regional lymphadenopathy, low-grade fever and night sweats often involving the cervical lymph nodes in young people with less frequent involvement of lymph nodes elsewhere (1). From 1972 with the first reports of Kikuchi-Fujimoto disease (KFD) in Japan (2), the knowledge of KFD has been confined to case reports and series.…”

Kikuchi-Fujimoto’s disease with abdominal pain due to intra-abdominal lymphadenitis

“…Twenty-eight cases of KFD involving intra-abdominal lymphadenopathy have been reported in the Japanese and English literature,10 11 and are summarised in table 1. In brief, of the 21 cases that reported the presence or absence of superficial lymphadenopathy, 11 had superficial lymphadenopathy.…”