Kikuchis lymphadenitis: Is biopsy necessary in managing these patients

Abstract

Kikuchis lymphadenitis: Is biopsy necessary in managing these patientsKikuchis-Fujimoto's is a benign, self-limiting, cervical lymphadenitis, fi ne-needle aspiration cytology (FNAC) plays a very important role in the diagnosis and management of these patients. We present a case of 30-year-old female presenting with supraclavicular lymphadenopathy and fever, diagnosed as Kikuchis-Fujimoto's lymphadenitis on FNAC with no recurrence or development of Lupus lymphadenitis even after 1-year of follow-up. Although Kikuchis-Fujimoto's is a rare cause of lymphadenopathy, FNAC is an important tool in diagnosing this entity and differentiating from tubercular lymphadenitis and Lupus adenitis. Presence of cresentric nucleated histiocytes engulfed karryorrhectic debris and monocytoid cells aids in the diagnosing. A defi nitive diagnosis made on FNAC can avoid biopsy and unnecessary diagnostic and therapeutic interventions in these patients. However, a look out for recurrence and development of Lupus with regular followup and serological examination is imperative.Key words: Fine-needle aspiration cytology, kikuchis-fujimoto's, lupus adenitis, tubercular adenitis INTRODUCTIONKikuchis-Fujimoto's disease (KFD) or histiocytic necrotising lymphadenitis was fi rst described by Kikuchis, simultaneously by Fujimoto's et al. in 1972. [1,2] Since then, numerous cases have been reported in both Asian and western population. Though a self-limiting disease that resolves on its own within few weeks and months, it is known to recur in 3-4% of cases. [3] Though fi ne-needle aspiration cytology (FNAC) is diagnostic in most of these cases, histopathological examination of the excised node is usually done to confi rm the diagnosis and differentiate from other causes of adenitis. CASE REPORTA 31-year-old female presented with fever (low grade, Intermittent), headache, edema, weight loss and pain in the right supraclavicular region of 3 month's duration. There was no history of cough with expectoration/weight loss/skin rash/joint pain or any other swellings in the body. On examination, she was febrile, with multiple nodules in right supraclavicular region. A diagnosis of viral fever with supraclavicular lymphadenopathy and was made, and she was treated symptomatically. Since her symptoms did not subside even after 1 week of treatment, the presumptive diagnosis of tubercular lymphadenitis was made, and laboratory workup was suggested. All her biochemical and hematological investigations were normal except an increase in erythrocyte sedimentation rate (80 mm at the end of 1 st h). Antinuclear antibody test was negative.An ultrasonography of right supraclavicular region revealed multiple nodes in upper and middle jugular areas largest measuring 1.4 cm across. A diagnosis of reactive lymph node enlargement was given.Fine-needle aspiration cytology of the node was highly cellular with a heterogeneous population of lymphocytes, histiocytes, cresentric nucleated histiocytes [ Figure 1] (histiocyte with cresentric nucleus and eosinophilic inclusions in ...