The Differential Diagnosis of Bilateral Pleural Effusion and Multiple Mediastinal Lymphadenopathies Includes Kikuchi-Fujimoto Disease

Abstract

Kikuchi-Fujimoto disease is an uncommon lymphohistiocytic disorder that frequently presents with acute or subacute clinical disease course. Cervical lymphadenopathy is the most common involved lymph node. Very rare cases of pathologic diagnosis of Kikuchi-Fujimoto disease with bilateral pleural effusion and multiple mediastinal lymphadenopathies have been reported in the literature. In this article, we report the case of a 60-year-old male presented with bilateral pleural effusion and multiple mediastinal lymphadenopathies. He received video-assisted thoracoscopic surgery of the right pleura and thoracoscopic excision of the mediastinal lymph node. The pathologic findings from the lymph node and pleura were compatible with Kikuchi-Fujimoto disease. He was treated with oral hydroxychloroquine and oral prednisolone. A computed tomography scan of the chest 4 months later showed regressive mediastinal lymphadenopathy and bilateral pleural effusion. Our case is a first reported case of Kikuchi-Fujimoto disease diagnosis by the pathology of the lymph node and pleura in the literature. Results from our case suggest that Kikuchi-Fujimoto disease should be included in the differential diagnosis of bilateral pleural effusion and multiple mediastinal lymphadenopathies.

Kikuchi-Fujimoto Disease: A Rare Cause of Cervical Lymphadenopathy

“…Some studies show female preponderance (4:1) in KFD [ 5 ]. However, new investigations have reported equal distribution of the disease among the male and female Asian populations [ 2 ]. Additionally, some rare case studies in the United States (US) and Europe found that the disease has been distributed in all racial groups and ethnic groups [ 6 ].…”

“…A low-grade fever may be reported in 50% of KFD patients, along with respiratory symptoms such as cough and headache. Less frequent symptoms of KFD include skin rash, weight loss, nausea, vomiting, sore throat, and night sweats [ 1 , 2 , 10 ]. Apart from fever and tender cervical lymphadenopathy, leukopenia has been detected in 50% of KFD patients.…”

“…Based on the results in histology and immunohistochemistry, it is seen that an overwhelming reaction to numerous organisms may cause KFD lymphadenopathy with fever [ 2 ]. In addition, genetically predisposed individuals have an immoderate T-cell-mediated immune response to different nonspecific stimuli.…”

“…The disease commonly causes mild fever, tender cervical adenopathy, night sweats, and headache. Weight loss, skin rash, nausea, vomiting, and sore throat can also be associate with KFD [ 1 , 2 ]. It resembles other diseases associated with lymph nodes.…”