A rare case of Kikuchi-Fujimoto disease
A 29-year-old non-smoker, normotensive, non-diabetic, male patient presented with two painless, round swellings in right side of the neck for three months with low-grade fever. Initial sizes of the swellings were 2 × 3 cm, and 2 × 2 cm respectively, and their sizes were not increased. There were no respiratory symptoms. Other symptoms like night sweats, fatigue, skin rash, significant weight loss, and anorexia were absent. There was no past history or family history of tuberculosis or intake of antitubercular drugs. There was no history of similar swellings in recent or remote past. On general survey, his pulse rate was 96 beats/minute, respiratory rate 16 breaths/minute, axillary temperature was 99°F, and blood pressure was 110/70 mmHg. Examination of neck revealed two, non-tender, rounded swellings in posterior triangle of right side. Swellings were mobile, discrete, not fixed to underlying structures or overlying skin, and firm in consistency with lobulated surface. Sizes of the swellings were 2 × 3 cm, and 2 × 2 cm respectively, and margins were discrete, not palpable inferiorly. Transillumination test and fluctuation test were negative. There was no color change or discharging sinus on overlying skin. Examination of respiratory and other system revealed no abnormality.\nComplete hemogram and blood biochemistry were normal. Chest radiograph, posteroanterior view revealed no abnormality. Ultrasound of whole abdomen was normal. Anti HIV-1/2 antibodies were non-reactive. Mantoux test (5 TU) was negative (induration of 6 cm at 72 hours). The patient was advised tablet co-amoxiclav-625 mg three times daily for seven days. As there was no improvement, fine needle aspiration cytology of cervical lymph node was done, which revealed reactive lymphoid hyperplasia only, no granuloma or malignant cell was found. Finally, excision biopsy of the cervical lymph node was done to establish the diagnosis, and histopathological examination of biopsy specimen showed lymphoid follicles with germinal centers, paracortical coagulative necrosis containing karyorrhectic foci, suggestive of Kikuchi's disease. The necrotic focis are surrounded by reactive histiocytes, lymphocytes, and occasionally by plasma cells. Ziehl Neelsen stain revealed no acid fast bacilli []. Immunohistochemistry revealed predominance of CD8+ T lymphocytes and histiocytes in the karyorrhectic foci expressed positivity for CD 68 antigen. Serum anti-nuclear antibody and anti-dsDNA antibody was negative. So, our final diagnosis was Kikuchi's disease. As it is a self-limited disease entity, no active treatment was given further; the complete recovery was documented on follow up after one month.