A 21-year-old female presented with fever, bilateral cervical tender lymphadenopathy, skin rashes and headache for 7 days. High ESR and neutrophilic leucocytosis were noted. Mantoux test was negative. Chest X-ray was normal. FNAC from one of the lymph nodes yielded thick pus-like material. The smears were full of nuclear debris and necrotic fragments. The cytomorphology was suggestive of tuberculous lymphadenitis. However, Z-N stain was negative for AFB. Differential diagnoses were tuberculosis, lymphoma, acute suppurative lymphadenitis, Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis and viral lymphadenitis.
However, the patient was started on antitubercular drugs (for the benefit of doubt), but the condition worsened after two weeks. Therefore, an excision biopsy was done for histopathology and to rule out malignancy. The biopsy confirmed acute histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease (see photomicrographs).
NSAIDs and corticosteroids were administered for 7 days following biopsy. The condition improved soon. No recurrence has been noted after 1 year, following recovery.
Learning Points/Take Home Messages
Though tuberculosis is so frequent in India, anti-tubercular drugs should not be given if some supportive report is not in hand!
About The Author
Dr. Samanta, MBBS, MD is currently a consultant at EKO Diagnostic PVT. LTD. Kolkata, India for histopath, cytopath and hematology. His other interests are: oncopathology, bone marrow and neuropathology.
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Quick Case: Kikuchi-Fujimoto Disease (KFD) Mistaken and Treated as a Case of Tuberculosis
A 21-year-old female presented with fever, bilateral cervical tender lymphadenopathy, skin rashes and headache for 7 days. High ESR and neutrophilic leucocytosis were noted. Mantoux test was negative. Chest X-ray was normal. FNAC from one of the lymph nodes yielded thick pus-like material. The smears were full of nuclear debris and necrotic fragments. The cytomorphology was suggestive of tuberculous lymphadenitis. However, Z-N stain was negative for AFB. Differential diagnoses were tuberculosis, lymphoma, acute suppurative lymphadenitis, Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis and viral lymphadenitis.
However, the patient was started on antitubercular drugs (for the benefit of doubt), but the condition worsened after two weeks. Therefore, an excision biopsy was done for histopathology and to rule out malignancy. The biopsy confirmed acute histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease (see photomicrographs).
NSAIDs and corticosteroids were administered for 7 days following biopsy. The condition improved soon. No recurrence has been noted after 1 year, following recovery.
Learning Points/Take Home Messages
Though tuberculosis is so frequent in India, anti-tubercular drugs should not be given if some supportive report is not in hand!
About The Author
Dr. Samanta, MBBS, MD is currently a consultant at EKO Diagnostic PVT. LTD. Kolkata, India for histopath, cytopath and hematology. His other interests are: oncopathology, bone marrow and neuropathology.