Kikuchi Disease Differential Diagnoses

Updated: Aug 12, 2017
  • Author: John Boone, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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Diagnostic Considerations

The main diagnostic problems encountered by clinicians and histopathologists is distinguishing Kikuchi disease from malignant lymphoma and systemic lupus erythematosus (SLE). In Dorfman and Berry's series, 40% of patients with Kikuchi disease were initially misdiagnosed as having lymphoma and were consequently overtreated with chemotherapy. [6] This pitfall remains an active source of diagnostic error.

Kikuchi disease can also mimic SLE. Both can present with lymphadenopathy and fever, and the cutaneous findings seen in 30% of Kikuchi disease patients can resemble those seen in SLE. Results from autoimmune antibody studies may help distinguish Kikuchi disease from SLE. In Kikuchi disease, antinuclear antibodies (ANA), rheumatoid factor (RF), and lupus erythematosus (LE) preparations are usually, although not always, negative.

Kikuchi disease and SLE can also have similar histopathologic appearances. Kikuchi disease is suggested by the absence or paucity of the hematoxylin bodies, plasma cells, and neutrophils usually seen in SLE. Additionally, T lymphocytes predominate in Kikuchi disease, whereas B lymphocytes predominate in SLE.

Other problems to be considered include the following:

  • Atypical mycobacterial lymphadenitis
  • Lymphoma
  • Metastatic carcinoma
  • Other viral- or bacterial-caused lymphadenitis
  • Rheumatoid arthritis lymphadenitis
  • Still disease

Differential Diagnoses