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.^[13]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

Workup

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Author

John Boone, MD Consulting Staff, Department of Otolaryngology, Naval Hospital Oak Harbor

John Boone, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Charles S Kuzma, MD Consulting Staff, Clinical Research Coordinator, First Health of the Carolinas Cancer Center

Charles S Kuzma, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology, California Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Lawrence H Brent, MD Associate Professor of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, American College of Rheumatology

Disclosure: Stock ownership for: Johnson & Johnson.

Chief Editor

Sara J Grethlein, MD, MBA, FACP Executive Medical Director and Medical Oncologist, Swedish Cancer Institute

Sara J Grethlein, MD, MBA, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Women's Association, American Society of Clinical Oncology, American Society of Hematology, Gold Humanism Honor Society, Leukemia and Lymphoma Society

Disclosure: Nothing to disclose.

Additional Contributors

Karen Seiter, MD Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College

Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology

Disclosure: Received honoraria from Novartis for speaking and teaching; Received consulting fee from Novartis for speaking and teaching; Received honoraria from Celgene for speaking and teaching.

Kikuchi Disease Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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