Medical Care

Treatment of Kikuchi disease is generally supportive. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to alleviate lymph node tenderness and fever. The use of corticosteroids, such as prednisone, has been recommended in severe extranodal or generalized Kikuchi disease.^{[30, 38]}Clinical and related laboratory indications for corticosteroid use include the following:

Neurologic involvement – Aseptic meningitis, cerebellar ataxia
Hepatic involvement – Elevated lactate dehydrogenase (LDH) level
Severe lupuslike syndrome – Positive antinuclear antibody (ANA) titers

Jang and colleagues recommended expanding the indications for corticosteroid use to less-severe disease.^[38]They administered prednisone when patients had prolonged fever and annoying symptoms lasting more than 2 weeks despite NSAID therapy, as well as for recurrent disease and for patients who desired a faster return to work.

In steroid-resistant and recurrent Kikuchi disease, case reports have described successful use of hydroxychloroquine and intravenous immunoglobulin.^{[2, 13, 39]}

Medication

Masab M, Surmachevska N, Farooq H. Kikuchi Disease. 2020 Jan. [Medline]. [Full Text].
Masab M, Farooq H. Kikuchi Disease. Clin Rheumatol. 2017 Jun. 27(8):1073-5. [Medline]. [Full Text].
Bosch X, Guilabert A, Miquel R, Campo E. Enigmatic Kikuchi-Fujimoto disease: a comprehensive review. Am J Clin Pathol. 2004 Jul. 122(1):141-52. [Medline].
Alam H, Saeed MO, Saeed AB, Zaidi A. Kikuchi disease. J Pak Med Assoc. 2015 Dec. 65 (12):1349-50. [Medline].
Lamzaf L, Harmouche H, Maamar M, Adnaoui M, Aouni M, Tazi Mezalek Z. Kikuchi-Fujimoto disease: report of 4 cases and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis. 2014 Dec. 131 (6):329-32. [Medline].
Kuo TT. Kikuchi's disease (histiocytic necrotizing lymphadenitis). A clinicopathologic study of 79 cases with an analysis of histologic subtypes, immunohistology, and DNA ploidy. Am J Surg Pathol. 1995 Jul. 19(7):798-809. [Medline].
Dorfman RF, Berry GJ. Kikuchi's histiocytic necrotizing lymphadenitis: an analysis of 108 cases with emphasis on differential diagnosis. Semin Diagn Pathol. 1988 Nov. 5(4):329-45. [Medline].
Gallien S, Lagrange-Xelot M, Crabol Y, et al. [Systemic lupus erythematosus and Kikuchi-Fujimoto disease mimicking tuberculosis] [French]. Med Mal Infect. 2008 Jun 17. epub ahead of print. [Medline].
Yilmaz M, Camci C, Sari I, et al. Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto's disease) mimicking systemic lupus erythematosus: a review of two cases. Lupus. 2006. 15(6):384-7. [Medline].
Poulose V, Chiam P, Poh WT. Kikuchi's disease: a Singapore case series. Singapore Med J. 2005 May. 46(5):229-32. [Medline]. [Full Text].
Scagni P, Peisino MG, Bianchi M, et al. Kikuchi-Fujimoto disease is a rare cause of lymphadenopathy and fever of unknown origin in children: report of two cases and review of the literature. J Pediatr Hematol Oncol. 2005 Jun. 27(6):337-40. [Medline].
Hedia G, Jamel A, Maher A, et al. Kikuchi-Fujimoto disease associated with systemic lupus erythematosus. J Clin Rheumatol. 2005 Dec. 11(6):341-2. [Medline].
Dumas G, Prendki V, Haroche J, Amoura Z, Cacoub P, et al. Kikuchi-Fujimoto disease: retrospective study of 91 cases and review of the literature. Medicine (Baltimore). 2014 Nov. 93 (24):372-82. [Medline]. [Full Text].
Spies J, Foucar K, Thompson CT, LeBoit PE. The histopathology of cutaneous lesions of Kikuchi's disease (necrotizing lymphadenitis): a report of five cases. Am J Surg Pathol. 1999 Sep. 23(9):1040-7. [Medline].
Sierra ML, Vegas E, Blanco-González JE, et al. Kikuchi's disease with multisystemic involvement and adverse reaction to drugs. Pediatrics. 1999 Aug. 104(2):e24. [Medline]. [Full Text].
Lee S, Yoo JH, Lee SW. Kikuchi Disease: Differentiation from Tuberculous Lymphadenitis Based on Patterns of Nodal Necrosis on CT. AJNR Am J Neuroradiol. 2011 Dec 15. [Medline].
Găman M, Vlădăreanu AM, Dobrea C, Onisâi M, Marinescu C, Voican I, et al. A Challenging Case of Kikuchi-Fujimoto Disease Associated with Systemic Lupus Erythematosus and Review of the Literature. Case Rep Hematol. 2018. 2018:1791627. [Medline]. [Full Text].
Hutchinson CB, Wang E. Kikuchi-Fujimoto disease. Arch Pathol Lab Med. 2010 Feb. 134(2):289-93. [Medline].
Supari D, Ananthamurthy A. Kikuchi-fujimoto disease: a study of 24 cases. Indian J Otolaryngol Head Neck Surg. 2014 Jan. 66(1):69-73. [Medline]. [Full Text].
Sopeña B, Rivera A, Vázquez-Triñanes C, Fluiters E, González-Carreró J, Del Pozo M, et al. Autoimmune Manifestations of Kikuchi Disease. Semin Arthritis Rheum. 2011 Dec 20. [Medline].
Lee EJ, Lee HS, Park JE, Hwang JS. Association Kikuchi disease with Hashimoto thyroiditis: a case report and literature review. Ann Pediatr Endocrinol Metab. 2018 Jun. 23 (2):99-102. [Medline]. [Full Text].
Hudnall SD. Kikuchi-Fujimoto disease. Is Epstein-Barr virus the culprit?. Am J Clin Pathol. 2000 Jun. 113(6):761-4. [Medline]. [Full Text].
Barbat B, Jhaj R, Khurram D. Fatality in Kikuchi-Fujimoto disease: A rare phenomenon. World J Clin Cases. 2017 Feb 16. 5 (2):35-39. [Medline]. [Full Text].
Shim EJ, Lee KM, Kim EJ, Kim HG, Jang JH. CT pattern analysis of necrotizing and nonnecrotizing lymph nodes in Kikuchi disease. PLoS One. 2017. 12 (7):e0181169. [Medline]. [Full Text].
Jung IY, Ann HW, Kim JJ, Lee SJ, Kim J, Seong H, et al. The incidence and clinical characteristics by gender differences in patients with Kikuchi-Fujimoto disease. Medicine (Baltimore). 2017 Mar. 96 (11):e6332. [Medline]. [Full Text].
Kang HM, Kim JY, Choi EH, Lee HJ, Yun KW, Lee H. Clinical Characteristics of Severe Histiocytic Necrotizing Lymphadenitis (Kikuchi-Fujimoto Disease) in Children. J Pediatr. 2016 Feb 4. [Medline].
Atwater AR, Longley BJ, Aughenbaugh WD. Kikuchi's disease: case report and systematic review of cutaneous and histopathologic presentations. J Am Acad Dermatol. 2008 Jul. 59(1):130-6. [Medline].
Yasukawa K, Matsumura T, Sato-Matsumura KC, et al. Kikuchi's disease and the skin: case report and review of the literature. Br J Dermatol. 2001 Apr. 144(4):885-9. [Medline].
Khishfe BF, Krass LM, Nordquist EK. Kikuchi disease presenting with aseptic meningitis. Am J Emerg Med. 2014 Oct. 32 (10):1298.e1-2. [Medline].
Singh YP, Agarwal V, Krishnani N, Misra R. Enthesitis-related arthritis in Kikuchi-Fujimoto disease. Mod Rheumatol. 2008 May 10. epub ahead of print. [Medline].
Tong TR, Chan OW, Lee KC. Diagnosing Kikuchi disease on fine needle aspiration biopsy: a retrospective study of 44 cases diagnosed by cytology and 8 by histopathology. Acta Cytol. 2001 Nov-Dec. 45(6):953-7. [Medline].
Osborn M, Aqel N, Levine TS. The fine needle aspiration appearances of Kikuchi's lymphadenitis. Cytopathology. 2009 Feb. 20 (1):36-43. [Medline].
Kwon SY, Kim TK, Kim YS, et al. CT findings in Kikuchi disease: analysis of 96 cases. AJNR Am J Neuroradiol. 2004 Jun-Jul. 25(6):1099-102. [Medline]. [Full Text].
Kato H, Kanematsu M, Kato Z, Teramoto T, Kondo N, Hirose Y, et al. MR imaging findings of cervical lymphadenopathy in patients with Kikuchi disease. Eur J Radiol. 2011 Dec. 80 (3):e576-81. [Medline].
Ryoo I, Suh S, Lee YH, Seo HS, Seol HY. Comparison of Ultrasonographic Findings of Biopsy-Proven Tuberculous Lymphadenitis and Kikuchi Disease. Korean J Radiol. 2015 Jul-Aug. 16 (4):767-75. [Medline]. [Full Text].
Wang M, Yu X, Yang Y. Diagnosing Kikuchi's disease on fine needle aspiration biopsy. Cytopathology. 2020 Jan. 31 (1):22-25. [Medline].
Tabata T, Takata K, Miyata-Takata T, Sato Y, Ishizawa S, Kunitomo T, et al. Characteristic Distribution Pattern of CD30-positive Cytotoxic T Cells Aids Diagnosis of Kikuchi-Fujimoto Disease. Appl Immunohistochem Mol Morphol. 2018 Apr. 26 (4):274-282. [Medline].
Jang YJ, Park KH, Seok HJ. Management of Kikuchi's disease using glucocorticoid. J Laryngol Otol. 2000 Sep. 114(9):709-11. [Medline].
Hyun M, So IT, Kim HA, Jung H, Ryu SY. Recurrent Kikuchi's Disease Treated by Hydroxychloroquine. Infect Chemother. 2016 Jun. 48 (2):127-31. [Medline].
Kishimoto K, Tate G, Kitamura T, Kojima M, Mitsuya T. Cytologic features and frequency of plasmacytoid dendritic cells in the lymph nodes of patients with histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease). Diagn Cytopathol. 2009 Nov 25. epub ahead of print. [Medline].

Media Gallery

of 0

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, FACP Professor of Clinical Medicine, Indiana University School of Medicine; Medical Director of Cancer Services, Indiana University Health, Adult Academic Health Center, IU Simon Cancer and IU North Hospital, Joe and Shelly Schwarz Cancer Center

Sara J Grethlein, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, 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 Treatment & Management

Medical Care

References

Tables

Contributor Information and Disclosures

What would you like to print?