Kikuchi—Fujimoto disease with involvement of the mesenteric lymph nodes: A case report

Background. Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is characterized primarily by regional benign lymphadenopathy. The disease can occur at any age; however, it is more commonly observed in individuals aged 30–40. The exact etiology of the disease remains elusive. The cervical lymph nodes appear most frequently affected, while involvement of other lymph node groups is exceedingly rare. Diagnosis is confirmed through histological and immunohistochemical analysis of lymph node biopsy specimens. The differential diagnosis of Kikuchi-Fujimoto disease includes infectious lymphadenitis of various etiologies, autoimmune disorders, and lymphomas. A lymphadenopathy generally obtains favorable prognosis. Treatment primarily involves symptomatic therapy and, rarely, glucocorticosteroids.

A case report. The paper presents a clinical case of Kikuchi-Fujimoto disease in an 11-year-old girl with involvement of the mesenteric lymph nodes. The girl was hospitalized with the abdominal pain syndrome. Due to suspicion of acute appendicitis, a diagnostic laparoscopy was performed, revealing a conglomerate of enlarged mesenteric lymph nodes. Initial histological analysis of the lymph node biopsy suggested Hodgkin lymphoma. However, as the patient exhibited no typical clinical manifestations of lymphoma, a review of the biopsy material was conducted, leading to the diagnosis of Kikuchi-Fujimoto disease. Over six months following the discharge from the surgical department, the patient’s condition remained satisfactory, with no recurrence of abdominal pain syndrome and no new symptoms noted. Continued follow-up with a hematologist was recommended.

Conclusion. The presented clinical case illustrates the complexity of diagnosing a very rare form of lymphadenopathy due to the lack of experience in managing such patients and the specific histological features observed in the lymph node biopsy. At the clinic the patient presented an isolated lymphadenopathy of the mesenteric lymph nodes, while systemic inflammatory response, weight loss, hepatosplenomegaly, and alterations in peripheral blood analysis remained absent. Consequently, the diagnosis of Hodgkin lymphoma was questioned, thereby preventing unnecessary and aggressive treatment from being conducted.

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