A white man with Kikuchi-Fujimoto disease mimicking lymphoma, preceded by frequent episodes of tonsillitis: a case report

Agata Szczurowska, Tomasz Pawlowski, Agnieszka Halon, Anna Skoczynska

Kikuchi-Fujimoto disease is a very rare cause of benign lymphadenopathy affecting mainly young Asiatic females. Little is known about the causative agent of Kikuchi-Fujimoto disease; however, there are hypotheses of infectious, autoimmune, or hyperimmune background of the disease that have not yet been confirmed in the conducted studies. Frequent episodes of tonsillitis preceding the onset of Kikuchi-Fujimoto disease have not been described as yet. A 23-year-old white man with a history of over 20 episodes of tonsillitis in the preceding 2 years was admitted to our hospital because of cervical unilateral lymphadenopathy, fever, night sweating, weight loss, and fatigue. On admission, slight tenderness of cervical lymph nodes and asymmetric palate tonsil enlargement were noted. Owing to the patient's general symptoms and history of malignancy in his close family, a malignant disease such as lymphoma was suspected. Histopathological examination of the excised lymph node revealed areas of coagulative necrosis with abundant karyorrhectic debris, with histiocytes and lymphocytes observed at the margins of the necrotic areas. The microscopic examination led to an unexpected diagnosis of Kikuchi-Fujimoto disease. The patient was treated symptomatically. All of the patient's symptoms, excluding tonsil enlargement, retreated within 2 months. In the differential diagnosis of cervical lymphadenopathy in patients with frequent episodes of tonsillitis, Kikuchi-Fujimoto disease should be taken into account. Kikuchi-Fujimoto disease may convincingly mimic symptoms characteristic of lymphoma.