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Is Kikuchi–Fujimoto disease a manifestation of systemic lupus erythematosus?
A 32‐year‐old woman presented with fever and swelling in the axillae of 2 months’ duration, and erythema of the face, fluid‐filled lesions on the trunk, oral ulcers, crusting of the lips, and redness and watering of the eyes for 3 days. The patient was initially diagnosed with tuberculous lymphadeni...
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| Published in: | International journal of dermatology 2006-04, Vol.45 (4), p.454-456 |
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| creator | Rao, Gatha S. Vohra, Deepak Kuruvilla, Maria |
| description | A 32‐year‐old woman presented with fever and swelling in the axillae of 2 months’ duration, and erythema of the face, fluid‐filled lesions on the trunk, oral ulcers, crusting of the lips, and redness and watering of the eyes for 3 days. The patient was initially diagnosed with tuberculous lymphadenitis and was given antituberculous treatment. One month later, she developed the present complaints (see below). The patient was photosensitive. There was no joint pain or Raynaud’s phenomenon. She had experienced three intrauterine deaths in the past with no live births.
On examination, the patient was pale. Bilateral axillary lymphadenopathy was present. The lymph nodes were mobile, nontender, and not matted. Mucocutaneous examination revealed a malar eruption, flaccid bullae on the back (Fig. 1), crusting of the lips (Fig. 2), oral ulcers, and redness and discharge from the eyes. On investigation, immunoglobulin G (IgG), IgM, and IgA for tuberculosis were negative. There was anemia and leukopenia, the erythrocyte sedimentation rate (ESR) was raised, albumin in urine was positive, enzyme‐linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was negative, and venereal disease research laboratory (VDRL) test was nonreactive. Antinuclear antibody (ANA), dsDNA, and antiphospholipid antibody were positive.
1
Upper back showing erosions and postinflammatory hypopigmentation
2
Crusting of the lips
Fine needle aspiration cytology (FNAC) of the axillary lymph node showed loss of nodal architecture. The extensive infiltrate consisted of lymphocytes, histiocytes, immunoblasts, and necrosis of cortical and paracortical areas. There was histiocytic necrotizing lymphadenitis without granulocytic infiltration. These features were suggestive of Kikuchi–Fujimoto’s disease (Fig. 3). Skin biopsy showed epidermal atrophy, basal cell vacuolation, focal hyperkeratosis, pilosebaceous atrophy, and follicular plugging. The dermis showed edema and a lymphocytic infiltrate in the upper dermis and around the blood vessels. These features were suggestive of systemic lupus erythematosus (SLE). Direct immunofluorescence of lesional skin showed a strong continuous basement membrane zone (BMZ) band of C3 and fibrinogen and a strong discontinuous granular BMZ band of IgG. IgA was negative. Covered skin showed moderate and strong positivity for IgM and IgG, respectively. C3, IgA, and fibrinogen were negative. These findings were suggestive of SLE (Fig. 4).
3
Fine needle aspir |
| doi_str_mv | 10.1111/j.1365-4632.2004.02379.x |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67924630</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1039348051</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4249-4882763ff31c3fe6f7cf40eb05f66aaf39ef4d3aa36e8ea01bb5573aed3f50cc3</originalsourceid><addsrcrecordid>eNqNkM1u1DAQxy1ERZfCKyALCW4J_oqdHBBChcK2FVzgbHm9Y9UhH0smFt0b78Ab8iQ47IpKnOrLeDS_Gf31I4RyVvL8XrUll7oqlJaiFIypkglpmvL2AVn9GzwkK8Y4LxpWNafkMWKbWym4ekROudYV48asyKc10qv4Lfmb-Pvnr4vUxn6cR7qNCA6BOtq7IQbA2c1xHOgYKO5xhj562qVdQgrTfr6B3s0jJnzzhJwE1yE8PdYz8vXi_Zfzj8X15w_r87fXhVdCNYWqa2G0DEFyLwPoYHxQDDasClo7F2QDQW2lc1JDDY7xzaaqjHSwlaFi3ssz8vJwdzeN31OOZ_uIHrrODTAmtNo0IktgGXz-H9iOaRpyNiuEqI2omcxQfYD8NCJOEOxuir2b9pYzuwi3rV282sWrXYTbv8LtbV59dryfNj1s7xaPhjPw4gg49K4Lkxt8xDvOaK2ausrc6wP3I3awv3cAu758t_zkH62vnVk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>222872803</pqid></control><display><type>article</type><title>Is Kikuchi–Fujimoto disease a manifestation of systemic lupus erythematosus?</title><source>Wiley-Blackwell Journals</source><creator>Rao, Gatha S. ; Vohra, Deepak ; Kuruvilla, Maria</creator><creatorcontrib>Rao, Gatha S. ; Vohra, Deepak ; Kuruvilla, Maria</creatorcontrib><description>A 32‐year‐old woman presented with fever and swelling in the axillae of 2 months’ duration, and erythema of the face, fluid‐filled lesions on the trunk, oral ulcers, crusting of the lips, and redness and watering of the eyes for 3 days. The patient was initially diagnosed with tuberculous lymphadenitis and was given antituberculous treatment. One month later, she developed the present complaints (see below). The patient was photosensitive. There was no joint pain or Raynaud’s phenomenon. She had experienced three intrauterine deaths in the past with no live births.
On examination, the patient was pale. Bilateral axillary lymphadenopathy was present. The lymph nodes were mobile, nontender, and not matted. Mucocutaneous examination revealed a malar eruption, flaccid bullae on the back (Fig. 1), crusting of the lips (Fig. 2), oral ulcers, and redness and discharge from the eyes. On investigation, immunoglobulin G (IgG), IgM, and IgA for tuberculosis were negative. There was anemia and leukopenia, the erythrocyte sedimentation rate (ESR) was raised, albumin in urine was positive, enzyme‐linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was negative, and venereal disease research laboratory (VDRL) test was nonreactive. Antinuclear antibody (ANA), dsDNA, and antiphospholipid antibody were positive.
1
Upper back showing erosions and postinflammatory hypopigmentation
2
Crusting of the lips
Fine needle aspiration cytology (FNAC) of the axillary lymph node showed loss of nodal architecture. The extensive infiltrate consisted of lymphocytes, histiocytes, immunoblasts, and necrosis of cortical and paracortical areas. There was histiocytic necrotizing lymphadenitis without granulocytic infiltration. These features were suggestive of Kikuchi–Fujimoto’s disease (Fig. 3). Skin biopsy showed epidermal atrophy, basal cell vacuolation, focal hyperkeratosis, pilosebaceous atrophy, and follicular plugging. The dermis showed edema and a lymphocytic infiltrate in the upper dermis and around the blood vessels. These features were suggestive of systemic lupus erythematosus (SLE). Direct immunofluorescence of lesional skin showed a strong continuous basement membrane zone (BMZ) band of C3 and fibrinogen and a strong discontinuous granular BMZ band of IgG. IgA was negative. Covered skin showed moderate and strong positivity for IgM and IgG, respectively. C3, IgA, and fibrinogen were negative. These findings were suggestive of SLE (Fig. 4).
3
Fine needle aspiration cytology of the axillary lymph node (hemotoxylin and eosin, ×40)
4
Direct immunofluorescence study showing evidence of systemic lupus erythematosus (fluorescein stain)
Based on the clinical findings and investigations, a diagnosis of Kikuchi–Fujimoto’s disease with SLE was made.</description><identifier>ISSN: 0011-9059</identifier><identifier>EISSN: 1365-4632</identifier><identifier>DOI: 10.1111/j.1365-4632.2004.02379.x</identifier><identifier>PMID: 16650177</identifier><identifier>CODEN: IJDEBB</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Antibodies, Antinuclear - blood ; Antibodies, Antiphospholipid - blood ; Biological and medical sciences ; Biopsy, Fine-Needle ; Complement C3 - analysis ; Dermatology ; DNA - immunology ; Female ; Histiocytic Necrotizing Lymphadenitis - diagnosis ; Humans ; Immunoglobulin G - analysis ; Immunoglobulin M - analysis ; Lupus Erythematosus, Systemic - diagnosis ; Lymph Nodes - pathology ; Medical sciences ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Skin - pathology</subject><ispartof>International journal of dermatology, 2006-04, Vol.45 (4), p.454-456</ispartof><rights>2006 INIST-CNRS</rights><rights>Copyright Blackwell Publishing Apr 2006</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4249-4882763ff31c3fe6f7cf40eb05f66aaf39ef4d3aa36e8ea01bb5573aed3f50cc3</citedby><cites>FETCH-LOGICAL-c4249-4882763ff31c3fe6f7cf40eb05f66aaf39ef4d3aa36e8ea01bb5573aed3f50cc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-4632.2004.02379.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-4632.2004.02379.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17664985$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16650177$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rao, Gatha S.</creatorcontrib><creatorcontrib>Vohra, Deepak</creatorcontrib><creatorcontrib>Kuruvilla, Maria</creatorcontrib><title>Is Kikuchi–Fujimoto disease a manifestation of systemic lupus erythematosus?</title><title>International journal of dermatology</title><addtitle>Int J Dermatol</addtitle><description>A 32‐year‐old woman presented with fever and swelling in the axillae of 2 months’ duration, and erythema of the face, fluid‐filled lesions on the trunk, oral ulcers, crusting of the lips, and redness and watering of the eyes for 3 days. The patient was initially diagnosed with tuberculous lymphadenitis and was given antituberculous treatment. One month later, she developed the present complaints (see below). The patient was photosensitive. There was no joint pain or Raynaud’s phenomenon. She had experienced three intrauterine deaths in the past with no live births.
On examination, the patient was pale. Bilateral axillary lymphadenopathy was present. The lymph nodes were mobile, nontender, and not matted. Mucocutaneous examination revealed a malar eruption, flaccid bullae on the back (Fig. 1), crusting of the lips (Fig. 2), oral ulcers, and redness and discharge from the eyes. On investigation, immunoglobulin G (IgG), IgM, and IgA for tuberculosis were negative. There was anemia and leukopenia, the erythrocyte sedimentation rate (ESR) was raised, albumin in urine was positive, enzyme‐linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was negative, and venereal disease research laboratory (VDRL) test was nonreactive. Antinuclear antibody (ANA), dsDNA, and antiphospholipid antibody were positive.
1
Upper back showing erosions and postinflammatory hypopigmentation
2
Crusting of the lips
Fine needle aspiration cytology (FNAC) of the axillary lymph node showed loss of nodal architecture. The extensive infiltrate consisted of lymphocytes, histiocytes, immunoblasts, and necrosis of cortical and paracortical areas. There was histiocytic necrotizing lymphadenitis without granulocytic infiltration. These features were suggestive of Kikuchi–Fujimoto’s disease (Fig. 3). Skin biopsy showed epidermal atrophy, basal cell vacuolation, focal hyperkeratosis, pilosebaceous atrophy, and follicular plugging. The dermis showed edema and a lymphocytic infiltrate in the upper dermis and around the blood vessels. These features were suggestive of systemic lupus erythematosus (SLE). Direct immunofluorescence of lesional skin showed a strong continuous basement membrane zone (BMZ) band of C3 and fibrinogen and a strong discontinuous granular BMZ band of IgG. IgA was negative. Covered skin showed moderate and strong positivity for IgM and IgG, respectively. C3, IgA, and fibrinogen were negative. These findings were suggestive of SLE (Fig. 4).
3
Fine needle aspiration cytology of the axillary lymph node (hemotoxylin and eosin, ×40)
4
Direct immunofluorescence study showing evidence of systemic lupus erythematosus (fluorescein stain)
Based on the clinical findings and investigations, a diagnosis of Kikuchi–Fujimoto’s disease with SLE was made.</description><subject>Adult</subject><subject>Antibodies, Antinuclear - blood</subject><subject>Antibodies, Antiphospholipid - blood</subject><subject>Biological and medical sciences</subject><subject>Biopsy, Fine-Needle</subject><subject>Complement C3 - analysis</subject><subject>Dermatology</subject><subject>DNA - immunology</subject><subject>Female</subject><subject>Histiocytic Necrotizing Lymphadenitis - diagnosis</subject><subject>Humans</subject><subject>Immunoglobulin G - analysis</subject><subject>Immunoglobulin M - analysis</subject><subject>Lupus Erythematosus, Systemic - diagnosis</subject><subject>Lymph Nodes - pathology</subject><subject>Medical sciences</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Skin - pathology</subject><issn>0011-9059</issn><issn>1365-4632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><recordid>eNqNkM1u1DAQxy1ERZfCKyALCW4J_oqdHBBChcK2FVzgbHm9Y9UhH0smFt0b78Ab8iQ47IpKnOrLeDS_Gf31I4RyVvL8XrUll7oqlJaiFIypkglpmvL2AVn9GzwkK8Y4LxpWNafkMWKbWym4ekROudYV48asyKc10qv4Lfmb-Pvnr4vUxn6cR7qNCA6BOtq7IQbA2c1xHOgYKO5xhj562qVdQgrTfr6B3s0jJnzzhJwE1yE8PdYz8vXi_Zfzj8X15w_r87fXhVdCNYWqa2G0DEFyLwPoYHxQDDasClo7F2QDQW2lc1JDDY7xzaaqjHSwlaFi3ssz8vJwdzeN31OOZ_uIHrrODTAmtNo0IktgGXz-H9iOaRpyNiuEqI2omcxQfYD8NCJOEOxuir2b9pYzuwi3rV282sWrXYTbv8LtbV59dryfNj1s7xaPhjPw4gg49K4Lkxt8xDvOaK2ausrc6wP3I3awv3cAu758t_zkH62vnVk</recordid><startdate>200604</startdate><enddate>200604</enddate><creator>Rao, Gatha S.</creator><creator>Vohra, Deepak</creator><creator>Kuruvilla, Maria</creator><general>Blackwell Publishing Ltd</general><general>Blackwell Science</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>200604</creationdate><title>Is Kikuchi–Fujimoto disease a manifestation of systemic lupus erythematosus?</title><author>Rao, Gatha S. ; Vohra, Deepak ; Kuruvilla, Maria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4249-4882763ff31c3fe6f7cf40eb05f66aaf39ef4d3aa36e8ea01bb5573aed3f50cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adult</topic><topic>Antibodies, Antinuclear - blood</topic><topic>Antibodies, Antiphospholipid - blood</topic><topic>Biological and medical sciences</topic><topic>Biopsy, Fine-Needle</topic><topic>Complement C3 - analysis</topic><topic>Dermatology</topic><topic>DNA - immunology</topic><topic>Female</topic><topic>Histiocytic Necrotizing Lymphadenitis - diagnosis</topic><topic>Humans</topic><topic>Immunoglobulin G - analysis</topic><topic>Immunoglobulin M - analysis</topic><topic>Lupus Erythematosus, Systemic - diagnosis</topic><topic>Lymph Nodes - pathology</topic><topic>Medical sciences</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Skin - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rao, Gatha S.</creatorcontrib><creatorcontrib>Vohra, Deepak</creatorcontrib><creatorcontrib>Kuruvilla, Maria</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of dermatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rao, Gatha S.</au><au>Vohra, Deepak</au><au>Kuruvilla, Maria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is Kikuchi–Fujimoto disease a manifestation of systemic lupus erythematosus?</atitle><jtitle>International journal of dermatology</jtitle><addtitle>Int J Dermatol</addtitle><date>2006-04</date><risdate>2006</risdate><volume>45</volume><issue>4</issue><spage>454</spage><epage>456</epage><pages>454-456</pages><issn>0011-9059</issn><eissn>1365-4632</eissn><coden>IJDEBB</coden><notes>ObjectType-Case Study-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-4</notes><notes>content type line 23</notes><notes>ObjectType-Report-1</notes><notes>ObjectType-Article-3</notes><abstract>A 32‐year‐old woman presented with fever and swelling in the axillae of 2 months’ duration, and erythema of the face, fluid‐filled lesions on the trunk, oral ulcers, crusting of the lips, and redness and watering of the eyes for 3 days. The patient was initially diagnosed with tuberculous lymphadenitis and was given antituberculous treatment. One month later, she developed the present complaints (see below). The patient was photosensitive. There was no joint pain or Raynaud’s phenomenon. She had experienced three intrauterine deaths in the past with no live births.
On examination, the patient was pale. Bilateral axillary lymphadenopathy was present. The lymph nodes were mobile, nontender, and not matted. Mucocutaneous examination revealed a malar eruption, flaccid bullae on the back (Fig. 1), crusting of the lips (Fig. 2), oral ulcers, and redness and discharge from the eyes. On investigation, immunoglobulin G (IgG), IgM, and IgA for tuberculosis were negative. There was anemia and leukopenia, the erythrocyte sedimentation rate (ESR) was raised, albumin in urine was positive, enzyme‐linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was negative, and venereal disease research laboratory (VDRL) test was nonreactive. Antinuclear antibody (ANA), dsDNA, and antiphospholipid antibody were positive.
1
Upper back showing erosions and postinflammatory hypopigmentation
2
Crusting of the lips
Fine needle aspiration cytology (FNAC) of the axillary lymph node showed loss of nodal architecture. The extensive infiltrate consisted of lymphocytes, histiocytes, immunoblasts, and necrosis of cortical and paracortical areas. There was histiocytic necrotizing lymphadenitis without granulocytic infiltration. These features were suggestive of Kikuchi–Fujimoto’s disease (Fig. 3). Skin biopsy showed epidermal atrophy, basal cell vacuolation, focal hyperkeratosis, pilosebaceous atrophy, and follicular plugging. The dermis showed edema and a lymphocytic infiltrate in the upper dermis and around the blood vessels. These features were suggestive of systemic lupus erythematosus (SLE). Direct immunofluorescence of lesional skin showed a strong continuous basement membrane zone (BMZ) band of C3 and fibrinogen and a strong discontinuous granular BMZ band of IgG. IgA was negative. Covered skin showed moderate and strong positivity for IgM and IgG, respectively. C3, IgA, and fibrinogen were negative. These findings were suggestive of SLE (Fig. 4).
3
Fine needle aspiration cytology of the axillary lymph node (hemotoxylin and eosin, ×40)
4
Direct immunofluorescence study showing evidence of systemic lupus erythematosus (fluorescein stain)
Based on the clinical findings and investigations, a diagnosis of Kikuchi–Fujimoto’s disease with SLE was made.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>16650177</pmid><doi>10.1111/j.1365-4632.2004.02379.x</doi><tpages>3</tpages></addata></record> |
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| ispartof | International journal of dermatology, 2006-04, Vol.45 (4), p.454-456 |
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| subjects | Adult Antibodies, Antinuclear - blood Antibodies, Antiphospholipid - blood Biological and medical sciences Biopsy, Fine-Needle Complement C3 - analysis Dermatology DNA - immunology Female Histiocytic Necrotizing Lymphadenitis - diagnosis Humans Immunoglobulin G - analysis Immunoglobulin M - analysis Lupus Erythematosus, Systemic - diagnosis Lymph Nodes - pathology Medical sciences Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Skin - pathology |
| title | Is Kikuchi–Fujimoto disease a manifestation of systemic lupus erythematosus? |
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