Fever, lymphadenopathy, and a diagnostic dilemma: a case of Kikuchi-Fujimoto disease masquerading as tuberculosis in a diabetic patient.
Chirag Bhojwani, Anirudh Jeedigunta, Shivam Thaker et al.
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Case in brief
A middle-aged man with diabetes from South India presented with prolonged fever, substantial weight loss, and generalized lymphadenopathy. Leukopenia, markedly raised inflammatory markers, and a moderately positive antinuclear antibody raised concern for systemic lupus erythematosus, while tuberculosis was also considered. Extensive infectious testing, including tuberculosis studies, was negative. Lymph node biopsy showed necrotizing lymphadenitis with karyorrhectic debris and crescentic histiocytes, without caseating granulomas or hematoxylin bodies, establishing Kikuchi-Fujimoto disease. The report describes the disease as self-limiting and emphasizes accurate diagnosis to avoid inappropriate antitubercular treatment.
What made this case unusual
The moderately positive antinuclear antibody added an autoimmune diagnostic complication in a case that clinically raised concern for tuberculosis; the report also highlights autoimmune serological markers as an emerging association with Kikuchi-Fujimoto disease.
Diagnostic / clinical pearl
In a patient with fever and lymphadenopathy, negative tuberculosis testing does not settle the diagnosis; lymph node biopsy can distinguish Kikuchi-Fujimoto disease from tuberculosis and other mimics.
Why it matters
Recognizing the biopsy pattern can help prevent misclassification as tuberculosis and avoid inappropriate antitubercular therapy.