Kikuchi-Fujimoto Disease: Three Cases Presenting as Acute Abdomen

Oh, Bum Jin; Choi, Wook Jin; Lim, Kyoung Soo; Kim, Won

Abstract

Kikuchi-Fujimoto disease is known as a benign disorder, affecting predilection for cervical lymphadenopathy. The disease is now recognized that can affect patients of any age, gender and can involve any anatomic sites. But, few cases presenting as an acute abdomen have been reported. In a university hospital, three patients of Kikuchi- Fujimoto disease presented as acute abdomen and diagnosed by surgically during the period from April 1998 to February 2004. All three patients, two man and one woman, aged 12 to 27 years, complained abdominal pain for 4 to 20 days. They had fever (in three patients), right lower quadrant tenderness (three), decreased bowel sound (three), anorexia (two), abdominal indirect tenderness (one), but there was no cervical or axillary lymphadenopathy. Abdomino-pelvic computed tomography showed multiple lymphadenopathy in peritoneum (three), periappendiceal fat infiltrations with small amount of ascites (one). Laboratory data showed no markedly increased leukocyte (3,400-6,400 mm(-3)), serum amylase level (47-98 U/L) or serum C-reactive protein concentration (0.8-2.03 mg/dL). Other specific studies revealed negative including tuberculosis infection, lymphoma, Yersinia infection. Laparoscopic operation (two) and open laparotomy (one) were performed. The size of excised lymph nodes in greatest dimension ranged from 1.0 to 7 cm. Histologic features was the presence of pale nodular lymphohistiocytic foci with coagulation necrosis and absence of granulocytic infiltration. All the patients discharged without any surgical complication and no recurrent abdominal symptom. Our study emphasizes that Kikuchi-Fujimoto disease could be considered as one of the differential diagnoses in patients with prolonged fever and suspicious acute abdomen.