Arthritis as an unusual manifestation of Kikuchi-Fujimoto disease

SIR, The cases are described of two young women presenting witharthritis, who were diagnosed with Kikuchi-Fujimoto disease(KFD; also called histiocytic necrotizing lymphadenitis). Arthritis has been described previously in patients in whomKFD is associated with other autoimmune disease, such as adultStill's disease and systemic lupus erythematosus (SLE). In ourpatients there was no evidence of coexistent autoimmune disease.To our knowledge, this is the first report of arthritis as apresentation of isolated KFD. We discuss the typical clinicalfeatures of KFD, its aetiology, associations and treatment. Case 1 (NM) was a 36-yr-old woman who recently immigrated toAustralia from Sri Lanka. She had undergone microdiscectomyfor left sciatic pain in Sri Lanka 6 months previously, andtook occasional paracetamol for residual pain. She was otherwisewell. NM was seen by her local doctor for worsening back pain.She displayed no     

Mycobacterium bohemicum--a cause of paediatric cervical lymphadenitis

We report on two toddlers suffering from Mycobacterium bohemicum lymphadenitis. Acid-fast bacilli were cultured from submandibular lymph nodes and identified by molecular methods as Mycobacterium bohemicum. Surgical treatment was successful and complemented by oral treatment with clarithromycin and rifampicin.     

Kikuchi-Fujimoto disease: an unusual association with acute renal failure

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis of unknown etiopathogenesis, is a self-limited disease which frequently appears as feverish lymphadenomegaly, thus creating the need for differential diagnosis with lymphoma, systemic lupus erythematosus (SLE), infectious mononucleosis, cat-scratch disease, and toxoplasmosis with lymphonodal impairment. However, there are cases in which it may evolve with complications such as aseptic meningitis, cerebellar ataxia, and aseptic myocarditis. We are presenting a case of a 24-year-old man who had an initial picture of arthralgia, evening fever and adenomegaly. Kikuchi disease was diagnosed through lymph node biopsy with immunohistochemistry and evolves with severe systemic manifestations, such as pericarditis with cardiac tamponade, pneumonitis, hepatitis, and acute kidney failure - the latter has not been reported in literature yet. There was significant improvement of the clinical picture with prednisone.     

An unusual cause of carcinoid heart disease

Carcinoid heart disease (CHD) is a rare form of valvular heart disease characterized by right-sided heart valve dysfunction. Carcinoid heart disease occurs most frequently when carcinoid tumour cells metastasize from a primary site in the gut to the liver, so that vasoactive substances produced by the tumour are able to reach the systemic circulation. By contrast, in ovarian carcinoid tumours carcinoid heart disease develops in the absence of liver metastasis, because vasoactive substances can be released directly into the systemic circulation, bypassing the first-pass metabolism of the liver. There are only a few case reports in the world literature of carcinoid heart disease caused by ovarian carcinoid tumour. We report a case of an 85-year-old woman with carcinoid heart disease caused by a bilateral ovarian carcinoid tumour metastasized from a primary ileal site.     

Bilateral anterior uveitis as an unusual manifestation of Kikuchi-Fujimoto disease

SIR, Kikuchi–Fujimoto disease (KFD) is a subacute necrotizinglymphadenitis of unknown origin and is usually a self-limitedcause of fever and lymph node enlargement [1]. KFD may be associatedwith a wide spectrum of immune diseases, such as polymyositis[2], systemic lupus erythematosus [3], arthritis [4] and uveitis[5]. However, as far as we are aware the simultaneous developmentof KFD and uveitis has not been reported. Here, we present thefirst case of KFD involving the     

Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis). Case study and a literature review

Kikuchi-Fujimoto disease is a rare feverish disease characterised by lymphadenopathy, the most frequently cervical, exanthem, arthralgias and arthritis. It affects especially young women. Patients have high erythrocyte sedimentation rate (ES) and leucopenia, antibodies are missing. Course of the disease is usually very benign and can subside spontaneously. However, clinical picture is usually very dramatic and can suggest infectious, autoimmune or malign systemic disease; also association with some of autoimmune diseases was described. Its occurrence is sporadic in all the world, the most of cases were seen in Asia, in the Czech Republic it has not been yet described. Therapy consists in antibiotics administration followed with corticoid therapy and usually can restore patients to perfect health. However, exacerbations have also been described. We describe a case of a 60 year old man, a past top sportsman, who has never been seriously ill except sport traumas and prosthesis implantation for coxarthritis reasons. The last two years he has suffered from exanthem and leucopenia of an unclear origin. In May 2002 he become feverish and arthritis, lymphadenopathy, splenomegalia and exanthem progression, high ES rate and high serum level of C-reactive protein (CRP) appeared in him. His condition was first evaluated as septic condition (founded staphylococci in two blood cultures), however, cause of potential sepsis has not been identified. The patient was treated with antibiotics with improvement of his total health condition after second treatment regiment. A neck node biopsy was done because of suspicion on lymphoprolipherative disease and histiocytic necrotizing lymphadenitis of Kikuchi type was found. Autoantibodies assessment was completely negative. After antibiotic and corticoid therapies his clinical condition quite quickly standardized and ES rate and serum CPR level decreased. 4 month after lowering the dose of prednisolon a temporary exacerbation of the disease appeared and again disappeared after increasing the dose of corticoid.     

Heart failure: An unusual cause

Renal artery aneurysms are uncommon and are usually detected when renal angiography is performed for other indications. Less often, they may present with loin pain, hematuria, renovascular hypertension, and a palpable mass. Renal artery aneurysms larger than 1.0 cm presenting with resistant hypertension and all aneurysms larger than 2.0 cm are the usual indications for surgical intervention. The most important indications for surgical repair appear to be the presence of concurrent hypertension and female gender (because of the higher chances of catastrophic rupture of the aneurysm during pregnancy). Surgery may result in better control of hypertension in some cases. In this report, we highlight a rare case of a huge aneurysm of the left renal artery presenting with resistant renovascular hypertension and heart failure. Aneurysmectomy, followed by repair of the renal artery, resulted in good control of heart failure and hypertension.     

Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease) associated with antiphospholipid syndrome: case report and literature review

Histiocytic necrotizing lymphadenitis (HNL), or Kikuchi-Fujimoto disease, is a benign, self-limited disease that predominantly occurs in women. The etiology remains undetermined, although a viral or autoimmune hypothesis has been suggested. The disease usually emerges with cervical lymphadenopathy with or without fever. The diagnosis can be confirmed only by histological findings of lymph node biopsy, characterized by necrosis and histiocytic infiltration without neutrophils. We report a case of a 28-year-old woman with a medical history of two episodes of unexplained pulmonary embolisms (3 and 2 years previously) who was admitted to our hospital because of unilateral cervical lymphadenopathy and mild fever that presented 1 week before admission. A diagnosis of HNL was performed by lymph node biopsy. In parallel, whereas the laboratory tests for inherited thrombophilia were negative, a progressive elevated titer of anti-beta(2) glycoprotein I (GPI) antibodies was established. Because of persistent fever, the patient received a short course of corticosteroid therapy and she recovered completely from the HNL after 2 months. It is noteworthy that to date the patient has displayed an elevated titer of anti-beta(2) GPI antibodies (18 months after the recovery from the HNL). Thus, considering the previous history of venous thrombosis and the presence of antiphospholipid antibodies, the diagnosis of primary antiphospholipid syndrome associated with HNL was made. To our knowledge, this is the first report in the literature describing antiphospholipid syndrome associated with HNL. Moreover, a brief literature review is provided with emphasis on the etiology, clinical course, and pathogenesis of this rare disease entity.     

An unusual cause of hematemesis： Goiter

INTRODUCTIONBleeding from distal esophageal varices is a frequent complication of portal hypertension. The portal blood drains into the superior vena cava by gastric and esophageal collaterals, also called uphill varices, referring to the upward direction…     

An unusual cause of syncope

We present an unusual cause for syncope that was initially thought to be due to drug therapy. Further investigations revealed the cause to be secondary to hypoadrenalism from a primary breast tumour. This case highlights the importance of arriving at the right diagnosis as signs and symptoms of adrenal insufficiency can mimic other conditions. Appropriate treatment also improves quality of life.