In their case report of a patient with Kikuchi’s disease Dr Chung and colleagues (July 2004 JRSM1) refer to reported associations with systemic lupus erythematosus, Hashimoto’s thyroiditis and infection with toxoplasmosis, Yersinia enterocolitica and herpesvirus 6. Kikuchi’s disease has also been associated with four other autoimmune diseases—polymyositis,2 mixed connective tissue disease,3 adult and juvenile onset Still’s disease4 and the antiphospholipid syndrome.5 In addition cases have been linked with breast and gastric malignancy6,7 and infections with Epstein–Barr virus, parvovirus B19 and herpesvirus 8.8–10
As Chung et al. state, a viral aetiology has been suggested but never satisfactorily proven. Given the variety of disease associations, it is possible that Kikuchi’s disease represents an unusual response of histiocytes and T-cells to a range of local or systemic immune stimuli, including both foreign and self antigens.
References
- 1.Chung TT, Chowdhury N, Piper K, Chowdhury TA. Pyrexia and lymphadenopathy in a south Asian woman. J R Soc Med 2004;97: 336–8 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wilkinson CE, Nichol F. Kikuchi-Fujimoto disease associated with polymyositis. Rheumatology 2000;39: 1302–4 [DOI] [PubMed] [Google Scholar]
- 3.Aqel NM, Amr SS, Najjar MM, Henry K. Kikuchi’s lymphadenitis developing in a patient with mixed connective tissue disease and Hashimoto’s thyroiditis. Br J Rheumatol 1997;36: 1236–8 [DOI] [PubMed] [Google Scholar]
- 4.Ohta A, Matsumoto M, Ohta T, et al. Still’s disease associated with necrotizing lymphadenitis (Kikuchi’s disease): reports of 3 cases. J Rheumatol 1988;15: 981–3 [PubMed] [Google Scholar]
- 5.Papaiouannou G, Speletas M, Kalousi V, Pavtilou-Tsiontsi A. Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease) associated with antiphospholipid syndrome: case report and literature review. Ann Haematol 2002;81: 732. [DOI] [PubMed] [Google Scholar]
- 6.Aqel NM, Al-Sewan M, Collier DS. Kikuchi’s disease in axillary lymph nodes draining breast carcinoma. Histopathology 2000;36: 280–1 [DOI] [PubMed] [Google Scholar]
- 7.Radhi JM, Shinnider L, McFadden A. Kikuchi’s lymphadenitis and carcinoma of the stomach. J Clin Pathol 1997;50: 530–1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Yen A, Fearneyhough P, Raimer SS, Hudnall SD. EBV-associated Kikuchi’s histiocytic necrotizing lymphadenitis with cutaneous manifestations. J Am Acad Dermatol 1997;36: 342–6 [DOI] [PubMed] [Google Scholar]
- 9.Yufu Y, Matsumoto M, Miyamura T, Nishimura J, Nawata H, Oshima K. Parvovirus B 19-associated haemophagocytic syndrome with lymphadenopathy resembling histiocytic necrotizing lymphadenitis (Kikuchi’s disease). Br J Haematol 1997;96: 868–71 [DOI] [PubMed] [Google Scholar]
- 10.Huh J, Kang GH, Gong G, Kim SS, Ro JY, Kim CW. Kaposi’s sarcoma-associated herpesvirus in Kikuchi’s disease. Hum Pathol 1998; 29: 1091–6 [DOI] [PubMed] [Google Scholar]