Kikuchi Fujimoto disease secondary to Entamoeba histolytica: case report.

Kikuchi Fujimoto disease (KFD) is a rare histiocytic necrotizing lymphadenitis which has a benign self-limiting clinical course. Its origin is unknown, but an abnormal autoimmune reaction has been suggested and infection is often considered to be an inciting agent. A 50-year-old man presented with fever, malaise, fatigue and sweat of 7 days duration, and diarrhea for 2 days. Physical examination revealed five mobile and painless cervical adenopathies. Entamoeba histolytica trophozoites and cysts were detected by microscopy of feces. Parenteral ornidazole treatment was commenced. Thorax computerized tomography showed lymph node sizes congruent with infection in the mediastinum, right hilus and right axillary region. Axillary lymph node biopsy and immunohistochemical analyses were then performed, and the results were consistent with histiocytic necrotizing lymphadenitis. From day 4 of antibiotic treatment the patient's body temperature decreased and reached a normal level on day 10. After discharge the patient returned for follow-up twice and was asymptomatic; his lymph nodes were either unpalpable or were decreased in size. We could not find any previous study or case report about a probable role for E. histolytica. Amebiasis can be a triggering factor in KFD or alternatively it is possible that its occurrence is coincidental.

Giardia lamblia intestinalis: a new pathogen with possible link to Kikuchi-Fujimoto disease. An additional element in the disease jigsaw.

A 16-year-old Caucasian girl of Albanian origin was admitted to the hospital complaining of intermittent fever (38 degrees C) for a week, nausea, vomiting, and abnormal laboratory findings (elevated serum aminotransferases levels AST/ALT 77/40 U/l and erythrocyte sedimentation rate 80 mm/first hour, as well as leukopenia 2.5 x 10(3)/mm3), which were found in a blood examination. Physical examination revealed slight hepatomegaly and splenomegaly, as well as cervical and axillary lymphadenopathy. A diagnostic open lymph node biopsy was performed and Kikuchi-Fujimoto disease (KFD) was established based on the characteristic histological pattern. Other abnormal laboratory findings were C-reactive protein 6.8 mg/dl and serum lactate dehydrogenase 900 U/l. Her history included a diarrhoea syndrome 2 months before the present admission, during the summer holidays, for which she was treated with metronidazole. At that time, characteristic cysts of giardia lamblia intestinalis were observed in the stools. Herein, we present this case hypothesising that the protozoal infection caused by the giardia lamblia intestinalis was probably triggering an immune response leading to KFD. The patient's age in combination with this firstly reported protozoal pathogen, as a triggering agent leading to KFD, consist a very interesting originality. Additionally, some review data is also given.