Management challenges of kikuchi-fujimoto disease mimicking tuberculous lymphadenopathy: an evidence-based case report

Abstract

A 27-year-old man presented with a tender left inguinal mass, fever, productive cough, anorexia, and weight loss. Laboratory findings showed leukocytosis, lymphocytopenia, and elevated ESR. Chest X-ray suggested pulmonary tuberculosis; however, GeneXpert and HIV tests were negative. Due to suspected tuberculous lymphadenitis, empirical antibiotics were administered and an excisional biopsy was performed. Histopathological examination revealed necrotizing histiocytic lymphadenitis consistent with Kikuchi–Fujimoto Disease which is rare but an important differential diagnosis. An evidence-based review was conducted to compare supportive management with aggressive pharmacological therapy in Kikuchi–Fujimoto Disease initially suspected as tuberculous lymphadenitis. Of 152 identified records, eight case-based studies met inclusion criteria after systematic screening and critical appraisal using the Joanna Briggs Institute tool. Empirical anti-tuberculosis therapy in Kikuchi–Fujimoto Disease may delay appropriate management due to lack of clinical improvement. Early tuberculosis testing and histopathological confirmation are essential to avoid misdiagnosis and unnecessary exposure to potentially toxic anti-tuberculosis therapy.Excisional biopsy is crucial for definitive diagnosis. Kikuchi–Fujimoto Disease generally responds well to supportive treatment with NSAIDs or corticosteroids, and empirical anti-tuberculosis therapy should be avoided without histopathological confirmation.