Histiocytic necrotizing lymphadenitis and tuberculous lymphadenitis in an HIV patient

Introduction: In an HIV patient presenting with cervical lymphadenopathy, a number of differential diagnoses can be considered. This is a first case report showing the co-occurrence of HIV, tuberculous lymphadenitis and Kikuchi-Fujimoto disease.

Presentation of Case: A 37-year-old male presented with a two-week history of fever, chills, weight loss, anorexia and multiple palpable cervical lymph nodes on physical examination. Diagnostic workup revealed the patient having Acquired Immune Deficiency Syndrome. Lymph node biopsy was positive for MTB PCR and Kikuchi Fujimoto's Lymphadenitis (Necrotizing Histiocytic Lymphadenitis).

Discussion: Kikuchi-Fujimoto disease is a rare, benign condition of unknown cause usually characterized by cervical lymphadenopathy with fever and night sweats. It is generally diagnosed on the basis of an excision biopsy, and histopathology differentiates it from similar conditions. Several cases have been reported of Kikuchi-disease and tuberculous adenitis co-existing in the same patient. Other cases also report Kikuchi-disease in HIV-positive patients.

Conclusion: It is still unclear whether tuberculosis caused the immune response resulting to Kikuchi-Fujimoto disease, or the co-existence of the two diseases is coincidental. The co-occurrence of HIV, tuberculous lymphadenitis, and Kikuchi-Fujimoto disease has not yet been reported in literature, and this will be the first case showing the co-existence of the three disease entities.