Kikuchi-Fujimoto disease: immediate remission with ciprofloxacin

An 18-year-old, human immunodeficiency virus (HIV)-negative, male patient was referred for dermatologic opinion for reactive hyperplasia of the cervical lymph nodes on fine needle aspiration cytology. History revealed multiple, painful, progressively enlarging, left cervical lymph nodes associated with episodes of moderate to high fever for more than 1 year. There was no history of previous cutaneous lesions. On examination, the patient was afebrile and showed three left supraclavicular lymph nodes, 2-4 cm in size, which were discrete, tender, of firm to hard consistency but with normal overlying skin. Cutaneous and systemic examination was normal. Hemogram, hepatorenal function, and chest X-ray film showed no significant abnormality, and the Mantoux test was negative. With the clinical possibilities of lymphoma, sarcoidosis, or tubercular lymphadenitis, one of the excised lymph nodes was subjected to histopathologic examination and acid-fast bacilli (AFB) culture. The patient was given ciprofloxacin, 500 mg orally twice daily. The histopathology report became available 1 week later and showed a thickened capsule infiltrated by chronic inflammatory cells. There were large areas of necrosis with nuclear debris palisaded by histiocytes and a peripheral rim of lymphocytes. Occasional vessels also showed fibrinoid necrosis. Features of lymphoma, sarcoidosis, and tuberculosis were absent and the stain for AFB was negative. Despite the histopathology, suggesting histiocytic necrotizing lymphadenitis, tests performed for antinuclear antibodies were negative. Culture of the lymph node specimen on Lowenstien Jensen (LJ) medium for AFB did not show any growth. After 10 days of treatment with ciprofloxacin, the patient showed complete regression of lymphadenopathy. He is being regularly followed up.