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Kikuchi–Fujimoto disease after allogeneic hematopoietic SCT mimicking post transplant lymphoproliferative disorder

Bone Marrow Transplantation volume 46, pages 1389–1390 (2011)Cite this article

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Post transplant lymphoproliferative disorders (PTLDs) comprise a heterogenous group of diseases featuring lymphoid proliferations, which have been a well-recognized complication of solid organ and hematopoietic SCT (HSCT) and should be one of the distinguishing characteristics for the differential diagnoses of ‘lymph node enlargement’ after transplantation. The worst form of PTLD is the monoclonal proliferation of B cells with the pathological features of diffuse large B-cell lymphoma. Kikuchi–Fujimoto disease (KFD), or necrotizing histiocytic lymphadenitis, is generally considered as a benign and self-limited disease due to viral infection. Although KFD is rarely seen in transplant recipients, it can be frequently misdiagnosed as malignant lymphoma.1, 2 Here, we present a patient with documented KFD that developed early after allogeneic HSCT with clinical presentation being undifferentiable to PTLD.

KFD, first reported in Japan in 1972,3, 4 is now known to be a disease that is spread worldwide, with a higher prevalence among Japanese and other Asians. Patients with KFD usually exhibit night sweats, fever, painful cervical lymphadenopathy and leukopenia. The pathogenesis of KFD is unknown, although viral infection and autoimmune reaction have been claimed. The diagnosis of KFD can only be established by pathological examinations, which typically show patchy necrosis localized to the cortex and paracortical area, nuclear dust engulfed by histiocytes and absence of neutrophils.1 The infiltration of plasmacytoid monocytes, small and large lymphocytes, and immunoblast in KFD varies in degrees. In extreme cases, the presence of numerous large lymphocytes or immunoblasts can be mistaken for high-grade lymphoma.5 Generally, morphological features favoring the diagnosis of KFD over that of lymphoma are the patchy distribution and non-expansible quality of the lesional areas, abundance of karyorrhectic debris and presence of admixed medium-sized cells with round nuclei (plasmacytoid DCs); an accurate diagnosis of KFD can often be made with confidence by experienced pathologists.6 In uncertain cases, immunohistochemical studies are helpful. In addition to the presence of large T cells in the lesion, there are many CD68-positive histiocytes coexpressing myeloperoxidase, as well as many CD68-positive CD123-positive plasmacytoid DCs.6, 7

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Acknowledgements

This study is in part supported from the research grant of Department of Health of Taiwan (DOH99-TD-C-III-005) DOH99-TD-C-III-005.

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  1. Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

    C-C Lin, S-P Yeh & C-F Chiu

  2. Department of Pathology, China Medical University Hospital, Taichung, Taiwan

    I-P Chiang

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  1. C-C Lin
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Correspondence to S-P Yeh.

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Lin, CC., Yeh, SP., Chiang, IP. et al. Kikuchi–Fujimoto disease after allogeneic hematopoietic SCT mimicking post transplant lymphoproliferative disorder. Bone Marrow Transplant 46, 1389–1390 (2011). https://doi.org/10.1038/bmt.2010.302

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