2026 Clinician Corner - Fever, lymphadenopathy, and a diagnostic dilemma: a case of Kikuchi-Fujimoto disease masquerading as tuberculosis in a diabetic patient

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Abstract 

Kikuchi-Fujimoto disease is a rare, self-limiting autoimmune necrotizing lymphadenitis that poses unique diagnostic challenges due to vague, overlapping clinical and laboratory features with numerous important and common differential diagnoses. Accurate diagnosis is needed to avoid unnecessary and unwanted treatment. Herein, we report a unique case of a middle-aged diabetic man from South India presenting with prolonged fever, significant weight loss, and generalized lymphadenopathy. Laboratory findings revealed leukopenia, markedly elevated inflammatory markers, and a moderately positive antinuclear antibody titer—raising immediate concern for systemic lupus erythematosus. An extensive infectious workup, including tuberculosis testing, was negative. The definitive diagnosis was established by lymph node biopsy demonstrating necrotizing lymphadenitis with karyorrhectic debris and crescentic histiocytes, without caseating granulomas or haematoxylin bodies. This case underscores the need for early lymph node biopsy in tuberculosis-endemic settings to avoid misdiagnosis and inappropriate antitubercular therapy and highlights the emerging association between Kikuchi-Fujimoto disease and autoimmune serological markers.  

Keywords:  Fever; Kikuchi-Fujimoto disease; lymphadenitis; systemic lupus erythematosus; tuberculosis

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on November 1, 2027.

Learning Objectives

After completing the article, the learner should be able to:

  • Evaluate patients presenting with fever and lymphadenopathy in tuberculosis-endemic regions and determine when early excisional lymph node biopsy is required for definitive diagnosis. 

  • Differentiate Kikuchi-Fujimoto disease from tuberculosis, lymphoma, and systemic lupus erythematosus using key histopathological features and clinical findings. 

  • Interpret positive autoimmune serologies (e.g., ANA) in the context of Kikuchi-Fujimoto disease and plan appropriate additional evaluation and follow-up. 

Key Points 

  • In tuberculosis-endemic regions, Kikuchi-Fujimoto disease (KFD) is misclassified as tuberculosis in up to 60% of initial encounters; lymph node biopsy is essential for definitive diagnosis.  

  • Positive antinuclear antibody in KFD is atypical and should prompt additional autoimmune serologic testing (anti-dsDNA, anti-SSA/SSB) to rule out concurrent systemic lupus erythematosus or Sjögren's syndrome.  

  • The diagnostic triad of KFD—karyorrhectic debris, crescentic histiocytes, and absence of neutrophils—reliably distinguishes it from tuberculosis, lymphoma, and systemic lupus erythematosus lymphadenitis.  

  • KFD is self-limiting; treatment is supportive, with nonsteroidal antiinflammatory drugs or corticosteroids reserved for severe cases.  

  • Niche immunohistochemical markers (CD8+, CD68+, CD123+) confirm the diagnosis when histomorphology remains ambiguous. 

Course summary

Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
11/01/2026
Course expires: 
11/01/2027
Cost:
$25.00

Chirag Bhojwani, MBBSa*, Anirudh Jeedigunta, MBBSa*, Shivam Thaker, MBBSa, Megha Murali, MDb, Hrishikesh Pandey, MDc, and M. Mukhyaprana Prabhu, MD, PhD, FRCPc  

a Kasturba Medical College, Manipal, India 

b Department of Pathology, Kasturba Medical College, Manipal, India 

c Department of Medicine, Kasturba Medical College, Manipal, India 

*Equal contribution and co-first authorship.  

Corresponding authors: Shivam Thaker, MBBS, Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India 576104 (e-mail: [email protected]) and M. Mukhyaprana Prabhu, MD, PhD, Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India 576104 (e-mail: [email protected]). 

Artificial intelligence assistance was used in the preparation of this manuscript. Specifically, ChatGPT (OpenAI, GPT-5.3) was utilized for language refinement and formatting support. All clinical content, interpretations, and conclusions were independently developed and verified by the authors. The authors take full responsibility for the accuracy and integrity of the work.  

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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