Man misdiagnosed with TB for six years, diagnosed with rare disease
A 32-year-old man from Visakhapatnam, who had been repeatedly treated for tuberculosis (TB) for nearly six years for recurrent lymph node swelling, has been diagnosed with the rare Kikuchi-Fujimoto disease. This inflammatory disorder can mimic TB, lymphoma, and other infections.
The case was reported at KIMS Hospitals, Seethammadhara, where the patient recently presented with painful swelling in the right axilla.
The patient first developed fever, swelling of the lymph nodes in the neck and axillary regions, and a low white blood cell count in 2020. A lymph node biopsy showed granulomatous changes, following which he was started on anti-TB treatment.
However, his fever persisted after four weeks of therapy. He subsequently developed oral ulcers and further abnormalities in his blood counts. Repeated microbiological investigations for TB returned negative results, prompting doctors to reconsider the diagnosis.
The lymph node swelling recurred in 2022, following which he was again treated for TB.
When he recently presented at KIMS Hospitals with painful swelling in the right armpit, doctors undertook a detailed evaluation in view of his prolonged and recurrent symptoms.
“A detailed assessment, including lymph node biopsy, blood investigations and immunological tests, eventually established the diagnosis of Kikuchi-Fujimoto disease,” said Dr. Konathala Surendra, consultant pulmonologist at KIMS Hospitals.
Kikuchi-Fujimoto disease, also known as Kikuchi disease, is a rare inflammatory condition affecting the lymph nodes. Its clinical and pathological features can overlap with those of tuberculosis, lymphoma and certain other infections, making diagnosis challenging.
Dr. Surendra said the case highlighted the need to consider diagnoses other than TB when lymph node enlargement recurred despite repeated negative microbiological investigations and a poor response to treatment.
“Histopathology must be interpreted alongside microbiological, immunological and clinical findings,” he said.
The patient has completed treatment and has been discharged in stable condition.
According to Dr. Surendra, recurrent lymph node enlargement should not automatically be attributed to tuberculosis or lymphoma. Granulomatous changes seen in lymph node biopsies need to be assessed comprehensively before a definitive diagnosis is made.