title: Kikuchi-Fujimoto lymphadenitis: role of parvovirus B-19, Epstein-Barr virus, human herpesvirus 6, and human herpesvirus 8.
abstract: Kikuchi-Fujimoto lymphadenitis is a self-limited disorder that typically presents in young females as painless cervical lymphadenopathy with fever, anemia, and leukopenia. The clinical manifestations and pathologic findings suggest a viral etiology, yet specific etiologic agents remain unknown. Although there are studies reporting positive associations between Kikuchi-Fujimoto lymphadenitis and parvovirus B19 and herpesviruses, other studies have failed to find an association with these viruses. To our knowledge, this current study is the largest study of Kikuchi-Fujimoto lymphadenitis in Western patients that used polymerase chain reaction testing for 4 different common viral pathogens often implicated as etiologic agents in Kikuchi-Fujimoto lymphadenitis. Archival material from 3 institutions was included, following confirmation of the diagnosis of Kikuchi-Fujimoto lymphadenitis by 2 independent pathologists. Polymerase chain reaction from the paraffin-embedded tissue sections for parvovirus B19, Epstein-Barr virus, human herpesvirus 6, and human herpesvirus 8 was performed. Eighteen cases of Kikuchi-Fujimoto lymphadenitis were analyzed, 12 of which (60%) were cervical lymph nodes. All the cases showed typical geographic necrosis with abundant apoptotic debris, although the degree of necrosis was variable. Polymerase chain reaction revealed a high prevalence of parvovirus B19 in the controls (44%); there were fewer positive cases seen in the Kikuchi-Fujimoto lymphadenitis cases (11%), but this did not reach statistical significance (P = .25).There were no significant differences between cases and controls in the prevalence of Epstein-Barr virus, human herpesvirus 6, and human herpesvirus 8 (P = .50 for all 3). Polymerase chain reaction failed to reveal a positive association between Kikuchi-Fujimoto lymphadenitis and 4 common suspected viral agents. These findings do not support a role for Epstein-Barr virus, human herpesvirus 6, human herpesvirus 8, or parvovirus B19 in the pathogenesis of Kikuchi-Fujimoto lymphadenitis.
authors.affiliation: Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232, USA. flaviarosado21@gmail.com
authors.forename: Flavia Guimaraes Nunes
authors.initials: FG
authors.lastname: Rosado
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Tang
authors.forename: Robert Paul
authors.initials: RP
authors.lastname: Hasserjian
authors.forename: Colt M
authors.initials: CM
authors.lastname: McClain
authors.forename: Beverly
authors.initials: B
authors.lastname: Wang
authors.forename: Claudio A
authors.initials: CA
authors.lastname: Mosse
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000821:virology; D005260:Female; D006566:Herpesviridae Infections / Q000150:complications / Q000821:virology; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D015654:Herpesvirus 6, Human / Q000235:genetics / Q000302:isolation & purification*; D019288:Herpesvirus 8, Human / Q000235:genetics / Q000302:isolation & purification*; D020042:Histiocytic Necrotizing Lymphadenitis / Q000473:pathology / Q000821:virology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010322:Parvoviridae Infections / Q000150:complications / Q000821:virology; D016732:Parvovirus B19, Human / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D019349:Roseolovirus Infections / Q000150:complications / Q000821:virology; D055815:Young Adult