Reactive lymphadenopathy: Kikuchi disease: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Reactive lymphadenopathy: Kikuchi disease

Sample item

A 22-year-old woman has fever, leucopenia and tender cervical lymphadenopathy. A node biopsy shows paracortical foci of necrosis with abundant karyorrhectic debris and histiocytes, and there are almost no neutrophils. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Kikuchi-Fujimoto disease

Kikuchi-Fujimoto disease is a self-limiting histiocytic necrotising lymphadenitis of young women, probably a hyperimmune response to a trigger. Necrosis with nuclear debris but without neutrophils and without granulomas is the hallmark. It can be associated with, or precede, systemic lupus erythematosus, so follow-up is advised.

Option by option

  • A. Cat-scratch disease

    Cat-scratch disease shows stellate necrotising granulomas rich in neutrophils.

  • B. Kikuchi-Fujimoto disease (correct)

    Karyorrhectic necrosis with histiocytes and no neutrophils is typical of Kikuchi disease.

  • C. Hodgkin lymphoma

    Hodgkin lymphoma shows Reed-Sternberg cells in an inflammatory background and no necrotic karyorrhectic foci.

  • D. Tuberculous lymphadenitis

    Tuberculous nodes show caseating granulomas with Langhans giant cells.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Kikuchi-Fujimoto disease. Kikuchi-Fujimoto disease is a self-limiting histiocytic necrotising lymphadenitis of young women, probably a hyperimmune response to a trigger.

Why is "Cat-scratch disease" not the answer?

Cat-scratch disease shows stellate necrotising granulomas rich in neutrophils.

Why is "Hodgkin lymphoma" not the answer?

Hodgkin lymphoma shows Reed-Sternberg cells in an inflammatory background and no necrotic karyorrhectic foci.

Why is "Tuberculous lymphadenitis" not the answer?

Tuberculous nodes show caseating granulomas with Langhans giant cells.

What concept does this question test?

It tests Reactive lymphadenopathy: Kikuchi disease in Pathology. Necrosis with nuclear debris but without neutrophils and without granulomas is the hallmark. It can be associated with, or precede, systemic lupus erythematosus, so follow-up is advised.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Reactive lymphadenopathy: Kikuchi disease?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.