Kikuchi disease complicated by disseminated tuberculosis and haemophagocytic lymphohistiocytosis – confirmed by the ‘E’xperts.

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare and usually self-limiting condition. In regions endemic to tuberculosis (TB), distinguishing KFD from tuberculous lymphadenitis can be challenging due to overlapping clinical presentations. We report a unique case of a young male initially diagnosed with KFD, who later developed disseminated TB and secondary haemophagocytic lymphohistiocytosis (HLH). Despite initial negative microbiological findings, the patient’s clinical deterioration prompted further investigation, which confirmed TB and HLH. He was successfully managed with anti-tubercular therapy (ATT) and high-dose corticosteroids. This case underscores the importance of repeat pathological and microbiological evaluations in persistent PUO, and the critical role of early intervention in HLH.