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In their case report of a patient with Kikuchi’s disease Dr Chung and colleagues (July 2004 JRSM1) refer to reported associations with systemic lupus erythematosus, Hashimoto’s thyroiditis and infection with toxoplasmosis, Yersinia enterocolitica and herpesvirus 6. Kikuchi’s disease has also been associated with four other autoimmune diseases—polymyositis,2 mixed connective tissue disease,3 adult and juvenile onset Still’s disease4 and the antiphospholipid syndrome.5 In addition cases have been linked with breast and gastric malignancy6,7 and infections with Epstein–Barr virus, parvovirus B19 and herpesvirus 8.8–10
As Chung et al. state, a viral aetiology has been suggested but never satisfactorily proven. Given the variety of disease associations, it is possible that Kikuchi’s disease represents an unusual response of histiocytes and T-cells to a range of local or systemic immune stimuli, including both foreign and self antigens.