Abstract
We experienced a case of discoid lupus erythematosus (DLE) associated with Epstein-Barr virus (EBV) infection with Kikuchi disease. The patient, a 7-year-old boy, was initially diagnosed with Kikuchi’s disease based on lymph node histology. The symptoms were resolved after initiation of glucocorticoid therapy; however, on discontinuation of the therapy, exudative erythema appeared on the cheeks, palms, and soles with recurrence of fever and deterioration of cervical lymphadenopathy. At the time of initial examination, EBV-VCA-IgG and whole blood EBV-DNA levels were high and EBNA was negative, suggesting a primary EBV infection. A cervical lymph node biopsy showed evidence of Kikuchi’s disease. The general findings improved spontaneously; whereas the erythema on the cheeks persistently worsened. Further serological examinations revealed positive results for anti-Sm, anti-Ro, anti-RNP, and anti-DNA antibodies. Based on the clinical findings and skin biopsy, the patient was finally diagnosed with discoid lupus erythematosus. Erythema improved with topical tacrolimus, and subsequently EBV-DNA became less sensitive and all the autoantibodies became negative. We hypothesized that EBV infection associated with Kikuchi’s disease leads to the production of autoantibodies and the subsequent development of DLE, which has a molecular mechanisms similar to Kikuchi’s disease.
