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5 In our patient, CSF did not show SB431542 mouse pleocytosis or other features of meningitis despite initial suspicion. Diagnosis of Kikuchi disease is made based on well-characterised histopathology features.6�C8 However, there are occasional reports of biopsies being read as Hodgkin's lymphoma.7 8 Somewhat similar histological features can also be seen in SLE.7�C9 Therefore, a diagnosis of Kikuchi disease based on histopathology can be challenging and requires careful interpretation in the context of clinical features.2 7 8 10 Most patients, as in this case, go through extensive diagnostic evaluation.2 Delay in diagnosis can lead to unnecessary and potentially harmful treatments, as well as financial and psychological comorbidity.2 Our patient's hospitalisation was complicated by an episode of acute renal failure secondary to biopsy-proven acute tubular necrosis. Although this was presumed secondary to her antibiotics, there has been one previous case report of acute renal failure associated with Kikuchi disease.11 Kikuchi disease has a benign, self-limited course in most patients with resolution of symptoms in 1�C4?months.2 Recurrences are rare in Kikuchi disease but have been reported.2 The role of steroids or immunosuppressive therapy for treatment of Kikuchi disease is unclear. Most patients show spontaneous resolution with supportive management; however, death from Kikuchi disease occurred in 2.1% of 244 cases.2 These were due to abrupt heart failure in a pregnant patient, pulmonary haemorrhage, haemophagocytic syndrome and pulmonary complications in the post-transplant setting. While SLE was seen in 13% cases, on longitudinal follow-up, only 2% Kikuchi disease patients developed SLE.2 Patients with cutaneous manifestations seem to have much a higher association with SLE12 13 and this subset may warrant careful follow-up. Learning points Kikuchi disease is a rare, benign disease presenting with fever and lymphadenopathy classically in young women. Diagnosis is made through typical findings on lymph node biopsy, and often can be challenging. There is no known effective treatment and symptoms usually resolve within 4?months of presentation. Footnotes Contributors: RPS, MEW and AB were involved in drafting of the article. JS was involved in the section related to histopathology of lymph node and manuscript review. Competing interests: None. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed.""A 26-year-old man was referred by his general practitioner as an urgent referral based on a 2-week history of a hard right testicular mass. There was no history of trauma, sexually transmitted infections or previous testicular surgery. On examination, a hard 2?cm irregular mass was palpable at the lower pole of the right testis. It was separate from the epididymis and scrotal wall.