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Autoimmune disorders

Case report: link between RYGB and rare disease

Rare disease, thought to be an autoimmune disorder, linked to weight loss affecting immune system
Paper acknowledges link could be "completely coincidental"
The patient's lymph node biopsy (above) showed symptoms of Kikuchi-Fujimoto disease

A report of a male patient developing Kikuchi-Fujimoto disease after Roux-en-Y gastric bypass has led researchers to suggest a potential link between bariatric surgery and the rare condition.

The case report, published in the Journal of Medical Case Reports by Juan Garcia-Arnes, Hospital Regional Universitario Carlos Haya, Spain, and colleagues, acknowledged that the link between the disease and the patient’s operation could be “entirely coincidental”, but speculated that the immune dysfunction associated with dramatic weight loss could have played an etiologic role in the development of the condition.

Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenitis, is characterised by a painful swelling of the cervical lymph nodes, low-grade fever and malaise.

Its pathogenesis is unknown, but the authors note that immune factors appear to be important, and it is suspected to be an autoimmune condition.

The disease develops in young adults, and affects women more often than men. The condition is relatively benign, and normally resolves itself within a few months.

The report describes what the authors believe to be the first case of Kikuchi-Fujimoto disease after bariatric surgery, discussing a 45-year-old Caucasian man who presented with a three-week history of a tender left axillary lump, as well as a low-grade fever.

The patient had undergone Roux-en-Y gastric bypass two years earlier, and had lost 112kg since, dropping from a BMI of 64.6 to 28.

Hypothesising about potential links between gastric bypass and Kikuchi-Fujimoto disease, the authors say that starvation can suppress the immune function, and note that some studies suggest that Roux-en-Y gastric bypass can modulate the immune system.

While the paper concludes that the association between the operation and the disease may be coincidental, the authors say they cannot rule out a hyperimmune response to dramatic weight loss leading to the development of the condition in predisposed patients.

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