JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2018.59.9.876 jkos-59-876 Case Report Bilateral Frosted Branch Angiitis in Kikuchi-Fujimoto Disease KimHun Min MD 1 ChoiYoung Je MD 2 KimSeong Taeck MD, PhD 1 Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea Gangjin Medical Center, Sinan, Korea Address reprint requests to Seong Taeck Kim, MD, PhD Department of Ophthalmology, Chosun University Hospital, #365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea Tel: 82-62-220-3190, Fax: 82-62-225-9839 E-mail: s20age@hanmail.net 09 2018 25 09 2018 599 876 880 17052018 22062018 28082018 Copyright © 2018 Korean Ophthalmological Society 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

A case of frosted branch angiitis in Kikuchi-Fujimoto disease is reported.

 Case summary

A 33-year-old male complained of a sudden decrease in visual acuity that developed in both eyes 5 days prior. He suffered from a headache, chills, myalgia, and flank pain 1 week before. The initial best-corrected visual acuity (BCVA) was 0.1 in the right eye and 0.2 in the left eye. On slit lamp examination, no inflammatory finding was observed in the anterior chamber and vitreous body of both eyes. On fundus examination, a diffuse vascular sheathing-like frosted branch was found in the retinal vessels, and retinal hemorrhage was observed. Fluorescein angiography showed staining and leakage of dye along the vascular sheathing. Serological findings were negative, showing no evidence of an autoimmune disease or viral infection. Neck ultrasonography revealed non-tender left cervical lymph node enlargement >1 cm in diameter. Ultrasound-guided fine needle aspiration cytology showed findings compatible with Kikuchi-Fujimoto disease, including necrotic changes and pronounced karyorrhexis, plus histiocyte and lymphocyte infiltration without neutrophils. We started systemic steroid therapy. One month after treatment, the BCVA of both eyes improved to 1.0.

 Conclusions

In patients with frosted branch angiitis, systemic disease such as Kikuchi-Fujimoto disease should be considered.

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Fundus exam at the initial visit. Fundus photograph shows sheathing of retinal vessels and multiple retinal hemorrhages in the right (A) and the left (B) eye. Fundus fluorescein angiography at the initial examination shows dye leakages from the sheathed retinal vessels with normal blood flow in the right (C) and the left (D) eye.

Histopathological finding of the cervical lymph node. Numerous phagocytic histiocytes and prominent karyorrhexis are identified (hematoxylin and eosin stain [H&E] stain, ×100).

Fundus photographs at 1 month after systemic steroid therapy. Fundus photograph shows almost normal without any sheathing of retinal vessels in the right (A) and the left (B) eye.