Case of rare presentation of Kikuchi-Fujimoto disease in 56-year-old female patient.
A 56-year-old Iranian woman presented with symptoms of low-grade fever, generalised malaise, weight loss, loss of appetite and swelling in the neck glands. She denied any other symptoms of joint pain, hair loss or any oral ulcers. Neither did she have any ear discharge, a sore throat or chronic cough. This article describes a rare presentation of kikuchi-fujimoto disease.
The patient did not complain of any alterations of bowel habits or melena. She did not have a past history of tuberculosis or any high-risk sex behaviour. Her medical history revealed hypertension and dyslipidemia. Similarly, she had visited a rheumatologist a month prior to the presentation with inflammatory bilateral knee joint arthritis. Her investigations were significant for thrombocytopenia. However, there was no involvement of other cell lines. Rheumatoid factor and anti-CCP were negative.
Examination showed that the patient was febrile and not pale or icteric. In addition, a firm, tender and discrete lymphadenopathy measuring 2 cm was palpable in the right upper cervical region. Abdominal examination did not show any evidence of organomegaly. Respiratory and cardiovascular examinations were also normal.
For further evaluation, a neck ultrasonography was performed which showed multiple cervical lymph nodes. The largest lymph node measured 24 mm in the right submandibular region with numerous lymphadenopathies in the right axillary region.
The patient was prescribed an oral course of antibiotics (co-amoxiclav and metronidazole) with the possibility of bacterial lymphadenopathy. However, there were no improvements in symptoms after 7 days of the antibiotics. In addition, the patient was noted to have a generalised urticarial rash.
The cervical lymph node was biopsied. Histopathological analysis showed areas of necrosis infiltrated with nuclear dust, paucity of granulocytes with mononuclear cells in the surrounding tissues. The findings were consistent with the diagnosis of Kikuchi’s disease.
Kikuchi–Fujimoto disease
Kikuchi–fujimoto disease is a rare, benign and self-limiting disease that presents with symptoms of fever and cervical lymphadenopathy.
The patient’s symptoms resolved after a few weeks with normalisation of hematological and biochemical parameters without any specific treatment.
One year after remission, the patient presented with low-grade fever, malaise, weight loss, loss of appetite associated with cervical lymphadenopathy. A repeat biopsy showed similar histopathology, consistent with Kikuchi’s disease. She was managed conservatively, after which she made full recovery. The patient is currently asymptomatic and under follow-up.
References
Rare Presentation of Self-Limiting Kikuchi–Fujimoto Disease in Relapsing Nature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525287/
