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Hamamoto Y, Kawamura M, Mori H, Uchida H, Hiramatsu K, Katori C, Asai H, Kawasaki H, Minamino T, Hashimoto M, Nakatsuka SI, Yoshida K. Kikuchi Disease After SARS-CoV-2 Vaccination: A Case Report With Immunohistochemical Analyses. Int J Surg Pathol 2024; 32:1123-1128. [PMID: 37981745 DOI: 10.1177/10668969231212428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
SARS-CoV-2 vaccines have been administered in many countries after the COVID-19 pandemic. Lymphadenopathy is a side effect of SARS-CoV-2 vaccine. We report a rare example of Kikuchi disease in the cervical lymph nodes after SARS-CoV-2 vaccination. A 41-year-old man complained of a swollen neck and fever 9 days after the first dose of SARS-CoV-2 mRNA-1273 vaccine. Computed tomography revealed enlarged cervical lymph nodes. Fine needle aspiration and resection were performed, and the clinicopathological diagnosis was consistent with Kikuchi disease. Histologically, the resected lymph nodes lost their polarity, and many histiocytes were aggregated with karyorrhectic nuclear debris and apoptosis. SARS-CoV-2 positive cells were small lymphocytes detected by immunohistochemistry. This is the first report that demonstrated SARS-CoV-2 expression in Kikuchi disease post-SARS-CoV-2 vaccination.
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Affiliation(s)
- Yuichiro Hamamoto
- Department of Diagnostic Pathology, Kinki Central Hospital, Itami, Hyogo, Japan
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Michihiro Kawamura
- Department of Clinical Laboratory, Kinki Central Hospital, Itami, Hyogo, Japan
| | - Hideo Mori
- Department of Diagnostic Pathology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiroki Uchida
- Department of Clinical Laboratory, Kinki Central Hospital, Itami, Hyogo, Japan
| | - Kazuhiro Hiramatsu
- Department of Clinical Laboratory, Kinki Central Hospital, Itami, Hyogo, Japan
| | - Chiaki Katori
- Department of Clinical Laboratory, Kinki Central Hospital, Itami, Hyogo, Japan
| | - Hinako Asai
- Department of Clinical Laboratory, Kinki Central Hospital, Itami, Hyogo, Japan
| | - Hiroko Kawasaki
- Department of Otorhinolaryngology, Kinki Central Hospital, Itami, Hyogo, Japan
| | - Taishi Minamino
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Michiko Hashimoto
- Department of Otorhinolaryngology, Kinki Central Hospital, Itami, Hyogo, Japan
| | | | - Kyotaro Yoshida
- Department of Clinical Laboratory, Kinki Central Hospital, Itami, Hyogo, Japan
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Leung CCD, Chan HCC, Chan MC, Chan YH, Ho MY, Chen CH, Ngai CM, Yeung YC. Kikuchi-Fujimoto disease following SARS-CoV-2 infection: A rare disease with increased incidence during the COVID-19 pandemic? Respirol Case Rep 2024; 12:e01414. [PMID: 38903947 PMCID: PMC11187840 DOI: 10.1002/rcr2.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/07/2024] [Indexed: 06/22/2024] Open
Abstract
Kikuchi-Fujimoto Disease (KFD), also known as Kikuchi disease or Kikuchi histiocytic necrotizing lymphadenitis, is a rare and self-limiting condition characterized by cervical lymphadenopathy and fever, primarily affecting young Asian adults. The aetiology of KFD remains unknown, although various infectious agents have been suggested as potential triggers. With the emergence of the COVID-19 pandemic, cases of post-COVID-19 KFD and post-COVID-19 vaccine KFD have been reported. In this article, we present the first case of post-COVID-19 KFD in Hong Kong. A 24-year-old man developed fever and painful neck swelling 1 month after recovering from COVID-19. Diagnostic evaluation, including ultrasound-guided fine needle aspiration cytology (FNAC), confirmed the diagnosis of KFD. The patient's symptoms resolved spontaneously with supportive care. This case underscores the importance of considering KFD as a potential differential diagnosis in patients presenting with cervical lymphadenopathy and fever following COVID-19 recovery or vaccination.
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Affiliation(s)
| | | | - Ming Chiu Chan
- Department of Medicine and GeriatricsPrincess Margaret HospitalHong Kong
| | - Yu Hong Chan
- Department of Medicine and GeriatricsPrincess Margaret HospitalHong Kong
| | - Man Ying Ho
- Department of Medicine and GeriatricsPrincess Margaret HospitalHong Kong
| | - Chun Hoi Chen
- Department of Medicine and GeriatricsPrincess Margaret HospitalHong Kong
| | - Ching Man Ngai
- Department of Medicine and GeriatricsPrincess Margaret HospitalHong Kong
| | - Yiu Cheong Yeung
- Department of Medicine and GeriatricsPrincess Margaret HospitalHong Kong
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Sandakly N, El Koubayati G, Sarkis J, Naderi S, Sebaaly D, Haddad F. Kikuchi-Fujimoto disease associated with a flare-up of a leukocytoclastic vasculitis: A rare case report and review of literature. Medicine (Baltimore) 2024; 103:e37626. [PMID: 38552071 PMCID: PMC10977597 DOI: 10.1097/md.0000000000037626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Kikuchi-Fujimoto disease (KFD) also known as histiocytic necrotizing lymphadenopathy is an exceedingly rare cause of cervical lymphadenopathy, commonly accompanied by systemic symptoms such as fever, fatigue, night sweats, myalgia, skin rash. PATIENT CONCERNS In this paper, we report the case of a 22-year-old female patient who experienced a flare-up of leukocytoclastic vasculitis that was complicated by the appearance of a cervical lymph node with dysphagia, fever and nausea. DIAGNOSIS Infectious and autoimmune workup came back negative. INTERVENTIONS Excisional lymph node biopsy was done and the pathology results were consistent with histiocytic necrotizing lymphadenitis in keeping with Kikuchi-Fujimoto disease. OUTCOMES Patient improved on intravenous corticosteroids and was discharged on per os prednisone. Six month follow-up shows complete resolution of her symptoms. LESSONS KFD should be ruled out in patients with autoimmune or inflammatory diseases who develop lymphadenopathies.
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Affiliation(s)
- Nicolas Sandakly
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Georgio El Koubayati
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Jeannette Sarkis
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Samah Naderi
- Department of Pathology, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Delivrance Sebaaly
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
- Department of Pathology, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Fady Haddad
- Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
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Moreno de Juan G, Pérez Del Barrio A, Herrera Romero EG, González Ruiz M, Montes Moreno S. Kikuchi-Fujimoto disease type lymph node reaction with increased plasmacytoid dendritic cells may appear as a side effect following COVID-19 vaccination: Report of a case and literature review. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2024; 57:42-47. [PMID: 38246709 PMCID: PMC9970933 DOI: 10.1016/j.patol.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 03/24/2023]
Abstract
Subsequent to mass vaccination programs against COVID-19, diverse side effects have been described, both at the injection site, such as pain, redness and swelling, and systemic effects such as fatigue, headache, muscle or joint pain. On rare occasions, a lymphadenopathic syndrome may develop, raising the clinical suspicion of a lymphoproliferative disorder. We present the case of a 30-year-old woman who developed self-limiting left axillary lymphadenopathy following COVID-19 vaccination. To date, only seven similar cases with a complete clinicopathological description have been published, and fourteen cases have been notified to the European adverse events databases (Eudravigilance) in relationship with vaccination against COVID-19. It is important to be aware of this potential complication when a lymphadenopathic syndrome develops following vaccination, to avoid unnecessary treatment.
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Affiliation(s)
- Germán Moreno de Juan
- Anatomic Pathology Service, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, Spain; Translational Hematopathology Lab, IDIVAL, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Santander, Spain
| | - Amaia Pérez Del Barrio
- Radiology Service, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain
| | | | - Mario González Ruiz
- Centro de Farmacovigilancia de Cantabria - Servicio de Farmacología Clínica de Atención Primaria, Santander (Cantabria), Spain
| | - Santiago Montes Moreno
- Anatomic Pathology Service, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, Spain; Translational Hematopathology Lab, IDIVAL, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Santander, Spain.
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Bakir M, Iqbal U, Gazal AN, Robertson D. Case Report: Acute abdomen and large mesenteric mass as another face of multisystem inflammatory syndrome in an adolescent child: measure twice, act once! Front Pediatr 2023; 11:1324670. [PMID: 38143532 PMCID: PMC10739509 DOI: 10.3389/fped.2023.1324670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction During the Covid-19 era, acute abdomen and mesenteric lymphadenopathy were encountered as frequent mimic of appendicitis. This phenomenon can further complicate the diagnosis of acute abdominal conditions, not solely due to bacterial or viral intestinal infections but also attributable to post-infectious acute inflammatory states resulting in either undertreatment of inflammatory conditions or unnecessary surgery. Case presentation In this case study, we present the case of an 11-year-old female who initially presented with fever and right lower quadrant abdominal pain, raising concerns of appendicitis. However, upon further investigation, it was revealed that she harbored a sizable mesenteric mass. Subsequent biopsy results unveiled a significant necrotic mesenteric lymphadenitis. Notably, this patient fulfilled the criteria for Multisystem Inflammatory Syndrome in Children (MIS-C), a condition that manifested following persistent postoperative fever. Remarkably, the patient exhibited a highly favorable response to the treatment administered. This clinical scenario presents an atypical manifestation of MIS-C, as the patient displayed a substantial mesenteric mass alongside symptoms mimicking appendicitis, within the context of an acute abdomen. Conclusion Clinicians should consider MIS-C and other post-infectious inflammatory conditions in mind when diagnosing acute abdominal cases. The presented case underscores the importance of recognizing atypical presentations of MIS-C that can mimic appendicitis, sometimes necessitating surgical resection of a large lymph node. We propose diagnostic flow chart to aid in the differentiation of acute bacterial appendicitis from MIS-C.
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Affiliation(s)
- Mustafa Bakir
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
| | - Umair Iqbal
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
| | - Ayoolamide N. Gazal
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
| | - Daniel Robertson
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
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Graef A, Willett A, Dang AH, Balakrishna J, Nicely C, Baiocchi R. A Case Report: Kikuchi Disease Associated With a Positive Auto-Immune Panel Triggered by COVID-19 Infection. Cureus 2023; 15:e50911. [PMID: 38249222 PMCID: PMC10799691 DOI: 10.7759/cureus.50911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Kikuchi disease (KD) is a rare, benign inflammatory condition characterized by fever and cervical lymphadenopathy. While the pathogenesis is largely unknown, Kikuchi disease onset has strong associations with various infections and autoimmune conditions. There are few reported cases of Kikuchi disease triggered by coronavirus disease 2019 (COVID-19) infection or vaccination. A 43-year-old Filipina female with a history of anemia and recent uncomplicated COVID-19 infection one month prior presented with a one-month history of progressive weakness, fatigue, anorexia with 30-pound weight loss, fevers, odynophagia, and new-onset hematemesis. Initial laboratory findings were most significant for a markedly elevated ferritin level prompting initial concern for hemophagocytic lymphohistiocytosis. Admission imaging revealed diffuse cervical and thoracic lymphadenopathy. Lymph node biopsy revealed paracortical expansion with numerous histiocytes with phagocytosed necrotic debris and germinal center necrosis, consistent with Kikuchi disease. She received supportive care without any medical intervention and improved clinically with the resolution of lymphadenopathy and inflammatory laboratory markers. This report describes the initial presentation and subsequent diagnostic workup of a unique and infrequently documented case of Kikuchi disease secondary to COVID-19 infection. This case highlights general constitutional symptoms, including fever and lymphadenopathy as defining characteristics of Kikuchi disease. During diagnostic workup, it is important to rule out hematologic emergencies, such as hemophagocytic lymphohistiocytosis, which can present similarly. This case also reports a concurrent autoimmune workup, which was positive at the time of the Kikuchi disease diagnosis. COVID-19 infections and deaths, while declining in the post-pandemic period, remain significant, thus diagnostic consideration for conditions of self-limited disorders, such as Kikuchi disease, should be considered.
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Affiliation(s)
- Andrew Graef
- Internal Medicine, OhioHealth Riverside Methodist Hospital, Columbus, USA
| | - Aimee Willett
- Internal Medicine, OhioHealth Riverside Methodist Hospital, Columbus, USA
| | - Andrew-Huy Dang
- Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Charles Nicely
- Hematopathology, OhioHealth Riverside Methodist Hospital, Columbus, USA
| | - Robert Baiocchi
- Hematology and Oncology, The Ohio State University Wexner Medical Center, Columbus, USA
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Nam KH, Choi Y. A rare encounter: Kikuchi-Fujimoto disease presenting atypically after BNT162b2 COVID-19 vaccination: a case report. Scand J Rheumatol 2023; 52:705-707. [PMID: 37606559 DOI: 10.1080/03009742.2023.2241760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023]
Affiliation(s)
- K-H Nam
- Department of Dermatology, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea
| | - Y Choi
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea
- Department of Internal Medicine, Division of Rheumatology, Jeonbuk National University Medical School, Jeonju, South Korea
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8
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Mahajan VK, Sharma V, Sharma N, Rani R. Kikuchi-Fujimoto disease: A comprehensive review. World J Clin Cases 2023; 11:3664-3679. [PMID: 37383134 PMCID: PMC10294163 DOI: 10.12998/wjcc.v11.i16.3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/29/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
Kikuchi-Fujimoto disease, a rare form of necrotizing lymphadenitis, is an uncommon, benign, self-limiting disorder of obscure etiology. It affects mostly young adults of both genders. Clinically, it presents with fever and lymphadenopathy of a firm to rubbery consistency frequently involving cervical lymph nodes while weight loss, splenomegaly, leucopenia, and elevated erythrocyte sedimentation rate feature in severely affected patients. Cutaneous involvement occurs in about 30%-40% of cases as facial erythema and nonspecific erythematous papules, plaques, acneiform or morbilliform lesions of great histologic heterogeneity. Both Kikuchi-Fujimoto disease and systemic lupus erythematosus share an obscure and complex relationship as systemic lupus erythematosus may occasionally precede, develop subsequently, or sometimes be associated concurrently with Kikuchi-Fujimoto disease. It is often mistaken for non-Hodgkin lymphoma while lupus lymphadenitis, cat-scratch disease, Sweet's syndrome, Still's disease, drug eruptions, infectious mononucleosis, and viral or tubercular lymphadenitis are other common differentials. Fine needle aspiration cytology mostly has features of nonspecific reactive lymphadenitis and immunohistochemistry studies usually show variable features of uncertain diagnostic value. Since its diagnosis is exclusively from histopathology, it needs to be evaluated more carefully; an early lymph node biopsy will obviate the need for unnecessary investigations and therapeutic trials. Its treatment with systemic corticosteroids, hydroxychloroquine, or antimicrobial agents mostly remains empirical. The article reviews clinicoepidemiological, diagnostic, and management aspects of KFD from the perspective of practicing clinicians.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Neeraj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
| | - Ritu Rani
- Department of Dermatology, Venereology and Leprosy, Dr. Radhakrishnan Government Medical College, Hamirpur 177001, Himachal Pradesh, India
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Ho TC, Shen DHY, Chang CC, Chan HP, Chuang KP, Yuan CH, Chen CN, Yang MH, Tyan YC. Immune Response Related to Lymphadenopathy Post COVID-19 Vaccination. Vaccines (Basel) 2023; 11:vaccines11030696. [PMID: 36992280 DOI: 10.3390/vaccines11030696] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Mass vaccination against coronavirus disease 2019 (COVID-19) is a global health strategy to control the COVID-19 pandemic. With the increasing number of vaccinations, COVID-19 vaccine-associated lymphadenopathy (C19-VAL) has been frequently reported. Current findings emphasize the characteristics of C19-VAL. The mechanism of C19-VAL is complicated to explore. Accumulated reports separately show that C19-VAL incidence is associated with receiver age and gender, reactive change within lymph nodes (LN), etc. We constructed a systematic review to evaluate the associated elements of C19-VAL and provide the mechanism of C19-VAL. Articles were searched from PubMed, Web of Science and EMBASE by using the processing of PRISMA. The search terms included combinations of the COVID-19 vaccine, COVID-19 vaccination and lymphadenopathy. Finally, sixty-two articles have been included in this study. Our results show that days post-vaccination and B cell germinal center response are negatively correlated with C19-VAL incidence. The reactive change within LN is highly related to C19-VAL development. The study results suggested that strong vaccine immune response may contribute to the C19-VAL development and perhaps through the B cell germinal center response post vaccination. From the perspective of imaging interpretation, it is important to carefully distinguish reactive lymph nodes from metastatic lymph node enlargement through medical history collection or evaluation, especially in patients with underlying malignancy.
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Affiliation(s)
- Tzu-Chuan Ho
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Daniel Hueng-Yuan Shen
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Chin-Chuan Chang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Electrical Engineering, I-Shou University, Kaohsiung 840, Taiwan
| | - Hung-Pin Chan
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Kuo-Pin Chuang
- Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 912, Taiwan
| | - Cheng-Hui Yuan
- Mass Spectrometry Laboratory, Department of Chemistry, National University of Singapore, Singapore 119077, Singapore
| | - Ciao-Ning Chen
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ming-Hui Yang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Center of General Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Yu-Chang Tyan
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 912, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Lencastre Monteiro R, Cabaço S, Soares L, Inácio H, Nazário Leão R. Kikuchi-Fujimoto Disease: A Case of SARS-CoV-2 Infection Triggering the Rare Disease. Cureus 2023; 15:e35858. [PMID: 37033518 PMCID: PMC10077921 DOI: 10.7759/cureus.35858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a rare, benign, and self-limited disease caused by subacute necrotizing regional lymphadenopathy. The etiology is unknown, although virus and autoimmune mechanisms have been proposed. Patients develop enlarged lymph nodes, fever, and, less frequently, extranodal signs. No specific laboratory test contributes to the diagnosis, and lymph node biopsy is the gold standard to define the diagnosis. The treatment is generally with supportive therapy and usually is spontaneously resolved within six months. In this article, the authors present the case of a 41-year-old female with mild SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection 10 weeks before she was admitted to the emergency department (ED) due to cervical lymphadenopathies and fever lasting over three weeks. Physical examination revealed multiple lymphadenopathies on the submandibular and jugular regions, cutaneous rash, and hepatosplenomegaly. Blood tests showed elevated acute phase proteins, thrombocytopenia, and increased transaminases and lactate dehydrogenase (LDH). Computed tomography (CT) of the neck showed multiple adenopathies at levels I, II, III, and IV according to the Classification for Lymph Nodes from the American Head and Neck Society and American Academy of Otolaryngology on the right side. Excision biopsy was performed and histopathological examination confirmed KFD. A comprehensive analysis performed was unrevealing of an infectious or autoimmune cause and was assumed to be most likely triggered by SARS-CoV-2 infection given the timeframe correlation. KFD diagnosis is challenging and there are few reported cases of association with SARS-CoV-2 in the literature. Although further investigation is still needed to better understand the relation between them, it is important that physicians take SARS-CoV-2 infection and vaccination into consideration in KFD's differential diagnosis.
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Abstract
A previously healthy Japanese woman in her 20s was admitted to our hospital with a 2-week history of fever (39.0°C) and a 1-week history of painful cervical lymphadenopathy. The day before fever onset, she had received her first Pfizer-BioNTech SARS-CoV-2 vaccine in her left arm. She had previously been treated with empirical antibiotics with no improvement. Physical examination revealed painful lymphadenopathy in both posterior cervical regions. CT showed symmetrical lymphadenopathies in the neck, supraclavicular, axillary and inguinal regions as well as hepatosplenomegaly. We suspected lymphoma and performed a lymph node biopsy in the right inguinal region, which revealed necrotising histiocytic lymphadenitis. The patient was, therefore, diagnosed with Kikuchi-Fujimoto disease (KFD). She improved after the corticosteroid therapy. This report highlights the importance of including KFD as a differential diagnosis of lymphadenopathy after SARS-CoV-2 vaccination. Additionally, lymph node biopsy is helpful for diagnosing KFD because it rules out other entities.
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Affiliation(s)
- Kohsuke Ikeda
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Seiji Adachi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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12
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Kikuchi-Fujimoto Disease: A Differential for When It is Not Systemic Lupus Erythematosus. Case Rep Rheumatol 2022; 2022:7709246. [PMID: 35968155 PMCID: PMC9363934 DOI: 10.1155/2022/7709246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare and benign disease process that is characterized by fever and lymphadenopathy that was first described in young Japanese women in the early 1970s. Knowledge of KFD is important as it can often mimic other causes of lymphadenopathy including systemic lupus erythematosus (SLE) or malignancies, and this can lead to invasive diagnostic testing and even treatments that can be avoided. The etiology and exact mechanism by which KFD develops is not fully understood at this time, but is thought to be an immune response of T cells and histiocytes to viral or bacterial infections. We present a 35-year-old African-American woman who was referred to the rheumatology clinic by our colleagues in the breast clinic with new onset right axillary lymphadenopathy and abnormal serologic testing with the suspicion of SLE after a malignancy had been ruled out.
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Saito Y, Suwa Y, Kaneko Y, Tsujiwaki M, Odagawa Y. Kikuchi-Fujimoto Disease Following COVID-19 Infection in a 7-Year-Old Girl: A Case Report and Literature Review. Cureus 2022; 14:e26540. [PMID: 35936128 PMCID: PMC9351715 DOI: 10.7759/cureus.26540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 11/29/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) symptoms in children are relatively mild and often do not require treatment. Nonetheless, complications caused by the immune response to COVID-19 in children are possible and diverse. We present the case of a 7-year-old girl with persistent fever and lymphadenopathy arising from SARS-CoV-2 infection, diagnosed with Kikuchi-Fujimoto Disease (KFD) on lymph node biopsy. KFD is a rare benign disease, clinically characterized by fever and tender cervical lymphadenopathy affecting posterior cervical lymph nodes. We also reviewed six previously reported cases of COVID-19-associated KFD that occurred in school-aged children and compared them with the present case. The clinical course of COVID-19-associated KFD was similar to that of previous reports of KFD with a favorable prognosis. This is the first report of a school-aged child developing KFD following SARS-CoV-2 infection. KFD should be considered when approaching patients with hyperinflammatory states who present with prolonged fever and cervical lymphadenopathy after COVID-19.
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Öztürk N, Kılıç İ, Göçün PU, Kaya Z. Kikuchi-Fujimoto disease in a child who had a high suspicion of COVID-19 infection. J Hematop 2022; 15:197-198. [PMID: 35669856 PMCID: PMC9154209 DOI: 10.1007/s12308-022-00501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nihan Öztürk
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - İlayda Kılıç
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Pınar Uyar Göçün
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Zühre Kaya
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Daghri S, Belmoufid N, Rami A, Al Bouzidi A, Bouanani N. Kikuchi-Fujimoto's Disease or Histiocytic Necrotizing Lymphadenitis Following mRNA COVID-19 Vaccination: A Rare Case. Cureus 2022; 14:e24155. [PMID: 35592214 PMCID: PMC9110038 DOI: 10.7759/cureus.24155] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD), also known as necrotizing histiocytic lymphadenopathy, is a rare and benign lymph node disorder that mainly occurs in young women. It is clinically characterized by fever with tender and painful cervical lymphadenopathy mostly; however, all areas of lymph nodes can be involved. This disorder is often mistaken for malignant lymphoma or infection. The precise pathophysiology of KFD remains unknown, but it is theorized that it may be post-viral or associated with an autoimmune disease. The diagnosis is based on the histological analysis of the excised involved lymph node. The treatment is mainly supportive with favorable outcomes within a few weeks or months. In this case, we present a 24-year-old woman without a past medical history, who consulted for painful bilateral cervical lymphadenopathy associated with fever that has been evolving for one month following the coronavirus disease 2019 (COVID-19) vaccination. The initial diagnostic workup was performed and the diagnosis of KFD was confirmed based on the histopathological findings of the excised lymphadenopathy. Therapeutic management was based on oral corticosteroid treatment with clinical and radiological improvement after a few days without recurrence during follow-up. This article aims to report a rare case of KFD in a patient after receiving the messenger ribonucleic acid (mRNA)-based COVID-19 vaccine. Therefore, this case highlights the possible association between COVID-19 vaccination and KFD and this should be considered in the differential diagnosis.
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