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Ciliberti V, Maffei E, Giudice V, Ciancia G, Zeppa P, Caputo A. COVID-19 vaccine-associated lymphadenopathy: a review. LE INFEZIONI IN MEDICINA 2024; 32:119-130. [PMID: 38827838 PMCID: PMC11142413 DOI: 10.53854/liim-3202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024]
Abstract
Following the introduction of RNA-based vaccines, COVID-19 vaccine-associated clinical lymphadenopathy (C19-LAP) has been reported as a side effect. Moreover, subclinical lymphadenopathy detected on imaging (SLDI) has also been observed, mainly as incidental findings while performing screening tests on oncological patients. In these cases, surgical lymphadenectomy, fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) have been used as a valuable diagnostic tool for SLDI and C19-LAP. In this review the clinical, histologic and cytologic features of SLDI and C19-LAP have been investigated. A search for studies that reported on C19-LAP and SLDI histopathology and cytopathology was performed on PubMed and Google Scholar, on 11 January 2023. Thirty-one reports on SLDI and C19-LAP were retrieved and included in a pooled analysis. In total, we included 54 patients with a median age of 47 years. In our research, surgical excision, CNB and/or FNAC of C19-LAP or SLDI enlarged lymph nodes have been performed in 54 cases. Of all cases, only two metastases were diagnosed and one case was diagnosed as reactive hyperplasia with atypical follicles. The remaining cases were reactive lymphadenopathy (28 cases), follicular hyperplasia (13 cases), Kikuchi-Fujimoto disease (6 cases), granulomatous lymphadenitis (2 cases), eosinophilic lymph node abscesses (1 case), Langherans cell histiocytosis (1 case), Rosai-Dorfman disease (1 case). SLDI and C19-LAP have represented a diagnostic dilemma, especially in oncologic patients. The role of different diagnostic tools for SLDI and C19-LAP has been discussed.
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Affiliation(s)
- Valeria Ciliberti
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Elisabetta Maffei
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Valentina Giudice
- Hematology and Transplant Center, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Giuseppe Ciancia
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Pio Zeppa
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Alessandro Caputo
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
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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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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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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: 0] [Impact Index Per Article: 0] [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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