THE DIAGNOSTIC DILEMMA: KIKUCHI FUJIMOTO DISEASE; A CASE REPORT

Abstract

TYPE: Abstract TOPIC: Respiratory Care PURPOSE: Kikuchi Fujimoto Disease (KFD) is a rare condition. Handful of cases have been reported in literature. Studying and reporting KFD cases could enable clinicians in timely management of patients. METHODS: An 18 year old male referred to the Respiratory outpatient clinic from Emergency department following a mechanical fall while skating with right cervical lymphadenopathy and generalised pain. Blood tests: Unremarkable. Cervical X ray: Unremarkable. MRI scan: Conglomerate enlarged right level V lymph nodes (inflammatory/ granulomatous in aetiology). CT scan Neck and Chest:Right posterior cervical lymphadenopathy. US guided biopsy: Right neck lymph node (1.5x4cm). Negative for ZN stain. Serology sampling: CMV and HIV negative. Smear test: Negative for AFB showing necrotizing granulomatous lymphadenitis. Primary B cell follicles were CD20, CD79a, CD3 positive. T cells, macrophages were CD68 and myeloperoxidase positive. EBV (EBER) was negative. Anti-EBV capsid IgG and IgM were however detected. HPV B19 IgM was also detected. QuantiFERON TB gold assay test: to exclude latent TB infection was negative. RESULTS: Based on the extensive investigation panel, it was thus formally concluded that the clinical features and results were consistent with the rare diagnosis of Kikuchi's lymphadenitis. CONCLUSIONS: KFD is a very rare disease of benign nature. Cause being unknown, treatment is mainly symptomatic with the use of analgesics such as NSAIDS. Occasionally steroids are used. CLINICAL IMPLICATIONS: Patients presenting with KFD may go on to developing SLE later in life. Due to limited data, it becomes difficult to establish a clear link between the two conditions. Further studies on similarly presenting patients are hence encouraged. DISCLOSURE: Nothing to declare. KEYWORD: Kikuchi Fujimoto Disease (KFD)