Tender Lymphadenopathy Research Articles

Kikuchi–Fujimoto disease and primary Sjögren’s syndrome coexisting: A case-based literature review

ABSTRACT Kikuchi–Fujimoto Disease (KFD), also known as Kikuchi histiocytic necrotising lymphadenitis, is an extremely rare and benign condition that mostly affects young women. It is characterised by lymph node involvement with a predilection for the cervical region, commonly presenting with tender lymphadenopathy and a low-grade fever. The diagnosis requires excisional lymph node biopsy with immunohistochemical analysis. KFD is mostly self-limiting within a few weeks to months, with only some patients requiring symptomatic relief with non-steroidal anti-inflammatory drugs or corticosteroids, and a minority developing recurrent episodes of the disease. Importantly, it has been reported in association with systemic lupus erythematosus and, to a lesser extent, other immune-mediated inflammatory rheumatic diseases, such as Sjögren’s syndrome, whose clinical presentation itself may include lymphadenopathy. In this paper, we present an unusual case of a woman with primary Sjögren syndrome (pSS) and a past medical history relevant for lymphoma, sarcoidosis, and thymoma, who later developed KFD, a particularly challenging diagnosis in this setting. We then performed a literature review of the association between KFD and pSS, gathering a total of 13 patients, and focusing epidemiological, clinical, and laboratory data.

First case of mpox diagnosed in Queensland, Australia: clinical and molecular aspects.

First case of mpox diagnosed in Queensland, Australia: clinical and molecular aspects.

Diagnosis Based on History, Not Examination

Cat scratch disease (CSD), caused by the bacterium Bartonella henselae, is usually self-limiting, presenting with low-grade fever and tender lymphadenopathy. With delayed diagnosis or reactivation of latent disease, CSD is associated with severe debilitating symptoms. We are presenting a patient who proved adiagnostic challenge, before being found to have reactivation of Bartonella henselae, requiring three-months IV Trimethoprim-Sulfamethoxazole andHydrocortisone.

Clinical Profile of Scrub Typhus among Paediatric Age Group in a Tertiary Care Center

Introduction: Scrub typhus, a dreaded disease in the pre-antibiotic era, was a serious military disease that killed thousands of people in the Far East during WWII. It is a zoonosis that is common throughout Asia and the Pacific Islands. Scrub typhus is a febrile illness characterized by a wide range of symptoms and indications. This disease has a wide spectrum of clinical symptoms, from subclinical through organ failure to death. The objective of this study was to assess the clinical profile of scrub typhus infection among children in a tertiary care hospital in south India.
 Methodology: This is a retrospective study of the clinical profile of 50 paedriatric children, who were admitted in the Paediatric ward of a tertiary care hospital, during the study period of JAN 2020 to DEC 2020.
 Results: All children presented with fever. Other common symptoms were vomiting (56%), facial swelling (52%), cough (35%), abdominal pain (33%), breathlessness (29%) and decreased urine output (29%). High grade fever (>101 oF) was recorded in 91% of children. Other common signs were hepatomegaly, splenomegaly, edema, tender lymphadenopathy and hypotension, observed in 82%, 59%, 39%, 38% and 36% of cases, respectively. An eschar and a maculopapular rash each were observed in 20% of patients. Within 48 hours of starting an appropriate antibiotic, 90% of the children became afebrile. Overall, there was a 7.5 percent mortality rate. Refractory shock, meningoencephalitis, acute respiratory distress syndrome, bronchopneumonia, acute renal damage, and myocarditis were among the causes of mortality.
 Conclusion: In any febrile child with a maculopapular rash, hepatosplenomegaly, tender lymphadenopathy, thrombocytopenia, or symptoms indicative of capillary leak, paediatricians should have a high index of suspicion for scrub typhus. Pending serological confirmation, empirical therapy with doxycycline or azithromycin should be initiated immediately, since any delay in treatment could lead to life-threatening consequences.

Subcutaneous panniculitis-like T cell lymphoma in children. Case report and literature review.

Subcutaneous panniculitis-like T cell lymphoma (SPTCL) is a rare peripheral T cell lymphoma presenting with tender nodules. We report a case of a 5-year-old boy who presented with tender nodules, lymphadenopathy, hepatosplenomegaly and pancytopenia and was treated with oral corticosteroids and cyclosporine. The report highlights the rarity of this case, associated features and response to corticosteroids and cyclosporine.

Prevalence and antibiotics susceptibility profiles of Streptococcus pyogenes among pediatric patients with acute pharyngitis at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia

BackgroundStreptococcus pyogenes (S. pyogenes) is a Gram positive bacterium which is a leading cause of pharyngitis, skin and soft tissue infection and post streptococcal syndromes. Due to lack of β-lactamase enzyme production, it was considered universally susceptible to penicillin group and later generation of β-lactam antibiotics. As such, empirical treatment was common which might leads to development of antibiotics resistance. Therefore, the aims of this study were to determine the prevalence, antibiotics susceptibility profile; and associated factors of S. pyogenes among pediatric patients with acute pharyngitis in Felege Hiwot Comprehensive Specialized Hospital (FHCSH), Northwest Ethiopia.MethodsHospital based cross-sectional study was carried out on 154 pediatric patients, whose age ranged from 0 to 18 years old using consecutive convenient sampling technique from 1st February to 19th June 2020 at FHCSH. S. pyogenes were identified by throat swab culture on 5% sheep blood agar with an overnight incubation at 37 °C in candle jar containing 5% CO2. Gram stain, catalase test and bacitracin test were used to identify S. pyogenes. Then,the data were entered into EpiData version 3.1 and analyzed by SPSS version 20 software. Finally, stepwise, bivariable and multivariable logistic regressions were carried out for identifyying factors having significant ssociation (p<0.05) with acute pharyngitis. ResultsFrom the total throat swabs, 14 (9.1%) with (95% CI; 4.5–14.3) were culture positive for S. pyogenes. From these, all isolates were sensitive to penicillin and ampicillin. On the otherhand, 4 (35.7%), 4 (35.5%), 3 (21.4%), 2 (14.3%), 1 (7.1%), 7 (50.0%) and 1 (7.1%) isolates were resistant for ceftriaxone, vancomycin, erythromycin, tetracycline, chloramphenicol, clindamycin and levofloxacin, respectively. The presence of any smoker in home showed significant association with S. pyogenes acute pharyngitis. Furthermore, having tender lymphadenopathy and recurrence were clinical predictors for S. pyogenes acute pharyngitis (P < 0.05).ConclusionThe prevalence of S. pyogenes was guaged at 9.1% which is considered as low prevalence. All S. pyogenes isolats remain sensitive to penicillin. However, resistance was reported to clindamycin 7 (50.0%), ceftriaxone 5 (35.7%) and erythromycin 3 (21.4%). The current practice of giving erythromycin, clindamycin instead of penicillin and ampicillin is againest the microbiology result. Therefore, current empirical treatment of acute pharyngitis shall take in to account the current evidences. Continuous surveillance of antibiotics resistance pattern of S. pyogenes for acute pharyngitis must be strengthen to improve the use of antibiotics in hospitals.

COVID‐19 associated Kikuchi‐Fujimoto disease

We discuss the case of a 17-year-old male who presented with painful lymphadenopathy, fevers, weight loss, anorexia and a history of preceding anosmia. Histological features on lymph node biopsy were in-keeping with Kikuchi-Fujimoto disease (KFD). We later confirmed SARS-CoV-2 (COVID-19) infection on antibody testing. This case describes an atypical presentation of COVID-19 in a young patient and highlights an association between the virus and this rare disease.

Pediatric Bartonella Infection (Cat Scratch Disease) Presenting as Inguinal Lymphadenopathy

Cat scratch disease is an infectious disease resulting from inoculation of Bartonella species through a cat scratch or bite, often presenting as an erythematous papule at the site of inoculation with nearby painful lymphadenopathy. The diagnosis of this disease is complicated by a wide variety of clinical presentations, as the primary lesion may not be initially noticed. Furthermore, cervical and axillary lymph nodes are the most commonly involved regions of tender lymphadenopathy, but there have been reported cases that do not fit the typical clinical picture – such the case discussed in this report of a pediatric Bartonella henselae infection that initially presented as left inguinal lymphadenopathy with underlying necrosis and abscess formation. In this case, a 9-year-old boy presented to the ED with a 4-day history of increasing mass in the left groin, as well as a subjective fever for the previous 2 days. An ultrasound revealed a necrotic abscess in the left inguinal lymph node which necessitated empiric antibiotic therapy and surgical excision; titers revealed a recent infection with Bartonella henselae. Atypical presentations of cat scratch disease, such as inguinal lymphadenopathy, have historically confounded the diagnosis. However, positive serology studies ultimately yielded the correct diagnoses in these children. Given that cat scratch disease can present in an atypical fashion in approximately 5 - 25% of cases, physicians should keep the disease on the differential even when presented with rare presentations such as inguinal lymphadenopathy; serological testing for B. henselae can be utilized once more likely etiologies have been ruled out.

A case of systemic cryptococcosis in an immunocompromised host : A chance diagnosis by FNAC

A case of systemic cryptococcosis in an immunocompromised host : A chance diagnosis by FNAC - ACHR- Print ISSN No: - 2581-5725 Online ISSN No:- 2456-9267 Article DOI No:- 10.18231/j.achr.2019.065, IP Archives of Cytology and Histopathology Research-IP Arch Cytol Histopathol Res

A teenager with Kikuchi-Fujimoto disease and brachial plexus neuritis

Introduction: Kikuchi- Fujimoto disease (KFD) is a benign and self-limiting condition of unknown etiology. Neurologic manifestations involving the brachial plexus is extremely rare with only two cases reported in adults. We hereby present the first case in pediatrics and review the literature on the subject. Case: A 14 years old female of Iraqi descent presented with right neck swelling and pain for 3 weeks duration but no fevers. There was limited range of motion of the neck as well as significant persistent tender lymphadenopathy in the right post-auricular and posterior cervical chains. The rest of the physical examination was unremarkable. …

Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice.

Background and Aims:Antibiotics are frequently prescribed for sore throat in developing countries, that in turn leads to huge healthcare expenditure and their irrational use may lead to antimicrobial resistance in the community. The aim of this study is to investigate the effect of environmental factors on the frequency of occurrence of group A beta hemolytic streptococcus (GABHS) sore throat and to work out enhancing effect on the sensitivity and specificity and positive predictive value of the signs and symptoms of GABHS sore throat for facilitation of rational antibiotic use.Settings and Design:This was a prospective, cross sectional study conducted over period of one year in Pediatric Outpatient Department (OPD) of a Tertiary care teaching hospital.Methods:All the children between the age of 5 years and 15 years of age presenting in OPD with the signs and symptoms of sore throat were included in the study.Statistical Analysis Used:Statistical analysis was carried out by using Statistical Package for Social Sciences software and statistical tests of Pearson's Coefficient, Chi-square Test, Fischer's Test, Likelihood Ratio, Odds Ratio, and ROC Curve were applied.Results:Out of 225 children of the study group, 153 (68%) of the children were in the 5-10 years’ age group. Positive throat swab culture was found to be positively associated with high grade fever, pain in throat while swallowing, severely enlarged tonsils, tender lymphadenopathy, poor housing condition, fuel used for cooking, and presence of smoker in house.Conclusions:The study stresses on the need of carefully evaluating children presenting with the symptoms of sore throat as majority of the cases may be viral and thus, self-limiting. Poor housing conditions and indoor pollution contribute to the increased prevalence of sore throat.

Lymphatic involvement in Chikungunya patient in Cardiovascular Practice

Chikungunya virus (CHIKV) is an RNA alphavirus of the Togaviridae family that produces an acute febrile illness in humans followed by Joint pain, Itchy rash and leg swelling. This emerging virus has caused several large outbreaks in parts of Africa, Asia, and the Indian Ocean Islands and more recently in the Caribbean. This study was done from December 2015 to November 2016 on 24 confirmed Chikungunya patients with leg swelling. Peripheral vascular duplex study was done in every patients to find out the cause of leg swelling. Unilateral leg swelling 83% and Bilateral leg swelling 17%. Lower limb vascular Duplex was done in all patients. Moderate resersible lymphatic oedema in subcutaneous tissue of lower limb was found in 22 patients only. 2 patients had cellulites with mild lymphatic swelling. DVT was absent. There was mild reduction of peak systolic arterial flow in 13 patients which is secondary to pressure effect of lymphedema and leg swelling. 16 patients had non tender lymphadenopathy (&gt;1cm in diameter), 2 had tender lymphadenopathy in inguinal region and no enlarged lymph glands was observed in rest of the 6 patients. 6 patients had neutropenia and 8 had lymphopenia. Gradual improvement of symptoms was observed with conservative treatment. Lymphedema is reversible and conservative therapy is appropriate. And Non tender lymphadenopathy does not require treatment.University Heart Journal Vol. 13, No. 1, January 2017; 13-16

Scrub typhus: A common rickettsial disease emerging in a new geographical region of north India

Scrub typhus is a commonly encountered rickettsial disease of the Indian subcontinent. In India, scrub typhus is being now reported from several areas where it was previously unknown. We report clinical profile and complications of an outbreak of scrub typhus in children from the north Indian state of Uttarakhand, a region not previously known to have endemic disease. We describe the results of a prospective observational study of children with scrub typhus, at a tertiary hospital during the year 2013. The diagnosis was confirmed serologically by an IgM ELISA test. Sixty-two children were diagnosed with scrub typhus. All presented with fever. Other common symptoms were vomiting (59%), facial swelling (53%), cough (24%), abdominal pain (35%), breathlessness (26%) and decreased urine output (21%). High grade fever (> 101 o F) was recorded in 95% of the children. Other common signs observed in cases of scrub typhus were hepatomegaly (77%), splenomegaly (63%), edema (37%), tender lymphadenopathy (42%) and hypotension (35%). An eschar was observed in 23% of patients. Meningoencephalitis (30.6%), severe thrombocytopenia (27.4%), shock (17.7%), hepatitis (16.1%) and acute kidney injury (11.3%) were the most commonly encountered complications. Eighty-seven percent of children became afebrile within 48 hours of initiating an appropriate anti- biotic. Median time to defervescence was 24 hours. The overall mortality rate was 6.4%. Pediatricians should keep a high index of suspicion for scrub typhus in any febrile child having a maculopapular rash, hepatosplenomegaly, lymphadenopathy, thrombocytopenia and features suggestive of capillary leak. Pending serological confirmation, early empirical therapy with doxycycline or azithromycin should be started, as delay in treatment would result in life threatening complications.

Longitudinally extensive transverse myelitis: a rare association with common variable immunodeficiency

Transverse myelitis requires careful investigation, as although many causes respond acutely to immunomodulation, the longer term management depends upon its precise cause. We describe a patient presenting acutely with a...

Efficacy of Australian red-back spider (Latrodectus hasselti) antivenom in the treatment of clinical envenomation by the cupboard spider Steatoda capensis (Theridiidae)

We describe the first Steatoda capensis envenomation treated with CSL red-back spider antivenom (RBSAV). The patient, a 51-year-old female, developed acute local pain, swelling, redness, and diaphoresis in association with tender lymphadenopathy and hypertension. These features responded, in a dose-dependent manner, to RBSAV. In vitro studies confirmed that RBSAV could neutralize S. capensis venom at equivalent concentrations required to neutralize red-back spider (Latrodectus hasselti) venom. Similar data were obtained using Mexican Latrodectus mactans antivenom (Aracmyn®). Although S. capensis yielded similar quantities of venom protein as L. hasselti, pooled S. capensis and Steatoda grossa venom was more rapidly toxic to insects than either L. hasselti or Latrodectus tredecimguttatus venom. By contrast, both Latrodectus venoms were more potent than S. capensis venom in contracting rat isolated mesenteric arteries. Size-exclusion and anion-exchange chromatography was used to purify a 130 kDa fraction from S. capensis venom that induced contracture and loss of twitch tension in chick isolated biventer cervicis nerve-muscle preparations in a manner similar to α-latrotoxin. This activity was abolished by pre-incubation with RBSAV. We conclude that ‘steatodism’ may overlap more closely with latrodectism than previously recognized and that this bite should be managed in the same way as for Australian red-back envenomation.

PReS-FINAL-2212: Mevalonate kinase deficiency: different faces with separate treatments

Mevalonate kinase deficiency-associated periodic fever is a systemic autoinflammatory disease caused by mutations in the mevalonate kinase gene (MVK), previously named hyper-IgD syndrome due to its characteristic increase in serum IgD level. The patients suffer recurrent fever attacks every 2-8 weeks beginning from infancy, often precipitated by immunizations, infections or emotional stress. Fever lasts 2-7 days and can be accompanied by malaise, headache, diarrhea, abdominal pain, vomiting, skin rashes, arthralgia, arthritis, tender lymphadenopathy and hepatosplenomegaly. Fever attacks usually respond to the administration of steroids. However, increasing frequency of fever episodes with steroid use and the natural chronic disease course may require a continuous long-term treatment. Colchicine, cyclosporine, thalidomide and statins are not effective. A TNF-α blocking agent etanercept and IL-1 blocking agents anakinra and canakinumab have been demonstrated to reduce the frequency of fever attacks in MKD. The course and severity of the disease may be quite different.

P02-008 - Dramatic response to canakinumab in MKD

Mevalonate kinase deficiency-associated periodic fever (MKD) is a systemic autoinflammatory disease caused by mutations in the mevalonate kinase gene (MVK), previously named hyper-IgD syndrome due to its characteristic increase in serum IgD level. The patients suffer recurrent fever attacks every 2-8 weeks beginning from infancy, often precipitated by immunizations, infections or emotional stress. Fever lasts 2-7 days and can be accompanied by malaise, headache, diarrhea, abdominal pain, vomiting, skin rashes, arthralgia, arthritis, tender lymphadenopathy and hepatosplenomegaly. Fever attacks usually respond to the administration of steroids. However, increasing frequency of fever episodes with steroid use and the natural chronic disease course may require a continuous long-term treatment. Colchicine, cyclosporine, thalidomide and statins are not effective. A TNF-α blocking agent etanercept and an IL-1 blocking agent anakinra have been demonstrated to reduce the frequency of fever attacks in MKD. Canakinumab is a human monoclonal antibody targeted at interleukin-1 beta. Here, we report a 6-year-old boy with MKD who had a dramatic response to canakinumab.

Plague: History and contemporary analysis

Plague has caused ravaging outbreaks, including the Justinian plague and the "black death" in the Middle Ages. The causative agents of these outbreaks have been confirmed using modern molecular tests. The vector of plague during pandemics remains the subject of controversy. Nowadays, plague must be suspected in all areas where plague is endemic in rodents when patients present with adenitis or with pneumonia with a bloody expectorate. Diagnosis is more difficult in the situation of the reemergence of plague, as in Algeria for example, told by the first physician involved in that outbreak (NM). When in doubt, it is preferable to prescribe treatment with doxycycline while waiting for the test results because of the risk of fatality in individuals with plague. The typical bubo is a type of adenitis that is painful, red and nonfluctuating. The diagnosis is simple when microbiological analysis is conducted. Plague is a likely diagnosis when one sees gram-negative bacilli in lymph node aspirate or biopsy samples. Yersinia pestis grows very easily in blood cultures and is easy to identify by biochemical tests and MALDI-TOF mass spectrometry. Pneumonic plague and septicemic plague without adenitis are difficult to diagnose, and these diagnoses are often made by chance or retrospectively when cases are not part of an epidemic or related to another specific epidemiologic context. The treatment of plague must be based on gentamicin or doxycycline. Treatment with one of these antibiotics must be started as soon as plague is suspected. Analysis of past plague epidemics by using modern laboratory tools illustrated the value of epidemic buboes for the clinical diagnosis of plague; and brought new concepts regarding its transmission by human ectoparasites.

Systemic Mycobacterium avium Complex Infection During Antitumor Necrosis Factor‐α Therapy in Pediatric Crohn Disease

Systemic <i>Mycobacterium avium</i> Complex Infection During Antitumor Necrosis Factor‐α Therapy in Pediatric Crohn Disease

Pseudomonas Mastitis Caused by Hot Tub Exposure

To the Editors: Mastitis most frequently occurs in relation to lactation, whereas nonlactational mastitis is rare in adolescents.1 We report a case of an 11-year-old prepubertal girl presenting with mastitis caused by Pseudomonas aeruginosa after using a hot tub. The patient presented to hospital with a 3-day history of left-sided mastalgia and breast swelling. Twenty-four hours after onset, she developed a widespread pustular, erythematous rash affecting her trunk, groin area, thighs, and upper arms, but sparing her face and neck. It first appeared on her abdomen in a single area, and then became widespread over a 24-hour period. She had no systemic symptoms. Four days before presenting to the hospital, she had shared a hot tub with several other people at a friend's house. Several children and one adult also noted a similar rash, but no one developed mastalgia or mastitis. Breast examination demonstrated a tender left breast, with overlying mild erythema. She had associated tender lymphadenopathy in the left axilla. There were no signs of a breast abscess. She also had a widespread symmetrical papulopustular rash affecting her trunk, groins, upper thighs, and upper arms. The pustules varied in size, but were not larger than 4 mm in diameter. The rash was not itchy, but several of the pustules were tender. A blood sample was obtained for assessment of a full blood count, urea and electrolytes, and C-reactive protein level. A swab was obtained from a pustule for microscopy, culture and sensitivity. The blood test results were within normal range, except for a slightly elevated C-reactive protein level of 11 mg/L (normal range, 0–10 mg/L). She was treated with oral flucloxacillin and regular analgesia for the mastitis. Clinical review after 48 hours revealed no improvement in her symptoms. A dermatology opinion was sought for the rash, and a literature search revealed an association between Pseudomonas folliculitis, the suspected clinical diagnosis for the rash, and mastitis. The results of the swab culture, reported on that day, identified P. aeruginosa. The antibiotic was changed to oral ciprofloxacin, as per sensitivity, and 24 hours later the rash had improved dramatically. There was complete resolution of the Pseudomonas folliculitis after 1 week. The mastitis had improved greatly, but there was still some mild tenderness, which settled after a few days. A swab obtained from a pustule of the patient's younger brother also identified P. aeruginosa. The other children who developed a rash did not attend hospital, and their symptoms resolved spontaneously within a few days. The association of mastitis with Pseudomonas folliculitis does not appear to be well recognized among clinicians treating either condition. In our patient, it is probable that the mastitis occurred as a direct result of infection of the mammary gland or glands of Montgomery.2,3 Her breasts were enlarging because of the influence of pubertal hormones, increasing their susceptibility to infection,4 and the high bather load and occlusion of her swimming costume made her susceptible to the development of infection with Pseudomonas.2,5 Susannah M. C. George, MRCP Department of Dermatology Brighton and Sussex University Hospitals NHS Trust Jaspal Rattan, MRCGP Department of Paediatrics Western Sussex Hospitals NHS Trust Katy Walker, MRCPCH Department of Paediatrics Brighton and Sussex University Hospitals NHS Trust Brighton, United Kingdom Anil Garg, FRCPCH, FRCPI Department of Paediatrics Western Sussex Hospitals NHS Trust Worthing, United Kingdom