A RARE CASE OF FEBRILE LYMPHADENOPATHY PRESENTING AS ASEPTIC MENINGITIS

Document Type

Conference Proceeding

Publication Date

6-23-2023

Publication Title

J Gen Intern Med

Abstract

CASE: 42-year-old female presented with a painful enlarged neck lymph node(LN), fever, night sweats, back pain, vomiting & rash(palm & soles) for three days. Patient was recently hospitalized, three weeks ago, for similar symptoms & treated for aseptic meningitis with clinical improvement. Currently, physical exam revealed tachycardia & palpable tender right cervical LN. Labs revealed anemia (Hb:8.8g/dl), leukopenia (WBC:2700/mm3), & elevated LFTs (AST:117, AST:53, ALP:214). Infectious workup including blood cultures, urinalysis, Quantiferon TB, aspergillus galactomannan, Histoplasma antigen, Blastomyces antigen, pneumocystis jiroveci IgG, Brucella (igG, IgM), Bartonella hensella (IgM, IgG), Q fever (IgG, IgM), syphilis serology, Francisella tularensis (IgG, IgM), Fungitell, VZV IgM, EBV IgM, CMV IgM, Hepatitis B, C & HIV were negative. Autoimmune labs revealed antinuclear antibody (Ab) of 1:320, dsDNA Ab, anti-histone Ab, anti- LKM Ab titer, antimitochondrial M2 Ab, anti-RNP Ab, antiSM Ab, anti-Ro & anti-La Ab were negative. C3 & C4 were within normal limits. CT scan of the chest abdomen pelvis demonstrated cervical lymphadenopathy with 2.5 cm in the largest dimension. The patient underwent a lymph node biopsy revealing benign necrotizing lymphadenitis with no evidence of lymphoma or metastatic process. She received high-dose steroids with clinical improvement. IMPACT/DISCUSSION: Kikuchi Fujimoto disease (KFD), an uncommon differential in febrile lymphadenopathy, resembles systemic lupus erythematosus(SLE) lymphadenitis, viral infections, bacterial adenitis & malignant lymphomas. Autoimmune & infectious workup was grossly negative. Histopathology differentiates KFD from lymphomas. KFD is a diagnosis of exclusion. Our patient was recently treated for aseptic meningitis, which is also an atypical presentation of KFD. Rash is common in KFD, although rash involving palms & soles is also seen in syphilis, coxsackie A virus & rickettsia but the remainder of the findings were less convincing for any of these infections. CONCLUSION: Kikuchi Fujimoto disease (KFD), a.k.a histiocytic necrotizing lymphadenitis, is a benign, self-limiting disease with unclear etiology & acute-subacute onset. It is more common in young, females & Asians. Symptoms include fever & lymphadenopathy, mostly posterior cervical group. Lymph nodes (LN) are painful, tender & swollen. Less frequent symptoms include nausea, vomiting & B-symptoms(chills, night sweats, weight loss). Atypical presentations include skin involvement & aseptic meningitis. Lab work may reveal cytopenia, elevated inflammatory markers & elevated liver function tests(LFTs). Diagnosis requires a lymph node biopsy. Management is conservative & steroids are used in severe cases.

Medical Subject Headings

Infectious Diseases

PubMed ID

Not assigned.

Volume

38

First Page

S416

Last Page

S417

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