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

Keywords

antigen, antinuclear antibody, double stranded DNA antibody, endogenous compound, galactomannan, histone antibody, immunoglobulin G, immunoglobulin M, La antibody, ribonucleoprotein antibody, Ro antibody, Sm antibody, steroid, abdomen, adult, anemia, antibody titer, aseptic meningitis, Asian, aspartate aminotransferase level, Aspergillus, backache, Bartonella, Blastomyces, blood culture, body weight loss, Brucella, cancer patient, case report, cervical lymph node, cervical lymphadenopathy, chill, clinical article, conference abstract, cytopenia, drug megadose, drug therapy, Enterovirus A, female, fever, Francisella tularensis, fungus test kit, hepatitis B, histopathology, Histoplasma, human, Human immunodeficiency virus, Kikuchi disease, leukopenia, liver function test, lymph node biopsy, lymphadenitis, lymphadenopathy, lymphoma, Mycobacterium tuberculosis test kit, nausea and vomiting, night sweat, nonhuman, pelvis, physical examination, Pneumocystis jiroveci, Q fever, rash, Rickettsia, syphilis, syphilis serology, systemic lupus erythematosus, tachycardia, thorax, urinalysis, Varicella zoster virus, vomiting, x-ray computed tomography

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.

Volume

38

Issue

Suppl 3

First Page

S416

Last Page

S417

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