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Resident PGY 3
Henry Ford Hospital
A 34-year-old Bengali man with past medical history of hyperthyroidism presented to Dermatology with a red asymptomatic rash affecting the ears, face, and upper body for 1 year. He endorsed fever prior to onset of his rash as well as chronic muscle aches, joint pain, and fatigue over the past 2 months. Previous treatments, including prednisone taper, triamcinolone ointment, and oral clindamycin, led to no improvement in the appearance of his lesions or associated symptoms. Physical exam was remarkable for cervical and right axillary lymphadenopathy, erythematous indurated plaques and papules and hyperpigmented patches on the face and back, and tender and thin desquamative plaques with petechiae on the distal right plantar toes. Prior labs were significant for elevated presence of IgG viral capsid antibodies to EBV and EBV Nuclear antigen. Previous punch biopsy of the left arm by an outside dermatologist demonstrated superficial and deep perivascular chronic inflammatory infiltrate with interface dermatitis concerning for lupus erythematosus. However, repeat biopsy of the left medial cheek and left mid-back revealed dense lymphohistiocytic infiltrate in the superficial and deep dermis and lymphocyte karyorrhexis. CD4 and CD8 staining revealed a predominance of CD8 lymphocytes and Granzyme B positivity. T cell clonality studies were also executed and failed to detect a dominant clonal population. Given these histopathological findings and clinical presentation, a diagnosis of Kikuchi-Fujimoto's Disease was made. The patient was referred for lymph node biopsy for confirmation of this diagnosis. However, he had spontaneous resolution of lymphadenopathy and associated symptoms as well as improvement of his skin findings without therapy. We present this case to review the rare presentation of Kikuchi-Fujimoto's Disease, potential for misdiagnosis given variability in clinical presentation, and the potential role of dermatologists in aiding in this diagnosis.
Awosika, Olabola and McHargue, Chauncey A., "Kikuchi's Disease presenting as Lupus Erythematosus" (2020). Case Reports. 111.