Kikuchi-Fujimoto disease presenting in a patient with SARS-CoV-2: a case report

Samuel D Racette; Borislav A Alexiev; Michael P Angarone; Ajay Bhasin; Kaitlin Lima; Lawrence J Jennings; Senthil Balasubramanian; Akihiro J Matsuoka

doi:10.1186/s12879-021-06048-0

Kikuchi-Fujimoto disease presenting in a patient with SARS-CoV-2: a case report

BMC Infect Dis. 2021 Aug 3;21(1):740. doi: 10.1186/s12879-021-06048-0.

Authors

Samuel D Racette¹, Borislav A Alexiev², Michael P Angarone³, Ajay Bhasin^{4

5}, Kaitlin Lima⁶, Lawrence J Jennings², Senthil Balasubramanian⁷, Akihiro J Matsuoka^{8

9

10}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1325, Chicago, IL, 60611, USA. samuel.racette@northwestern.edu.
² Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
³ Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁴ Department of Medicine, Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁵ Department of Pediatrics, Division of Hospital Based Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁶ Department of Medicine, Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁷ NorthShore University Health System, Evanston, IL, 60201, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1325, Chicago, IL, 60611, USA.
⁹ Roxelyn and Richard Pepper Department of Communication Science Disorders, School of Communication, Northwestern University, Evanston, IL, 60208, USA.
¹⁰ Hugh-Knowles Hearing Center, Evanston, IL, 60208, USA.

Abstract

Background: We present a yet to be described association of SARS-CoV-2 infection with Kikuchi-Fujimoto disease.

Case presentation: A 32-year-old physician with history of SARS-CoV-2 infection presented to the emergency department with 2 weeks of fever, chills, and right sided cervical lymphadenopathy. He was treated empirically for presumed folliculitis with worsening of symptoms leading to repeat presentation to the emergency department. Extensive workup was unrevealing of an infectious cause and needle biopsy of the lesion was unrevealing. An excisional lymph node biopsy revealed follicular hyperplasia with necrotic foci showing abundance of histiocytes at the edge of necrosis with CD8 predominance of T-cells. Final diagnosis was deemed to be Kikuchi-Fujimoto disease. Antibiotic therapy was discontinued, and the patient's symptoms resolved with steroid therapy and expectant management.

Conclusions: This is the first report of a patient developing Kikuchi-Fujimoto disease following SARS-CoV-2 infection. Clinicians should be aware of Kikuchi-Fujimoto disease as a possibility when approaching patients with hyper-inflammatory states who present with cervical lymphadenopathy.

Keywords: COVID-19; Cervical lymphadenopathy; Kikuchi-Fujimoto Syndrome; SARS-CoV-2.

Publication types

Case Reports

MeSH terms

Adult
COVID-19*
Diagnosis, Differential
Histiocytic Necrotizing Lymphadenitis* / complications
Histiocytic Necrotizing Lymphadenitis* / diagnosis
Humans
Lymph Nodes
Lymphadenopathy* / diagnosis
Lymphadenopathy* / etiology
Male
SARS-CoV-2