Kikuchi-Fujimoto Disease: An Atypical Presentation of a Rare Disease

Kikuchi-Fujimoto's Disease or Histiocytic Necrotizing Lymphadenitis Following mRNA COVID-19 Vaccination: A Rare Case

Kikuchi-Fujimoto disease (KFD), also known as necrotizing histiocytic lymphadenopathy, is a rare and benign lymph node disorder that mainly occurs in young women. It is clinically characterized by fever with tender and painful cervical lymphadenopathy mostly; however, all areas of lymph nodes can be involved. This disorder is often mistaken for malignant lymphoma or infection. The precise pathophysiology of KFD remains unknown, but it is theorized that it may be post-viral or associated with an autoimmune disease. The diagnosis is based on the histological analysis of the excised involved lymph node. The treatment is mainly supportive with favorable outcomes within a few weeks or months.

In this case, we present a 24-year-old woman without a past medical history, who consulted for painful bilateral cervical lymphadenopathy associated with fever that has been evolving for one month following the coronavirus disease 2019 (COVID-19) vaccination. The initial diagnostic workup was performed and the diagnosis of KFD was confirmed based on the histopathological findings of the excised lymphadenopathy. Therapeutic management was based on oral corticosteroid treatment with clinical and radiological improvement after a few days without recurrence during follow-up.

This article aims to report a rare case of KFD in a patient after receiving the messenger ribonucleic acid (mRNA)-based COVID-19 vaccine. Therefore, this case highlights the possible association between COVID-19 vaccination and KFD and this should be considered in the differential diagnosis.

Bilateral preretinal hemorrhage associated with Kikuchi-Fujimoto disease

Purpose

To present a case of a patient with human immunodeficiency virus (HIV) disease and Kikuchi-Fujimoto disease (KFD) who presented with a unique pattern of retinopathy.

Observations

A 7-year-old Taiwanese girl with HIV disease who was recently diagnosed with KFD had a sudden onset of blurry vision in both eyes one month after her KFD systemic symptoms had relatively resolved. Ophthalmic examination showed decreased visual acuity in both eyes (OU). On fundus examination, she had bilateral preretinal, subhyaloid, and vitreous hemorrhage that was more severe than anemic retinopathy.

Conclusion

Ocular manifestations in Kikuchi-Fujimoto disease are rare; however, if they occur, presentations may vary. The exact etiology of the disease has remained elusive and controversial. This case is the first report of a patient with HIV disease and KFD presenting with ocular involvement. Furthermore, bilateral preretinal, subhyaloid, and vitreous hemorrhage, which was beyond anemic retinopathy, is an unprecedented manifestation of KFD that has not been previously reported. This case highlights the necessity for clinicians to consider all possible differential diagnoses when evaluating patients with similar findings to identify the best therapeutic approach and avoid unnecessary treatment.

Evaluation of a unilateral neck mass in a 16-year-old female: Kikuchi-Fujimoto disease with superimposed bacterial lymphadenitis

The evaluation of pediatric neck masses offers the opportunity for consideration of a diverse range of pathologies, from infectious to neoplastic. A 16-year-old female presented with 2 weeks of worsening swelling and pain of a left-sided neck mass. Findings were consistent with Epstein–Barr virus and cytomegalovirus coinfection, but considering profound lymphadenopathy of the supraclavicular, mammillary, and axillary chains, further investigations were undertaken. Hematopathologic examination demonstrated necrotizing lymphadenitis, consistent with Kikuchi-Fujimoto disease. A diagnosis of Kikuchi-Fujimoto disease alongside chronic bacterial lymphadenitis was made on the basis of her response to clindamycin, and the chronic course of her illness and subsequent persistence of the swelling managed on an outpatient basis. The case study describes the initial diagnostic considerations and management as well as a review of the disease pathology.