SHM Converge Scientific Abstract ePoster Gallery-A Postpartum Puzzler

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A 28-year-old previously healthy woman developed persistent perineal pain and recurrent fevers beginning six weeks after a forceps-assisted vaginal delivery complicated by lacerations and hemorrhage. Early postpartum exams showed only mild vaginal pain and later perineal tenderness with yellow discharge and erythema, but no clear abscess or wound breakdown. By six weeks postpartum, she had ongoing intermittent fevers despite multiple antimicrobials, prompting a broad fever-of-unknown-origin workup involving infectious disease, rheumatology, hematology/oncology, and pathology.<br /><br />Her differential diagnosis included perineal soft tissue infection, septic pelvic thrombophlebitis, endocarditis, autoimmune disease, and non-Hodgkin lymphoma. Laboratory studies showed elevated inflammatory markers, mild anemia, leukopenia with lymphopenia, and elevated LDH and ferritin. Extensive infectious testing and blood cultures were negative, and flow cytometry and peripheral smear did not support lymphoma. Imaging revealed nonspecific pelvic findings, but PET/CT demonstrated intensely hypermetabolic multi-station lymphadenopathy above and below the diaphragm, raising concern for lymphoma or systemic inflammatory disease. A right submandibular lymph node biopsy showed histiocytic necrotizing lymphadenitis.<br /><br />She was ultimately diagnosed with Kikuchi-Fujimoto disease, a rare, benign, self-limited condition characterized by necrotizing lymphadenopathy and fever that can mimic infection, autoimmune disease, or malignancy. This case highlights the importance of considering Kikuchi-Fujimoto disease in postpartum patients with unexplained fever and lymphadenopathy to avoid unnecessary and prolonged treatment.

Asset Subtitle

Sahana Sarin

Meta Tag

Author List Katherine I. Harris, Sahana Sarin

Category Clinical Vignettes

Concept Kikuchi-Fujimoto disease

Concept Fever

Concept Lymphadenopathy

Concept Delivery

Concept Fever of Unknown Origin

Distinguished Non-Finalist

Presenter Organization Carver College of Medicine, University of Iowa

Presenting Author Sahana Sarin

Track Adult

Keywords

Kikuchi-Fujimoto disease

postpartum fever

necrotizing lymphadenitis

lymphadenopathy

fever of unknown origin

perineal pain

forceps-assisted vaginal delivery

PET/CT

histiocytic necrotizing lymphadenitis

lymph node biopsy

Kikuchi-Fujimoto disease

Fever

Lymphadenopathy

Delivery

Fever of Unknown Origin