SHM Converge Scientific Abstract ePoster Gallery-Histiocytic Necrotizing Lymphadenitis: Kikuchi-Fujimoto Disease

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A 22-year-old woman with asthma presented with fever of unknown origin that began as a brief self-limited febrile illness with malaise on May 21, 2023, then recurred persistently starting June 3. After an outpatient visit on June 10, she was empirically treated with cefdinir for presumed sinusitis, but her fever continued. She came to the Emergency Department on June 13 with recurrent fever, tachycardia, diffuse abdominal and back pain, nausea, and mild sinus pain, without respiratory, urinary, gastrointestinal, rash, joint, or edema symptoms. She had no recent travel, exposures, sick contacts, or recent sexual activity, and her only pet was a dog. She was admitted for further evaluation.<br /><br />During hospitalization, she remained febrile most days, with a maximum temperature of 39.8°C and last documented fever on June 24. Examination showed fever, tachycardia, and axillary lymphadenopathy. Because the presentation was nonspecific, a broad workup was pursued. Extensive infectious testing was negative, including respiratory viral panel, strep PCR, blood and urine cultures, HIV testing, EBV and CMV PCR, tick-borne studies, tuberculosis testing, toxoplasma, adenovirus, chlamydia/gonorrhea, and other serologies. Rheumatologic and hematologic studies showed elevated ferritin, ESR, CRP, LDH, GGT, and mild triglyceride elevation, with a positive RNP antibody but negative ANA, dsDNA, RF, complement, SSA/SSB, and Sm antibodies.<br /><br />Imaging did not identify an infectious source: CTA chest showed enlarged bilateral axillary nodes, CT abdomen/pelvis and facial imaging were unrevealing, MRI spine excluded osteomyelitis or epidural abscess, and chest X-ray was normal. Lumbar puncture showed lymphocytic CSF without evidence of infection or malignancy, making meningitis/encephalitis unlikely. HLH was considered but not supported by the degree of ferritin elevation, absence of cytopenias, or splenomegaly.<br /><br />Ultimately, a left axillary lymph node biopsy on June 22 demonstrated necrotizing histiocytic lymphadenitis, confirming Kikuchi-Fujimoto disease. She improved with prednisone and NSAIDs and was discharged afebrile with follow-up.

Asset Subtitle

Gilmer Rodriguez

Meta Tag

Author List Gilmer Rodriguez, Lourdes Rodriguez

Category Clinical Vignettes

Concept Fever of Unknown Origin

Concept Kikuchi-Fujimoto disease

Concept Lymph Node Biopsy

Concept Diagnostic Workup

Concept Infectious Disease Testing

Distinguished Non-Finalist

Presenter Organization University of Chicago Medicine

Presenting Author Gilmer Rodriguez

Track Adult

Keywords

Kikuchi-Fujimoto disease

necrotizing histiocytic lymphadenitis

fever of unknown origin

axillary lymphadenopathy

prednisone

NSAIDs

elevated ferritin

lymphocytic cerebrospinal fluid

negative infectious workup

young woman with asthma

Fever of Unknown Origin

Kikuchi-Fujimoto disease

Lymph Node Biopsy

Diagnostic Workup

Infectious Disease Testing