SESSION TITLE: Infectious Disease Cases III
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Monday, October 28, 2013 at 04:15 PM - 05:15 PM
INTRODUCTION: We describe a case of KFD presenting with left axillary lymphadenopathy following influenza vaccination.
CASE PRESENTATION: A 45-year-old healthy woman with no PMH was admitted to the hospital with complaints of fever, night sweats and poor oral intake for 2 weeks. The patient had been well until 2 months earlier, when she had an influenza vaccine and soon after noted repeated spikes in fever with chills. She tried ibuprofen, acetaminophen and azithromycin course before being admitted to the hospital. The only other complaint was a swelling in the left axilla 2 days prior to admission. A physical exam revealed a temp of 39.5 C, no hepatosplenomegaly and tenderness in the left axilla. Lab test results showed decreased WBC and elevated ESR. Rest of the work-up is listed out in the table. CT scan of the chest with contrast revealed multiple enlarged lymph nodes (LN) measuring up to 3 cm in largest dimensions, localized in the left axilla. She underwent excisional LN biopsy. The pathology report of the LN revealed lymphoid tissue with extensive geographic necrosis suggestive of KFD. She was discharged home and initially felt better after excisional biopsy, only to note recurrence of fevers and chills within a week. She was treated with low dose prednisone starting at 0.2mg/kg/day with dramatic improvement in symptoms and no recurrence.
DISCUSSION: KFD is commonly seen in younger women. It usually presents with fever (prominent symptom) and cervical lymphadenopathy. It can mimic serious conditions. It’s an idiopathic disease, with possible viral and autoimmune etiology. To the best of our knowledge, the above patient encounter is the first reported case of KFD following influenza vaccination. It is also rare for KFD to present as isolated axillary lymphadenopathy. KFD has been reported to coincide with, precede or follow a diagnosis of SLE. There is no effective treatment for KFD. The signs and symptoms typically resolve in 1-4 months with recurrence being common in the first year. Glucocorticoids (1mg/kg/day) have been shown to have some benefit in severe forms.
CONCLUSIONS: KFD is an uncommon cause of lymphadenopathy that is rare and benign. Awareness of this disorder is essential in preventing unnecessary emotional and mental distress associated with labeling a patient as having a more serious condition such as lymphoma or SLE. Further studies are needed to check for any association between KFD and vaccinations.
Reference #1: Vivekanandarajah A, et al. Kikuchi’s Disease: A rare cause of fever and lymphadenopathy. Clinical medicine insights: Pathology 2012:5 7-10.
DISCLOSURE: The following authors have nothing to disclose: Amareshwar Podugu, Margaret Kobe
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