Pulmonary Manifestations of Systemic Disease: Pulmonary Manifestations of Systemic Disease |

Bilateral Lung Opacities as an Atypical Presentation of Kikuchi-Fujimoto Disease FREE TO VIEW

Asad Omar, MD
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St John Providence Hospital, West Bloomfield, MI

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A464. doi:10.1016/j.chest.2016.02.483
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SESSION TITLE: Pulmonary Manifestations of Systemic Disease

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 08:30 AM - 09:30 AM

PURPOSE: Kikuchi-Fujimoto disease (KFD) is a rare disorder, thought to be viral in etiology, characterized mostly by tender cervical lymphadenopathy which can be accompanied with fever and night sweats. KFD has a higher prevalence among Japanese individuals and extensive literature search resulted in less than 30 fully described cases in the United States with even fewer cases presenting predominantly with respiratory symptoms. Its recognition however is important so as not to be confused with other disorders such as systemic lupus (SLE), malignant lymphoma, or pneumonia, as treatment for KFD is supportive.

METHODS: We report a case of a 21 year old African American female who presented with fever and cough initially treated as pneumonia due to bilateral lung opacities on CT Thorax. Axillary lymphadenopathy on CT scan was also noted, biopsy of which revealed KFD.

RESULTS: The patient is a 21 year old female who presented for fevers and worsening shortness of breath over the past month. She had a Tmax of 101 and O2 saturation of 93% on 4L. Physical examination revealed diminished breath sounds. Lab values were unremarkable. Chest X-Ray revealed bilateral opacities. CT scan of the thorax with contrast was negative for pulmonary embolus but showed diffuse lower lobe opacities. Numerous enlarged axillary lymph nodes measuring up to 1.2cm were also noted. She was initially started on ceftriaxone and azithromycin for pneumonia. She was transferred to ICU due to worsening respiratory status and had to be intubated. The antibiotics were switched for broad spectrum coverage. A bronchoscopy revealed no significant findings. Extensive infectious and rheumatologic workup including HIV remained negative. As no significant improvement was noted, an axillary lymph node biopsy was done to rule in other causes, findings of which came back consistent with KFD. Supportive treatment with symptomatic improvement was ongoing at the time of this report.

CONCLUSIONS: KFD is a self-limiting disease that has predominantly been described in the Japanese population. We report a case of a 21 year old African American female who presented with predominantly respiratory symptoms found to have KFD.

CLINICAL IMPLICATIONS: This case highlights the importance of recognizing the diagnosis of KFD even with atypical presentations since it can be confused with SLE, malignant lymphoma, or pneumonia, as the treatment for each entity is different. It is also important to follow up these patients as they do have a higher incidence of developing SLE in the future.

DISCLOSURE: The following authors have nothing to disclose: Asad Omar

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[Kikuchi-Fujimoto disease in an atypical site]. Arch Bronconeumol 2009;45(7):359-60.
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