Pulmonary Manifestations of Systemic Disease: Fellow Case Report Slide: Pulmonary Manifestations of Systemic Disease |

A Rare Case of Kikuchi-Fujimoto Diagnosed via Pleuroscopy and Endobronchial Ultrasound FREE TO VIEW

Amit Tandon, MD; Abhishek Singla, MD; Sadia Benzaquen, MD
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University of Cincinnati, Cincinnati, OH

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

Chest. 2016;150(4_S):1061A. doi:10.1016/j.chest.2016.08.1168
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SESSION TITLE: Fellow Case Report Slide: Pulmonary Manifestations of Systemic Disease

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 23, 2016 at 10:45 AM - 12:00 PM

INTRODUCTION: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphangitis is a self-resolving illness which was first described in 1972.1,3 Here we describe the first case of KFD diagnosed by medical pleuroscopy and endobronchial ultrasound (EBUS) with fine needle aspiration (FNA) and core biopsies.

CASE PRESENTATION: A 19 year-old Caucasian female presented to the emergency room with complaints of chest tightness for one month. Exam revealed dullness to percussion and diminished breath sounds over the posterior left back. There was no palpable lymphadenopathy. A CXR showed a left pleural effusion. A CT of the chest, abdomen and pelvic was obtained revealing mediastinal lymphadenopathy, a large pleural effusion and enhancing left paraspinal soft tissue along the pleural surface. Thoracentesis obtained 1100mL of lymphocytic predominant transudative fluid. She returned 2 weeks later with shortness of breath and a CXR revealed a large left pleural effusion. CRP and ESR were 235 mg/L and 55 mm/hr respectively. Other lab data obtained: HIV, ANA, ANCA, Anti-Sm, Anti-DNA, fungal serologies, toxoplasmosis, bartonella, EBV PCR returned negative. Pleuroscopy revealed 1700 mL of serous fluid and inflamed parietal pleura which was biopsied. FNA was obtained using the EBUS with a 21G needle from stations 4R, 7, and 10R and then a 22G esophageal needle for 2 core biopsies from station 7. Pathology from all sites revealed histiocytes and acute necrotizing lymphangitis. All cultures and cytology were negative. Steroids were started with symptomatic improvement within 48 hours and decreased CRP and ESR to 178 mg/L and 19 mm/hr.

DISCUSSION: She did not fit the classic features of KFD which includes cervical lymphadenopathy, leukopenia and fever. On the other hand, she had a transudative pleural effusion which in previous reported cases has been exudative. KFD is a diagnosis of exclusion via excisional biopsy. FNA has recently been used to help confirm the diagnosis.2

CONCLUSIONS: This case is the first time KFD was diagnosed via pleuroscopy and EBUS with FNA and core biopsy.

Reference #1: Fujimoto Y, et. al. Cervical subacute necrotizing lymphadenitis: a new clinicopathologic entity. Naika 1972, 20:920-927.

Reference #2: Hasan, M. et al. Fine-needle aspiration cytology of Kikuchi Fujimoto disease. Journal of Cytology/Indian Academy of Cytologists. 2009;26(1):43-45.

Reference #3: Kikuchi M. Lymphadenitis showing focal reticulum cell hyperplasia with nuclear debris and phagocytes: a clinicopathological study. Acta Hematol Jpn 1972, 35:379-380.

DISCLOSURE: The following authors have nothing to disclose: Amit Tandon, Abhishek Singla, Sadia Benzaquen

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