FUO and Kikuchi Fujimoto disease

We reviewed an interesting case of a young female who presented with >2 months of fever, unintentional weight loss, and tender cervical lymphadenopathy who had an extensive rheumatologic, infectious disease, and hematologic work up who was eventually found to have biopsy proven histiocytic necrotizing lymphadenitis or Kikuchi Fujimoto disease.

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Learning points:

See recent blog post from a case from the other side of the bridge for the definition of FUO and broad categories to help narrow the differential diagnosis (rheum/malignancy/infection/other).

  1. Histocytic necrotizing lymphadenitis (aka Kikuchi Fujimoto disease) is a rare condition that usually affects young women under 40 years old.
  2. Hallmarks of the disease include tender cervical lymphadenopathy and fever. It is postulated that this may be caused by an immune response of T cells to an infectious trigger, often viral.
  3. Lymph node biopsy shows paracortical foci of necrosis and histiocytic cellular infiltrate.
  4. Dr. Miller reviewed a series of case reports and there is no effective treatment, although NSAIDs and steroids have been used. It is generally a self-limited condition that typically resolves within weeks to months.