A rare differential for myalgia and fever associated with cervical and axillary lymphadenopathy presenting via same-day emergency care (SDEC)
Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting necrotising lymphadenitis, with very few reported cases in the UK. It presents mainly in young adults with non-specific symptoms, such as fever, cervical lymphadenopathy, night sweats, weight loss and myalgia. Given its rarity and overlapping f...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
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| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825000727 |
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| Summary: | Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting necrotising lymphadenitis, with very few reported cases in the UK. It presents mainly in young adults with non-specific symptoms, such as fever, cervical lymphadenopathy, night sweats, weight loss and myalgia. Given its rarity and overlapping features with malignancy, viral and autoimmune conditions, diagnosis requires histological confirmation via lymph node biopsy. Management is primarily supportive with non-steroidal anti-inflammatory drugs (NSAIDs) and/or a tapering course of steroids.We report the case of a 23-year-old White woman with a background of Hashimoto's thyroiditis. The patient presented to our same-day emergency care (SDEC) on 9 April 2024 with a 6-week history of multiple systemic symptoms, including myalgia, fevers and weight loss. The patient described her myalgia as so severe that it had left her predominantly bedbound for the preceding 6 weeks.Initial blood tests revealed normocytic anaemia, leukopenia, abnormal liver function tests and a raised erythrocyte sedimentation rate.During her admission, the patient was initially treated with antibiotics and blood transfusions. A wide range of autoimmune, malignant and infectious differential diagnoses were considered, with early working diagnoses of autoimmune hepatitis, systemic lupus erythematosus, Epstein–Barr Virus (EBV) and lymphoma.CT imaging revealed bulky lymphadenopathy in the axilla and further enlarged lymph nodes in the retroperitoneum suspicious for lymphoma, prompting plans for a transfer to a specialist haematology oncology inpatient bed. A lymph node biopsy performed on 12 April 2024 initially reported some large histiocytic cells, reminiscent of Hodgkin’s lymphoma. A subsequent specialist review at UCLH confirmed the biopsy appearances were in keeping with Kikuchi's lymphadenitis. The patient was discharged on the 22 April 2024 with NSAIDs and a tapering course of prednisolone.The notable aspects of this case include the large range of non-specific presenting symptoms, a coexisting EBV infection, an underlying autoimmune disorder (Hashimoto's thyroiditis) and a diagnostic delay of 14 days with a long inpatient admission.The aetiology of KFD remains uncertain, with proposed autoimmune and infectious triggers. Several cases of KFD have been reported in association with autoimmune conditions, occurring before, after or simultaneously with their onset.KFD poses a diagnostic dilemma because the non-specific presentations prompt differentials from a range of varying aetiologies.This case underscores the diagnostic challenges posed by KFD, highlighting the importance of early histopathology for diagnosis confirmation. Consideration of KFD in patients presenting like this, alongside a timely lymph node biopsy, is critical to prevent unnecessary investigations, reduce patient distress and facilitate timely treatment. An early multidisciplinary approach involving haematology, gastroenterology and rheumatology is crucial to arrive at the correct diagnosis.Researching KFD revealed no specific national guidelines, with current management strategies focusing on symptomatic relief and supportive care. Our experience suggests a need for greater awareness among medical clinicians to consider KFD early in similar presentations. By sharing our experience, we hope to contribute to the boarder understanding of the clinical course of KFD and advocate for a more structured diagnostic approach. |
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| ISSN: | 1470-2118 |