COVID-19 in a case with Kikuchi-Fujimoto disease
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A 16-year-old girl was admitted to the hospital with a 6-month history of left cervical lymphadenopathy. At the beginning of the disease, the lymph nodes were painless with 0.5 cm size, but over time, they became mobile, rubbery, painful, and larger (About 2.5 cm). Three months after initial of symptoms, she had frequent fevers, night sweats, myalgia, and weight loss. One month later, the patient complained of hair loss and erythematous plaques on the face, limbs, and hands. The patient did not have any history of autoimmune or infectious disease before symptom onset.

CBC showed elevated erythrocyte sedimentation rate (ESR, 98 mm/h), lactate dehydrogenase (LDH, 865 IU/L), and C-reactive protein (CRP, 25 mg/dL). On the other hand, white blood count (WBC, 3600/mcL), red blood count (RBC, 3.3 million/mcL), hemoglobin (HB, 9 g/dL), and hematocrit were decreased. Immunoassay for autoimmune disease was 50 IU/mL for antidouble stranded DNA (anti-dsDNA) and 1/1000 titer for antinuclear antibody (ANA). Serology test was negative for rheumatoid factor (RF), human immunodeficiency virus (HIV), and hepatitis B and C. Blood culture to detect bacteria, fungi, or other common germs was also negative.

A core needle biopsy was performed from a 0.7 × 0.7 × 0.1 cm cervical lymph node under ultrasound guided. Immunohistochemistry assessment revealed cores of lymphoid tissue with well-defined paracortical necrotic lesions with nuclear debris. In addition, there was no infiltration of polymorphonuclear (PMN) leukocytes or plasma cells in microscopic examination. The diagnosis of Kikuchi-Fujimoto disease (KFD) was made for the patient.

The patient was initially supposed to be given prednisolone, but due to fever and cough, prednisolone was refused. The patient was re-admitted, and after PCR test, she was diagnosed with SARS-CoV-2. The patient underwent supportive treatment, and interestingly after 7 days, the cervical lymphadenopathy and skin rashes significantly improved.

To best knowledge, this is the first reported case of KFD, who was affected by COVID-19. Although the association of KFD and COVID-19 cannot be confirmed in this case, considering some cutaneous manifestations of COVID-19, such condition should not be missed.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3748?af=R
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