Case report
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) (Figure 1a). 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 (Figure
1b-1c). The patient did not have any history of autoimmune or infectious
disease before symptom onset.
Complete blood count showed elevated erythrocyte sedimentation rate
(ESR, 98 mm/h), lactate dehydrogenase (LDH, 865 IU/L), 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
were 50 IU/mL for Anti-double stranded DNA (Anti-dsDNA) and 1/1000 Titer
for Antinuclear Antibody (ANA). Serology test was negative for
rheumatoid factor (RF), human immunodeficiency virus (HIV), hepatitis B
and C. Blood culture to detect bacteria, fungi or other common germs
were 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 define paracortical necrotic
lesions with nuclear debris. In addition, there was no infiltration of
polymorphonuclear (PMN) leukocytes or plasma cells in microscopic
examination (Figure 2). 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 Severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2). The patient underwent supportive
treatment and interestingly after 7 days the cervical lymphadenopathy
and skin rashes significantly improved (Figure 3).