scholarly journals Kikuchi-Fujimoto disease presenting in a patient with SARS-CoV-2: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Samuel D. Racette ◽  
Borislav A. Alexiev ◽  
Michael P. Angarone ◽  
Ajay Bhasin ◽  
Kaitlin Lima ◽  
...  
Keyword(s):  
Emergency Department ◽  
Needle Biopsy ◽  
Cervical Lymphadenopathy ◽  
Expectant Management ◽  
Final Diagnosis ◽  
Lymph Node Biopsy ◽  
Case Presentation ◽  
Follicular Hyperplasia ◽  
Node Biopsy ◽  
History Of

Abstract Background We present a yet to be described association of SARS-CoV-2 infection with Kikuchi-Fujimoto disease. Case presentation A 32-year-old physician with history of SARS-CoV-2 infection presented to the emergency department with 2 weeks of fever, chills, and right sided cervical lymphadenopathy. He was treated empirically for presumed folliculitis with worsening of symptoms leading to repeat presentation to the emergency department. Extensive workup was unrevealing of an infectious cause and needle biopsy of the lesion was unrevealing. An excisional lymph node biopsy revealed follicular hyperplasia with necrotic foci showing abundance of histiocytes at the edge of necrosis with CD8 predominance of T-cells. Final diagnosis was deemed to be Kikuchi-Fujimoto disease. Antibiotic therapy was discontinued, and the patient’s symptoms resolved with steroid therapy and expectant management. Conclusions This is the first report of a patient developing Kikuchi-Fujimoto disease following SARS-CoV-2 infection. Clinicians should be aware of Kikuchi-Fujimoto disease as a possibility when approaching patients with hyper-inflammatory states who present with cervical lymphadenopathy.

UM CASO ATÍPICO DE LEPTOSPIROSE NO HOSPITAL GERAL PÚBLICO DE PALMAS

2018 ◽  
Vol 5 (3) ◽  
pp. 52-55
Author(s):  
Raissa Bela Cruz Lelitscewa ◽  
Camila Lima Alves ◽  
Isabella Andrade Vulcano ◽  
Argemiro Manoel Torres Novaes Bastos ◽  
Olivia Maria Veloso Costa Coutinho
Keyword(s):  
Cervical Lymphadenopathy ◽  
Signs And Symptoms ◽  
Lymph Node Biopsy ◽  
Histopathological Analysis ◽  
Complete Regression ◽  
Follicular Hyperplasia ◽  
Classical Pattern ◽  
History Of ◽  
Diagnostic Hypothesis ◽  
Low Incidence

RESUMO Introdução: A Leptospirose é uma doença febril aguda, considerada uma importante zoonose, de baixa incidência no Estado do Tocantins. Relato do caso: A. M. S., 50 anos, masculino, pardo, residente em zona rural, agricultor. Deu entrada em pronto-socorro com quadro de febre há 30 dias, histórico de "olhos vermelhos", dores generalizadas. Foram solicitadas diversas sorologias; PPD, biópsia de linfonodo cervical com análise histopatológica e geneXpert (PCR). No 15° dia de internação, apresentou regressão da febre, apenas com sintomáticos e, após 24 horas afebril, foi iniciado tratamento empírico para leptospirose, com Ceftriaxone. Após cinco dias, apresentou febrícula, que cedia com dipirona. No 22° dia de internação o resultado da sorologia para leptospirose veio com IgM reagente na primeira amostra, e restante dos exames negativos. A análise histopatológica dos linfonodos mostrava achados de Hiperplasia folicular. O paciente apresentou melhora do estado geral, recebendo alta em D14 de Ceftriaxone, e com Leptospirose como único diagnóstico confirmado. Discussão: Na forma anictérica da Leptospirose ocorre uma síndrome febril, semelhante ao quadro da dengue clássica, com curso bifásico (aguda e imune), sendo que a febre dura no máximo 30 dias. Porém, na fase imune podem ocorrer algumas complicações, como febre prolongada. Encontramos sinais e sintomas característicos da forma anictérica desta zoonose: mialgia em panturrilhas e dorso, inclusive com dor a palpação; cefaleia frontal; astenia; febre alta e remitente, histórico de ‘olho vermelho’ antes da internação e linfadenopatia cervical. No entanto, o paciente permaneceu sem regressão total da febre durante os 30 dias de internação. Isso foge da duração comumente encontrada na fase imune desta doença. Conclusão: Apesar do paciente não se enquadrar no padrão clássico da doença, a leptospirose é a hipótese diagnostica que melhor se aplica ao caso.   Palavras-chave: Leishimaniose Visceral, Doenças Transmissiveis Emergentes. Zoonose. ABSTRACT Introduction: Leptospirosis is an acute febrile disease, considered an important zoonosis, of low incidence in the State of Tocantins. Case report: A. M. S., 50 years old, male, brown, resident in rural, farmer. He entered the emergency room with fever for 30 days, a history of "red eyes", generalized pains. Several serologies were requested; PPD, cervical lymph node biopsy with histopathological analysis and geneXpert (PCR). On the 15th day of hospitalization, he presented a regression of the fever, with symptomatic only, and after 24 hours afebrile, empiric treatment for leptospirosis with Ceftriaxone was started. After five days, he presented fever, which gave him dipyrone. On the 22nd day of hospitalization the serology result for leptospirosis came with reagent IgM in the first sample, and the rest of the negative tests. Histopathological analysis of the lymph nodes showed findings of follicular hyperplasia. The patient presented an improvement in the general condition, receiving discharge in D14 of Ceftriaxone, and with Leptospirosis as the only confirmed diagnosis. Discussion: In the anicteric form of Leptospirosis, there is a febrile syndrome, similar to that of classical dengue fever, with a biphasic course (acute and immune), with fever lasting at most 30 days. However, in the immune phase some complications can occur, such as prolonged fever. We found signs and symptoms characteristic of the anicteric form of this zoonosis: myalgia in calves and back, including palpation pain; frontal headache; asthenia; high and remitting fever, 'red eye' history prior to hospitalization, and cervical lymphadenopathy. However, the patient remained without complete regression of the fever during the 30 days of hospitalization. This escapes the duration commonly found in the immune phase of this disease. Conclusion: Although the patient does not fit the classical pattern of the disease, leptospirosis is the diagnostic hypothesis that best applies to the case. Keywords: Visceral Leishmaniasis, Emerging Transmissible Diseases. Zoonosis.

scholarly journals Cystic pancreatic lesions: MR imaging findings and management

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Giovanni Morana ◽  
Pierluigi Ciet ◽  
Silvia Venturini
Keyword(s):  
Differential Diagnosis ◽  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Main Pancreatic Duct ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Morphological Findings ◽  
History Of ◽  
Cystic Pancreatic Lesions ◽  
Radiological Examinations

AbstractCystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms. As they require different management according to their histological nature, differential diagnosis is essential. Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions. Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.

scholarly journals Kikuchi necrotizing lymphadenopathy: a tip of the iceberg disease?

2021 ◽  
Vol 8 (9) ◽  
pp. 1602
Author(s):  
Sushil Singla ◽  
Mohitesh Kumar ◽  
Vinod Kumar Jat ◽  
Deepika Parwan
Keyword(s):  
Lymph Node ◽  
Laboratory Test ◽  
Young Patient ◽  
Healthy Individual ◽  
Cervical Lymphadenopathy ◽  
Lymph Node Biopsy ◽  
Histiocytic Necrotizing Lymphadenitis ◽  
Benign Condition ◽  
Node Biopsy ◽  
Necrotizing Lymphadenitis

Kikuchi-Fujimoto disease (KFD) is a rare benign condition also called histiocytic necrotizing lymphadenitis, which typically presented as fever with cervical lymphadenopathy in previously healthy individual. We presented a case of 11 year old boy with fever and cervical lymphadenopathy since 2 months. Lymph node biopsy was performed which suggested of KFD and was treated symptomatically. KFD incidence is rare but clinicians should be alert if young patient comes with fever and cervical lymphadenopathy to lower the chance of unwanted laboratory test and harmful treatment. 

Baffled with fever and lymphadenopathy: neither infection nor malignancy, think Kikuchi disease

2021 ◽  
Vol 14 (1) ◽  
pp. e238914
Author(s):  
Ali Hussain ◽  
Mohsin Gondal ◽  
Hira Yousuf ◽  
Mubashar Iqbal
Keyword(s):  
Young Women ◽  
Cervical Lymphadenopathy ◽  
Complete Recovery ◽  
Symptomatic Treatment ◽  
Lymph Node Biopsy ◽  
Asian Woman ◽  
Unknown Aetiology ◽  
Benign Condition ◽  
Node Biopsy ◽  
Clinical Investigations

Kikuchi disease is a rare, benign condition of unknown aetiology, which usually involves young women and is characterised by cervical lymphadenopathy and fever. Herein, we are reporting a case of a young Asian woman, who presented with fever and lymphadenopathy raising possibility of either infection or malignancy but after appropriate clinical investigations including lymph node biopsy, it turned out to be Kikuchi disease. She made an uneventful complete recovery with only symptomatic treatment.

Abstract TP174: Identifying Predictors for Final Diagnosis of Ischemic Events in an Emergency Department Observation Unit

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Arooshi Kumar ◽  
Koto Ishida ◽  
Ava Liberman ◽  
Cen Zhang ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Features ◽  
Univariate Analysis ◽  
Final Diagnosis ◽  
Minor Stroke ◽  
Symptom Duration ◽  
Facial Weakness ◽  
Presenting Symptoms ◽  
History Of ◽  
Ischemic Events

Introduction: Transient neurologic events have high rates of diagnostic uncertainty. Emergency department observation units (ED-OU) allow an accelerated diagnostic work up for suspected transient ischemic attacks (TIAs). However, clinical decision support regarding which patients to admit to these units is lacking. This study aimed to identify clinical features that differentiate true ischemic events from nonischemic transient neurological attacks (NI-TNA) among patients admitted to an ED-OU for suspected TIA. Methods: A retrospective analysis was performed on consecutive patients admitted to the ED-OU at a single academic center for suspected TIA. Demographics, vascular risk factors, presenting symptoms, and details of the clinical presentation were abstracted from chart review. Final discharge diagnosis was dichotomized to either ischemic event (TIA or minor stroke, TIAMS) or NI-TNA based on the treating vascular neurologist’s final diagnosis. Standard statistical tests were used for comparison testing between the two groups. Significantly different factors with p<0.2 on univariate analysis were carried forward in a multivariable logistic regression model. Results: Of 186 consecutive patients, 101 (54%) had a final diagnosis of NI-TNA and 85 (46%) of TIAMS. The median population ABCD2 score was 4 [IQR 3-4]. On univariate analysis, older age (63 vs. 70, p<0.01), history of atrial fibrillation (AF) (12% vs. 26%, p=0.01), and facial weakness (5% vs. 14% p=0.03) were associated with TIAMS. Headache (24% vs. 12%, p=0.04) and symptom duration>60min (57% vs. 40%, p=0.02) were associated with NI-TNA. On multivariable analysis, only symptom duration>60 minutes predicted NI-TNA (OR 0.39, p=0.04) and only history of AF (OR 2.53, p=0.03) predicted TIAMS. Facial weakness was strongly predictive of TIAMS (OR 3.22, p=0.05), but not significant. Conclusion: We identified two clinical features that distinguished TIAMS from NI-TNA among patients admitted to an ED-OU for suspected TIA.These may be helpful in emergency room triage of TIAMS. Data from ED-OU can be used to identify factors associated with cerebral ischemia and improve current care pathways for patients with suspected TIA, so diagnostic evaluation is received in the most appropriate setting.

scholarly journals Feasibility of preoperative tattooing of percutaneously biopsied axillary lymph node: an experimental pilot study

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Abida K. Sattar ◽  
Basim Ali ◽  
Imrana Masroor ◽  
Shaista Afzal ◽  
Mohammad Usman Tariq ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Axillary Lymph Node ◽  
Needle Biopsy ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Negative ◽  
Node Biopsy ◽  
India Ink ◽  
Clinically Node Positive

Abstract Background In the last three decades, axillary lymph node dissection (ALND) has been replaced by sentinel lymph node biopsy (SLNB) in all clinically node-negative patients. However, when SLNB alone is performed in clinically node-positive patients who are rendered node-negative by neoadjuvant chemotherapy, the procedure has a high false-negative rate and other complementary procedures have been described to improve its reliability. Preoperative tattooing of the suspicious lymph node with India ink at the time of biopsy, in addition to sentinel lymph node biopsy, is a reasonable alternative. The objective of our study is to determine, in clinically node-positive patients, the feasibility of tattooing suspicious axillary lymph node at the time of percutaneous needle biopsy and its retrieval at the time of surgery. Methods A prospective experimental study will be conducted divided into two phases—phases I and II. In phase I, 10 patients committed to undergo upfront surgery (without neoadjuvant chemotherapy) will have a suspicious lymph node tattooed by injecting India ink at the time of core needle biopsy. All patients will undergo a SLNB, during which the axilla will be inspected to determine if the tattooed lymph node can be visualized. Routine microscopic examination will follow, and concordance between the sentinel and tattooed node will also be established. In phase II, the process will be repeated for 30 patients who undergo surgery after neoadjuvant chemotherapy. The analysis will be performed in Stata version 12. Discussion There is a need to identify and test the techniques for the down-staged axilla in post-neoadjuvant chemotherapy patients, which are not only practical and limit the number of invasive procedures necessary but are representative of the new axillary status and help limit the extent of axillary surgery without negatively impacting outcomes. We propose that, for the patient undergoing neoadjuvant chemotherapy with a biopsy-proven disease in the axilla, this could be achieved by India ink which allows marking, identification, and retrieval of the biopsied lymph node. Retrieval of this previously biopsied lymph node along with sentinel nodes, if found to be representative of the status of the remainder of the axilla, could potentially eliminate the need for routine axillary lymph node dissection and thus limit morbidity. Trial Registration ClinicalTrials.gov, NCT03939598. Retrospectively registered on 7 May 2019.

scholarly journals A Rare Case of HHV-8 Associated Hemophagocytic Lymphohistiocytosis in a Stable HIV Patient

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Nonso Osakwe ◽  
Diane Johnson ◽  
Natalie Klein ◽  
Dalia Abdel Azim
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Rare Case ◽  
Viral Infections ◽  
Rare Condition ◽  
Lymph Node Biopsy ◽  
Castleman Disease ◽  
Human Herpes Virus 8 ◽  
Case Presentation ◽  
Multicentric Castleman Disease ◽  
History Of

Background. Hemophagocytic lymphohistiocytosis (HLH) is a rare condition associated with viral infections including HIV. Cases have been reported mainly in advanced HIV/AIDS. This is a rare case that reports HLH associated with human herpes virus-8 (HHV-8) associated multicentric Castleman disease in a stable HIV patient. Case Presentation. A 70-year-old Asian male patient with history of stable HIV on medications with CD 4 cell count above 200 presented with cough and fever and was initially treated for pneumonia as an outpatient. Persisting symptoms prompted presentation to the hospital. The patient was found to have anemia which persisted despite repeated transfusion of packed red cells. A bone marrow biopsy to investigate anemia revealed hemophagocytosis. A CT scan revealed multiple enlarged lymph nodes and hepatosplenomegaly. An excisional lymph node biopsy revealed HHV-8 associated multicentric Castleman disease. The patient deteriorated despite initiation of treatment. Conclusion. HLH can occur at any stage of HIV, rapid diagnosis to identify possible underlying reactive infectious etiology and prompt initiation of treatment is crucial to survival.

scholarly journals Perichondritis: inspect the lobule

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Eli Bress ◽  
Jason E. Cohn
Keyword(s):  
Emergency Department ◽  
Physical Examination ◽  
Marked Improvement ◽  
Otitis Externa ◽  
Left Auricle ◽  
Case Presentation ◽  
Physical Examination Finding ◽  
Examination Finding ◽  
History Of ◽  
Caucasian Female

Abstract Case presentation This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule. Diagnosis The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. In this case, the diagnosis of perichondritis was made by a classic physical examination finding: erythema and edema with sparing of the fatty lobule. This key finding helps to distinguish perichondritis from otitis externa.

scholarly journals Kikuchi-Fujimoto Disease: A Report of 3 Cases

2007 ◽  
Vol 86 (7) ◽  
pp. 412-413 ◽  
Author(s):  
Eimear Phelan ◽  
Emer Lang ◽  
Peter Gormley ◽  
John Lang
Keyword(s):  
Weight Loss ◽  
Cervical Lymphadenopathy ◽  
Lymph Node Biopsy ◽  
Accurate Diagnosis ◽  
Histiocytic Necrotizing Lymphadenitis ◽  
Kikuchi’S Disease ◽  
Node Biopsy ◽  
Night Sweats ◽  
Necrotizing Lymphadenitis ◽  
Kikuchi's Disease

Cervical lymphadenopathy has many underlying etiologies. One of its rare causes is Kikuchi-Fujimoto disease (Kikuchi's disease, histiocytic necrotizing lymphadenitis). We discovered such a cause in a 37-year-old woman who had presented with malaise, night sweats, and weight loss in addition to cervical lymphadenopathy. We based our diagnosis on excisional lymph node biopsy. We also review 2 other cases of Kikuchi's disease that were diagnosed by others at our institution. Clinically and histologically, Kikuchi's disease is very similar to lymphoma, and distinguishing the two is difficult. However, despite the fact that Kikuchi's disease is benign, an accurate diagnosis is important because misdiagnosis might lead to unnecessary surgery and/or chemotherapy.

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