First case of paediatric abdominal Kikuchi‐Fujimoto disease in Australia

Abstract

A 7-year-old boy of Liberian descent with no significant past medical history, family history or travel history presented to our centre with a 1-day history of right lower quadrant abdominal pain, without associated systemic symptoms. On abdominal examination, he was tender maximally at his right lower quadrant without evidence of peritonism, and he had no hepatosplenomegaly. He also had no apparent cervical, axillary or inguinal lymphadenopathy, and no rash or arthritis.Initial laboratory investigations showed a leukopenia with raised inflammatory markers. Abdominal ultrasound revealed a large 43 Â 19 mm heterogenous lymphatic mass in the right para-aortic region with loss of normal architecture. The terminal ileum was diffusely thickened and enlarged mesenteric nodes were seen throughout the right side of the abdomen (Fig. 1).Given the concern for a potential lymphoproliferative process, abdominal computed tomography was performed with intravenous contrast. This demonstrated a lobulated, enhancing mass, measuring 43 Â 20 Â 28 mm, arising from the para-aortic nodes to the right of the midline and anterior to the right common iliac vessels with multiple other prominent nodes in the ileocolic chain. The right colic vein was encased but not compressed. No adjacent fat stranding or invasion into adjacent structures was seen, nor was any other pathology identified (Fig. 2).A presumptive diagnosis of lymphoma was established and the child underwent a laparotomy for biopsy and consideration of resection. Intraoperatively, a large, solid, white mass in the right colonic mesentery was identified and a wedge biopsy was taken.