Kikuchi-Fujimoto Disease Following COVID-19 Infection in a 7-Year-Old Girl: A Case Report and Literature Review

Abstract

The coronavirus disease 2019 symptoms in children are relatively mild and often do not require treatment. Nonetheless, complications caused by the immune response to COVID-19 in children are possible and diverse. We present the case of a 7-year-old girl with persistent fever and lymphadenopathy arising from SARS-CoV-2 infection, diagnosed with Kikuchi-Fujimoto Disease (KFD) on lymph node biopsy. KFD is a rare benign disease, clinically characterized by fever and tender cervical lymphadenopathy affecting posterior cervical lymph nodes. We also reviewed six previously reported cases of COVID-19-associated KFD that occurred in school-aged children and compared them with the present case. The clinical course of COVID-19-associated KFD was similar to that of previous reports of KFD with a favorable prognosis. This is the first report of a school-aged child developing KFD following SARS-CoV-2 infection. KFD should be considered when approaching patients with hyperinflammatory states who present with prolonged fever and cervical lymphadenopathy after COVID-19.

COVID‐19 post‐vaccination lymphadenopathy: A review of the use of fine needle aspiration cytology

“…No restrictions were placed on the year of publication. Only literature published in English was selected, including studies that reported histopathological and/or cytological findings in vaccine‐related lymphadenopathy 17,20,22,23,35–64 . Studies on SLDI, which was generally detected by 18F‐FDG PET‐CT, were also selected and used for the general comprehension and description of the phenomenon and to retrieve cases evaluated by histology or LN‐FNAC 65–68 .…”

“…In our research, surgical excision or CNB of C19‐LAP‐ or SLDI‐enlarged lymph nodes have been performed in 55 cases 20,22,23,35,39,41–43,47,49–63 . The histological diagnoses were as follows: negative for neoplasia, reactive hyperplasia, and florid reactive hyperplasia (39 cases), 23,39,50–61 progressive transformation of germinal centres (1 case), 54 atypical follicular hyperplasia with light chain‐restricted germinal centres (1 case) 62 granulomatous reaction (2 cases), 50,63 metastases (4 cases), 20,22,50 Kikuchi‐Fujimoto disease (KFD; 6 cases), 40–42,49,56,64 Rosai‐Dorfman‐Destombes disease (RDD; 1 case), 48 and Langerhans cell histiocytosis (LCH; 1 case) 57 . In cases of reactive hyperplasia, the histological features were described as a preserved lymph node structure with cortical follicular hyperplasia, enlarged germinal centres and interfollicular expansion by small lymphocytes.…”

“…The histological features showed eosinophil‐rich inflammation with micro‐abscesses 43 . COVID‐19 cases associated with KFD and RDD have been described as exhibiting the typical histological features of the corresponding, non‐vaccine‐related entities 40–42,48,56,64 …”

“…In our research, surgical excision or CNB of C19-LAP-or SLDI-enlarged lymph nodes have been performed in 55 cases. 20,22,23,35,39,[41][42][43]47,[49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] The histological diagnoses were as follows: negative for neoplasia, reactive hyperplasia, and florid reactive hyperplasia (39 cases), 23,39,[50][51][52][53][54][55][56][57][58][59][60][61] progressive transformation of germinal centres (1 case), 54 atypical follicular hyperplasia with light chain-restricted germinal centres (1 case) 62 granulomatous reaction (2 cases), 50,63 metastases (4 cases), 20,22,50 Kikuchi-Fujimoto disease (KFD; 6 cases), [40][41]…”

“…43 COVID-19 cases associated with KFD and RDD have been described as exhibiting the typical histological features of the corresponding, non-vaccine-related entities. [40][41][42]48,56,64…”