Kikuchi-Fujimoto disease following SARS CoV2 vaccination: Case report

Abstract

Kikuchi's disease (KD) also known as Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis was first described in 1972 independently by Kikuchi and Fujimoto et al. It is a benign self-limited condition of unknown etiology which usually presents with cervical lymphadenopathy or fever of unknown origin. The diagnosis of KFD is based on histopathologic examination of the involved lymph node, showing the presence of well-defined necrosis without granulocytic cells. There is no special treatment for KFD. However non-steroidal anti-inflammatory drugs or corticosteroids are required occasionally to control the associated systemic manifestations. The outcome of the disease is usually favorable with resolution of symptoms in most cases within one to four months. We report a case of Kikuchi-Fujimoto disease that occurred in a young Qatari male patient 10 days following receiving the first dose of BNT162b2 vaccine. Diagnosis was established by lymph node biopsy and recovery was complete after 10 days.

Kikuchi–Fujimoto Disease Post COVID-19 Vaccination: Case Report and Review of Literature

“…While there is no specific treatment for KFD, symptomatic treatment with analgesics is usually sufficient, with steroids sometimes being used in more severe or recurrent cases [5,6]. In our two cases as well as the other case reported in literature by Soub et al [3], the patients' symptoms resolved within a month of onset, and treatment with analgesics proved to be effective for the relief of symptoms. For our two cases, non-steroidal anti-inflammatory drugs (NSAIDs), in particular, appeared to be more effective than paracetamol.…”

“…KFD very uncommonly occurs following vaccination, with only rare reports in the literature describing its occurrence after influenza vaccination [7], human papillomavirus vaccination and Japanese encephalitis virus vaccination [8]. A literature search yielded only one case report of KFD following COVID-19 vaccination at the time of writing [3], with many other papers describing cytologic or histologic findings of reactive follicular hyperplasia or reactive lymphadenopathy [9][10][11][12][13][14]. Table 1 details the key features of published cases of lymphadenopathy post COVID-19 vaccination, which also had cytologic and/or histologic follow-up.…”

“…For case reports that included some form of cytologic or histologic confirmation, most observed that the cause of lymphadenopathy was reactive in nature. In contrast, Kikuchi-Fujimoto Disease (KFD) or necrotizing histiocytic lymphadenitis is a very rare occurrence with only one published case report to date [3]. We describe two more patients from our institution who developed histologically confirmed KFD after receiving mRNA-based COVID-19 vaccine (Pfizer-BioNTech).…”

Kikuchi-Fujimoto's Disease or Histiocytic Necrotizing Lymphadenitis Following mRNA COVID-19 Vaccination: A Rare Case

“…In the current case, as well as the other cases reported in the literature, lymphadenopathy appeared after several days ranging from 10 to 35 days. It is unclear how the vaccination could lead to the occurrence of KFD, but it could be potentially secondary to the viral or other antigens in the vaccine that may cause an aberrant immune response with some form of exaggerated T-cell mediated immune in vaccinated individuals [ 5 , 6 ].…”

“…More recently in the coronavirus disease 2019 (COVID-19) pandemic, few cases of KFD after infection have been reported [ 3 , 4 ]. However, to our knowledge, only four cases of KFD following vaccination against COVID-19 have been described to date [ 5 - 7 ].…”