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

Abstract

The coronavirus disease 2019 (COVID-19) 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.

Keywords: cervical lymphadenopathy; covid-19; histiocytic necrotizing lymphadenitis; kikuchi-fujimoto disease; sars-cov-2.

Figure 1. Coronal and axial cuts of a contrast-enhanced computed tomography of the neck

Coronal and axial cuts of a contrast-enhanced computed tomography of the neck showing multiple enlarged and enhanced lymph nodes in the left cervical chain (arrows).

Figure 2. Histopathology of the lymph node biopsy specimens

(A) Hematoxylin & eosin (H&E) stain (100× magnification) showing zones of necrosis. Necrotizing lymphadenitis with Kikuchi-Fujimoto disease-like features (B) Histiocytes are CD68-positive. (100× magnification)