Cervical lymphadenopathy is a sign that can be presented in many diseases condition. We are presenting a case of fever with cervical lymphadenopathy due to kikuchi Fujimoto diseases. Kikuchi lymphadenitis is a rare, benign condition of unknown cause usually characterised by cervical lymphadenopathy and fever. While, 40% of patient with kikuchi disease were initially misdiagnosed as having lymphoma and were consequently over treated with chemotherapy. This pitfall remains an active source of diagnostic error.Case
Mr. Am is a 25 years old Malay man initially admitted under Internal Medicine department with history of fever and neck swelling for more than 2 weeks. During admission, his routine blood tests were normal. Chest X ray was also clear. Thereafter patient transferred under Palliative medicine unit for the further evaluation and management. His CT-TAP (thorax, abdomen and pelvis) reported as normal study. He underwent FNAC (fine needle aspiration and cytology) of the cervical lymph node which showed T cell lymphoma. Although, FNAC report did not clinically correlate. Therefore, for the further workup we performed bone marrow aspiration and trephine. His bone marrow showed leukopenia. We started to treat with steroid which showed some clinical improvement. Mr. Am was seen in the NUH (National University hospital) Singapore for second opinion. His working diagnosis is now Kikuchi lymphadenitis. Unfortunately, he was presented with fever and low WBC count again in September 2014 and went to NUH Singapore and his current working diagnosis is recurrent Kikuchi lymphadenitis with Mycoplasma and Infectious mononucleosis infection. His PET CT scan reported as increased mediastinal masses with low significance. Currently he is under care of Palliative medicine of RIPAS hospital.Discussion
Our case illustrates a significant role of palliative medicine for the complicated clinical case. Which could be achieved by meticulous history taking and symptoms assessment and relevant investigations. Hence, integrated palliative care service could prevent the miss diagnosis, and ensures a better outcome.