Persistent Pediatric Cervical Lymphadenopathy: A Case Report of Kikuchi-Fujimoto Disease Mimicking Infection and Malignancy.
- 1Spencer Fox Eccles School of Medicine University of Utah Health Salt Lake City Utah USA.
- 2Department of Pediatrics University of Utah Health Salt Lake City Utah USA.
Abstract
Case presentation
A 10-year-old female presented with 2 months of unilateral cervical lymphadenopathy despite several courses of oral antibiotics. She presented to the emergency department due to persistent pain and swelling along with new fever. On presentation, she was febrile to 39.0°C. Physical examination revealed significant left-sided cervical and submandibular lymphadenopathy with tenderness, warmth, and overlying erythema. Initial labs were notable for leukopenia (2.6 × 10³/μL), thrombocytopenia (135,000/μL), and elevated liver enzymes. Computed tomography (CT) of the neck demonstrated necrotic left cervical lymphadenopathy with prominent right cervical lymph nodes. An infectious workup, including testing for Epstein-Barr virus, Cytomegalovirus, human immunodeficiency virus, coccidioidomycosis, tuberculosis, and microbial cell-free DNA sequencing, was negative. Initial fine-needle aspiration (FNA) and core needle biopsy showed predominantly necrotic tissue. Cultures obtained during the biopsy showed no growth, and flow cytometry was negative for leukemia/lymphoma markers. Intravenous (IV) ceftriaxone administration resulted in improvement in neck swelling and fever resolution. Histopathologic examination from excisional biopsy revealed histiocytic necrotizing lymphadenitis consistent with Kikuchi-Fujimoto (KFD) lymphadenitis. Comprehensive autoimmune serologies were negative. Naproxen was prescribed to help with residual inflammation.Discussion
KFD should be considered in children presenting with prolonged cervical lymphadenopathy refractory to antibiotics. This case illustrates several diagnostic challenges inherent in making this diagnosis. The patient's prolonged unilateral cervical lymphadenopathy, necrotic imaging findings, and transient improvement with antibiotics strongly suggested bacterial lymphadenitis or malignancy. However, the persistence of symptoms despite multiple appropriate antibiotic courses, the development of cytopenias and elevated liver enzymes, and ultimately nondiagnostic cultures represented key findings prompting reconsideration of the initial differential diagnoses. This case also highlights the importance of considering excisional biopsy when core biopsy is nondiagnostic.
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BibTeX
@article{thomas2026persistent,
title = {{Persistent Pediatric Cervical Lymphadenopathy: A Case Report of Kikuchi-Fujimoto Disease Mimicking Infection and Malignancy.}},
author = {Maegan Thomas and Dillon Stevens and Chloe Davis and Nathan M Money},
journal = {Case reports in pediatrics},
year = {2026},
month = oct,
doi = {10.1155/crpe/4898588},
url = {https://europepmc.org/article/MED/42948176},
note = {CC BY},
}
RIS
TY - JOUR
TI - Persistent Pediatric Cervical Lymphadenopathy: A Case Report of Kikuchi-Fujimoto Disease Mimicking Infection and Malignancy.
AU - Maegan Thomas
AU - Dillon Stevens
AU - Chloe Davis
AU - Nathan M Money
PY - 2026
DA - 2026/10/27
JO - Case reports in pediatrics
DO - 10.1155/crpe/4898588
UR - https://europepmc.org/article/MED/42948176
AB - Case presentation A 10-year-old female presented with 2 months of unilateral cervical lymphadenopathy despite several courses of oral antibiotics. She presented to the emergency department due to persistent pain and swelling along with new fever. On presentation, she was febrile to 39.0°C. Physical examination revealed significant left-sided cervical and submandibular lymphadenopathy with tenderness, warmth, and overlying erythema. Initial labs were notable for leukopenia (2.6 × 10³/μL), thrombocytopenia (135,000/μL), and elevated liver enzymes. Computed tomography (CT) of the neck demonstrated necrotic left cervical lymphadenopathy with prominent right cervical lymph nodes. An infectious workup, including testing for Epstein-Barr virus, Cytomegalovirus, human immunodeficiency virus, coccidioidomycosis, tuberculosis, and microbial cell-free DNA sequencing, was negative. Initial fine-needle aspiration (FNA) and core needle biopsy showed predominantly necrotic tissue. Cultures obtained during the biopsy showed no growth, and flow cytometry was negative for leukemia/lymphoma markers. Intravenous (IV) ceftriaxone administration resulted in improvement in neck swelling and fever resolution. Histopathologic examination from excisional biopsy revealed histiocytic necrotizing lymphadenitis consistent with Kikuchi-Fujimoto (KFD) lymphadenitis. Comprehensive autoimmune serologies were negative. Naproxen was prescribed to help with residual inflammation.Discussion KFD should be considered in children presenting with prolonged cervical lymphadenopathy refractory to antibiotics. This case illustrates several diagnostic challenges inherent in making this diagnosis. The patient's prolonged unilateral cervical lymphadenopathy, necrotic imaging findings, and transient improvement with antibiotics strongly suggested bacterial lymphadenitis or malignancy. However, the persistence of symptoms despite multiple appropriate antibiotic courses, the development of cytopenias and elevated liver enzymes, and ultimately nondiagnostic cultures represented key findings prompting reconsideration of the initial differential diagnoses. This case also highlights the importance of considering excisional biopsy when core biopsy is nondiagnostic.
SN - 2090-6803
SN - 2090-6811
ER -