A rare case of Kikuchi disease with recurrent symptoms

Kikuchi disease with recurrent symptoms

Subathra Devi M^1*, Maha Lakshmi²

¹Nurse Educator Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

²Nursing Superintendent, Kauvery hospital, Cantonment Trichy, Tamil Nadu

*Correspondence

Abstract

A 21-year-old male patient with a past history of Kikuchi disease diagnosed in 2013 initially presented with neck swelling, fever, vomiting, and poor oral intake. He consulted multiple doctors but showed improvement only after starting steroid therapy. Recently, he has been presented with fever, fatigue, and chills for the past three days and has been referred to the hematology department for further evaluation and management.

Key words: Kikuchi disease; Neck swelling; Hematology

Introduction

Kikuchi disease is a rare and usually self-limiting condition that mainly affects young adults. It commonly presents swollen lymph nodes in the neck, fever, and weakness. Although the exact cause is unknown, it may be related to infections or immune reactions. Proper diagnosis and follow-up are important to manage symptoms and rule out other serious conditions.

Case Presentation

A 21-year-old male patient had been suffering from neck swelling and persistent health issues for a long period, including fever, vomiting, and a reduced ability to take food properly. Due to these ongoing symptoms, he consulted multiple doctors but did not experience significant improvement initially. Over time, his condition worsened, with continued episodes of vomiting and general weakness. Eventually, he started steroid therapy, which led to a gradual reduction in his symptoms. After further evaluation and investigations, he was finally diagnosed with Kikuchi disease in 2013. At present, he presents with complaints of fever, fatigue, and chills for the past three days. Hence, he has been referred to the hematology department for further evaluation and management.

Relevant Clinical Findings

Social History: He does not have any social history of cigarette smoking and alcohol addiction.

Allergies: Not a well-known medicine

Past Medical History: Known case of Kikuchi

Physical Examinations

Patient conscious, oriented, febrile

B/L cervical lymph nodes (R>L), Tender

PR	74/min
BP	110/70 mm hg
SpO2	97% on room air
Temp	99 F
CVS	S1S2 (+)
RS	NVBS (+)
P/A	Soft, no palpable organomegaly

Relevant Investigation

Alkaline Phosphatase	70 U/L
Bicarbonate	22 mEq/L
A/G Ratio	1.1 .
Indirect Bilirubin	1.1 mg/dL
Sodium	137 mmol/L
Alanine Aminotransferase (ALT/SGPT)	22 U/L
Globulin	3.2 g/dl
Urine Nitrite	Negative
Direct Bilirubin	0.3 mg/dL
Albumin, Serum	3.7 g/dl
Urea Serum	19 mg/dL
Creatinine	0.9 mg/dL
Chloride	107 mmol/L
Total Protein	6.8 g/dl
Potassium	3.6 mmol/L
Gamma - Glutamyl Transferase (GGT)	31 U/L
Aspartate Aminotransferase (AST/SGOT)	21 U/L
Total Bilirubin	1.4 mg/dL
Lactate Dehydrogenase (LDH)	327 U/L
Creatine Phosphokinase (CPK)	95 U/L
Ferritin	178 ng/mL
C3 Complement	132 mg/dL
C4 Complement	29.2 mg/dL
Casts	Nil
Bilirubin	Negative
PH Urine	5
Urine Protein	Nil
RBC	Nil
Leuykocyte	Negative
Urine Blood	Negative
Crystals	Nil
Epithelial cells	Occasional
Urine Glucose	Nil
Urobilinogen	Normal
Ketone	Negative
Urine Specific Gravity	1.03
Appearance	Clear
Colour	Yellow
Neutrophil	69.90%
Basophil	0.10%
Lymphocyte	22.40%
Mean Corpuscular Volume (MCV)	82.3
Total WBC Count	6860 Cells/Cumm
Monocyte	7.30%
Absolute Neutrophil Count (ANC)	4790 cells/µl
Total RBC Count	5.08 ML/10^9
Haemoglobin	14.1 g/dl
(MCHC) Mean Corpuscular Haemoglobin Concentration	33.7 g/dl
Absolute Monocyte Count (AMC)	500 cells/µl
Packed Cell Volume (PCV)	41.80%
Absolute Eosinophil Count (AEC)	20 cells/µl
Absolute Lymphocyte Count (ALC)	1540 cells/µl
(MCH) Mean Corpuscular Haemoglobin	27.8 pg/cell
Platelet Count	129000 cells/µl
Mean Platelet Volume (MPV)	12.1 NA
Absolute Monocyte Count (AMC)	520 cells/µl
Neutrophil	56.60%
Absolute Eosinophil Count (AEC)	50 cells/µl
Total RBC Count	5.15 ML/10^9
(MCHC) Mean Corpuscular Haemoglobin Concentration	33.2 g/dl
Mean Platelet Volume (MPV)	11.8 NA
Monocyte	9.80%
Platelet Count	150000 (Manual count) cells/µl
Total WBC Count	5320 Cells/Cumm
Mean Corpuscular Volume (MCV)	82.5
Haemoglobin	14.1 g/dl
Lymphocyte	32.50%
Packed Cell Volume (PCV)	42.50%
Absolute Neutrophil Count (ANC)	3010 cells/µl
Absolute Lymphocyte Count (ALC)	1730 cells/µl
Basophil	0.20%
(MCH) Mean Corpuscular Haemoglobin	27.4 pg/cell
Eosinophil	0.30%
RDW - CV	11.70%
Absolute Basophil Count (ABC)	10 cells/µl
RDW - CV	11.90%
Absolute Basophil Count (ABC)	10 cells/µl
Eosinophil	0.90%
Rheumatoid Arthritis (RA) Factor	9.3 IU/ml

Diagnosis

Acute febrile illness, Viral etiology
Kikuchi disease (2013)

Management

The patient was managed with supportive care. He was given intravenous (IV) fluids to maintain hydration and antipyretics such as Paracetamol to control fever. His vital signs and symptoms were closely monitored. As he had mild thrombocytopenia, regular blood count monitoring was done. Since Kikuchi disease is usually self-limiting, no specific treatment was required.

Outcome

The patient showed symptomatic improvement and was discharged in stable condition with advice to follow up on an outpatient (OPD) basis.

Nursing Management

Monitor vital signs regularly (temperature, pulse, BP, respiration)
Assess fever pattern and administer antipyretics like Paracetamol as prescribed
Maintain adequate hydration (IV fluids and encourage oral intake)
Monitor intake and output chart
Assess neck swelling (size, tenderness, changes)
Observe for signs of infection or worsening condition
Monitor for bleeding signs due to thrombocytopenia (petechiae, bruising, gum bleeding)
Ensure adequate rest and provide a comfortable environment
Provide nutritional support (small, frequent, soft diet)
Maintain personal hygiene and skin care
Administer medications as prescribed (antipyretics, steroids if ordered)
Provide psychological support and reassurance
Educate patients about Kikuchi disease
Instruct on importance of follow-up and compliance with treatment
Report any abnormal findings to the doctor immediately

Discharge medications

S.No	Drug Name	Strength	Route of admin	Relationship with meal	Days
1	Tab. Dolo	1 gm	Oral	After food	SOS

Discussion

Kikuchi disease is a rare and usually self-limiting condition that presents with fever and neck lymph node swelling. In this case, the patient had a previous history of Kikuchi disease and now presented with fever, fatigue, and chills, which may suggest recurrence or a mild infection. Clinical findings like tender lymph nodes and mild thrombocytopenia support the diagnosis, while negative EBV results help rule out viral causes. Management is mainly supportive, including fluids, antipyretics, and monitoring. The patient showed improvement with treatment. This case highlights the importance of proper evaluation and follow-up to identify recurrence early and to rule out other serious conditions.

Conclusion

Kikuchi disease is a rare but self-limiting condition that commonly affects young adults. Early recognition and proper diagnosis are important to avoid unnecessary treatments and to rule out serious conditions. In this case, the patient responded well to supportive management and showed clinical improvement. Regular follow-up is essential to monitor for recurrence and ensure complete recovery.

A rare case of Kikuchi disease with recurrent symptoms

Kikuchi disease with recurrent symptoms

Subathra Devi M1*, Maha Lakshmi2

Nightingale Journals

Subathra Devi M^1*, Maha Lakshmi²