Kikuchi-Fujimoto Disease With Systemic Lupus Erythematosus and Systemic Sclerosis Overlap: A Unique Clinical Presentation.

Kikuchi-Fujimoto Disease (KFD), or histiocytic necrotizing lymphadenitis (HNL), is a rare self-limiting disorder presenting with fever and swollen lymph nodes. It is characterized by the focal proliferation of reticular cells, the presence of nuclear debris, and histiocytes. In advanced cases, it can present with hepato-splenomegaly and generalized lymphadenopathy. Historically, it has been associated with viral infections, as it frequently was found to be associated with upper respiratory symptoms. Alternative explanations include the immune response of T-cells leading to alteration in CD8-positive T-cell-mediated cell apoptosis. It is also speculated that KFD can be associated with rheumatological autoimmune diseases. We present a case of a 21-year-old African American female with a known diagnosis of systemic lupus erythematosus (SLE)-systemic sclerosis (SS) overlap presented with febrile lymphadenopathy and was diagnosed to have HNL on histological exam of lymph node biopsy.

Altered Mental Status on Top of Anaplasmosis-Induced Severe Rhabdomyolysis: A Rare Clinical Presentation.

Human granulocytic anaplasmosis (HGA) is a disease caused by tick-borne infection of Anaplasma phagocytophilum. The typical symptoms are fever, malaise, and body aches accompanied by abnormal blood tests such as leukopenia, thrombocytopenia, and transaminitis. Some rare complications may occur, especially in patients living in heavily wooded areas, with a mean age of 70 years. We present a case of a 67-year-old male who was admitted for lower abdominal pain, fever, and diarrhea with derangement of his blood tests. Despite treatment, his condition deteriorated and complicated rhabdomyolysis and acute kidney dysfunction. Empiric treatment including doxycycline was initiated while waiting for the infection blood work results. PCR came back positive for HGA. Empiric therapy was narrowed down to doxycycline for 14 days, and the patient's condition began to improve gradually and steadily. Aggressive hydration markedly improved rhabdomyolysis and, in turn, kidney function. Our case underscores the importance of considering HGA in ambiguous clinical scenarios and highlights the value of early diagnosis, empiric treatment, and intravenous hydration, especially in the presence of rhabdomyolysis.