ABSTRACT
Kikuchi-Fujimoto disease is usually a self-limited cause of lymphadenitis. It is a prevalent disease amongst Asian individuals, but rare in other parts of the world. It affects especially young women, with limited cases described in children. Kikuchi-Fujimoto disease is characterized by focal and tender lymphadenopathy, mostly cervical, accompanied by fever and, less commonly, systemic manifestations. This disease is seldom associated with systemic lupus erythematosus. Herein we describe the case of a previously healthy 7-year-old male patient, who presented with prolonged fever, rash, polyarthritis, cervical lymphadenopathy, hepatosplenomegaly, leucocytosis and markedly elevated inflammatory markers. No changes were seen on the echocardiogram. Antinuclear antibodies were not identified and complement levels were normal. Differential diagnosis included systemic juvenile idiopathic arthritis, infectious diseases and malignancy. Bone marrow aspiration and biopsy were normal. The cervical node biopsy was diagnostic for Kikuchi-Fujimoto disease. Oral corticosteroids were started with notorious clinical response. After one year of follow up, the patient is without medication and remains asymptomatic. This case report shows the often-convoluted course of Kikuchi-Fujimoto disease and diagnostic dilemmas clinicians face when dealing with atypical presentations.
Subject(s)
Arthritis, Juvenile , Histiocytic Necrotizing Lymphadenitis , Lupus Erythematosus, Systemic , Lymphadenopathy , Arthritis, Juvenile/complications , Child , Female , Fever/complications , Histiocytic Necrotizing Lymphadenitis/complications , Humans , Lupus Erythematosus, Systemic/complications , Lymphadenopathy/complications , Male , Neck/pathologyABSTRACT
Delayed diagnosis, low socioeconomic status and infection have been associated with diabetic ketoacidosis (DKA) at type 1 diabetes mellitus presentation. A teenager from a low socioeconomic status family, with longstanding weight loss, polyphagia, polyuria, vomiting and abdominal pain, attended the emergency department, also complaining of anosmia and odynophagia. He was diagnosed with COVID-19 and new-onset DKA. The second child had 2 weeks of diabetes symptoms and was admitted with new-onset mild DKA. SARS-CoV-2 RT-PCR test was positive, although asymptomatic. Persistent hyperglycaemia with high insulin requirements was a common feature to both patients. Both cases support that SARS-CoV-2 may have an association with rapidly increasing insulin daily needs. In case one, not only fear of COVID-19 delayed hospital attendance but also the setting of a low socioeconomic status family appears to have enhanced the risk for late diagnosis and challenging disease management.
