A Woman with Fever, Cervical Lymphadenopathy, and Leukopenia

The white-cell count was 2900 per microliter (reference range, 4000 to 11,000), the lactate dehydrogenase level was elevated, and serum testing also showed liver injury. She also reported night sweats, fatigue, and arthralgias. Imaging identified evolving necrosis of her cervical nodes with no drainable fluid collections. Antinuclear antibodies (ANA) were not detected, and there was no thoracic or mediastinal lymphadenopathy. After a nondiagnostic fine- and core-needle biopsy, an excisional biopsy showed abnormal histiocytes (Figure 1) suggestive of Kikuchi-Fujimoto disease.