Kikuchi-Fujimoto Disease in Pregnancy: A Rare Case With Atypical Presentation and Potential Viral Trigger

Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a rare, self-limiting condition characterized by cervical lymphadenopathy, fever, and night sweats. Although KFD is most commonly reported in young Asian women, cases have emerged globally, including among non-Asian populations. The etiology remains unclear, with viral and autoimmune triggers, such as Epstein-Barr Virus (EBV) and systemic lupus erythematosus (SLE), being commonly proposed. Diagnosing KFD is challenging due to its overlapping symptoms with more severe conditions like tuberculosis, malignancies, and autoimmune disorders. Diagnosis typically requires an excisional lymph node biopsy due to the insufficiency of noninvasive methods. This case report describes a 29-year-old pregnant African-American female who presented with diffuse cervical lymphadenopathy, B symptoms, and a positive purified protein derivative (PPD) test. Her clinical course included a comprehensive infectious and autoimmune workup, revealing positive EBV IgG, ultimately leading to a diagnosis of KFD via lymph node biopsy. Management focused on supportive care, and she had a favorable outcome with an uncomplicated delivery. The case underscores the importance of considering KFD in the differential diagnosis of lymphadenopathy, particularly in high-risk populations. It also highlights the need for careful balancing of symptomatic treatment with fetal safety. While KFD generally resolves spontaneously, ongoing monitoring is critical due to its potential association with SLE. This case adds to the limited literature on KFD in pregnancy, emphasizing the importance of early recognition, appropriate biopsy, and multidisciplinary management. Further research is warranted to explore the pathogenesis of KFD, especially its potential link with viral infections like EBV.