Systemic lupus erythematosus associated Kikuchi's disease

    A 31 year old African-Caribbean male presented with two weeks of persistent fever and lymphadenopathy.  He had shaking chills with the fevers associated with rash, malaise, arthralgia, and myalgia.  Additionally he had experienced nasal congestion, fatigue, and weight loss of 10 pounds over two months.  Two months prior to admission he had seen his general practitioner for fatigue and was diagnosed with anemia.   His review of systems was negative for photosensitivity, alopecia, Raynaud’s phenomenon, cardiac, pulmonary, neurologic, or genitourinary symptoms.  His only medications were iron and ibuprofen for fevers.  On physical examination he had discoid and malar rashes, oral ulcers, and occipital, anterior and posterior cervical lymphadenopathy.  Examination of his heart, lungs, abdomen, and joints were normal.  His initial laboratory tests are shown in Table 1.  He had leukopenia and anemia.   He was admitted for further work-up  with a broad initial differential diagnosis including infectious, neoplastic, and rheumatologic etiologies.  Infectious and rheumatologic serologies were done, the patient was evaluated by hematology and dermatology, and biopsies were taken of skin, lymph node and bone marrow.