Case Report of Kikuchi-Fujimoto Disease from Sub-Saharan Africa: An Important Mimic of Tuberculous Lymphadenitis
Identifieur interne : 000178 ( Pmc/Checkpoint ); précédent : 000177; suivant : 000179Case Report of Kikuchi-Fujimoto Disease from Sub-Saharan Africa: An Important Mimic of Tuberculous Lymphadenitis
Auteurs : Karishma Sharma [Kenya] ; Fredrick Otieno [Kenya] ; Reena Shah [Kenya]Source :
- Case Reports in Medicine [ 1687-9627 ] ; 2020.
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare form of painful lymphadenopathy, usually cervical, which is more common in Southeast Asia and rarely reported from Africa. Symptoms are usually nonspecific (fever, night sweats, etc.), and can mimic more common diseases such as tuberculosis (TB) in endemic areas. We report a case of a 29-year-old black African woman who was admitted with headache, neck pain, fever, and lymphadenopathy. She was found to have aseptic meningitis, eventually attributed to TB based on cervical node biopsy, although further histology suggested KFD. Blood tests for systemic lupus erythematosus (SLE) were negative; she had already been commenced on anti-TB treatment and had responded well and so was continued with this therapy. She was also later diagnosed with Hashimoto's thyroiditis 3 months after her diagnosis of KFD. Five months after stopping TB treatment, she was readmitted with the same symptoms and associated painless lymphadenopathy. Repeat biopsy was morphologically similar to that of 2017, and repeat evaluation confirmed SLE. She has since been managed by a rheumatologist and continues to do well.
Url:
DOI: 10.1155/2020/4385286
PubMed: 31969905
PubMed Central: 6969645
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Case Report of Kikuchi-Fujimoto Disease from Sub-Saharan Africa: An Important Mimic of Tuberculous Lymphadenitis</title><author><name sortKey="Sharma, Karishma" sort="Sharma, Karishma" uniqKey="Sharma K" first="Karishma" last="Sharma">Karishma Sharma</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Medicine, Aga Khan University Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Otieno, Fredrick" sort="Otieno, Fredrick" uniqKey="Otieno F" first="Fredrick" last="Otieno">Fredrick Otieno</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Medicine, Aga Khan University Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Shah, Reena" sort="Shah, Reena" uniqKey="Shah R" first="Reena" last="Shah">Reena Shah</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Medicine, Aga Khan University Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31969905</idno><idno type="pmc">6969645</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969645</idno><idno type="RBID">PMC:6969645</idno><idno type="doi">10.1155/2020/4385286</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000275</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000275</idno><idno type="wicri:Area/Pmc/Curation">000275</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000275</idno><idno type="wicri:Area/Pmc/Checkpoint">000178</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000178</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Case Report of Kikuchi-Fujimoto Disease from Sub-Saharan Africa: An Important Mimic of Tuberculous Lymphadenitis</title><author><name sortKey="Sharma, Karishma" sort="Sharma, Karishma" uniqKey="Sharma K" first="Karishma" last="Sharma">Karishma Sharma</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Medicine, Aga Khan University Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Otieno, Fredrick" sort="Otieno, Fredrick" uniqKey="Otieno F" first="Fredrick" last="Otieno">Fredrick Otieno</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Medicine, Aga Khan University Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Shah, Reena" sort="Shah, Reena" uniqKey="Shah R" first="Reena" last="Shah">Reena Shah</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Medicine, Aga Khan University Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author></analytic><series><title level="j">Case Reports in Medicine</title><idno type="ISSN">1687-9627</idno><idno type="eISSN">1687-9635</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Kikuchi-Fujimoto disease (KFD) is a rare form of painful lymphadenopathy, usually cervical, which is more common in Southeast Asia and rarely reported from Africa. Symptoms are usually nonspecific (fever, night sweats, etc.), and can mimic more common diseases such as tuberculosis (TB) in endemic areas. We report a case of a 29-year-old black African woman who was admitted with headache, neck pain, fever, and lymphadenopathy. She was found to have aseptic meningitis, eventually attributed to TB based on cervical node biopsy, although further histology suggested KFD. Blood tests for systemic lupus erythematosus (SLE) were negative; she had already been commenced on anti-TB treatment and had responded well and so was continued with this therapy. She was also later diagnosed with Hashimoto's thyroiditis 3 months after her diagnosis of KFD. Five months after stopping TB treatment, she was readmitted with the same symptoms and associated painless lymphadenopathy. Repeat biopsy was morphologically similar to that of 2017, and repeat evaluation confirmed SLE. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Med</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Med</journal-id><journal-id journal-id-type="publisher-id">CRIM</journal-id><journal-title-group><journal-title>Case Reports in Medicine</journal-title></journal-title-group><issn pub-type="ppub">1687-9627</issn><issn pub-type="epub">1687-9635</issn><publisher><publisher-name>Hindawi</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31969905</article-id><article-id pub-id-type="pmc">6969645</article-id><article-id pub-id-type="doi">10.1155/2020/4385286</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Case Report of Kikuchi-Fujimoto Disease from Sub-Saharan Africa: An Important Mimic of Tuberculous Lymphadenitis</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">https://orcid.org/0000-0003-0798-0745</contrib-id><name><surname>Sharma</surname><given-names>Karishma</given-names></name><xref ref-type="aff" rid="I1"></xref></contrib><contrib contrib-type="author"><name><surname>Otieno</surname><given-names>Fredrick</given-names></name><xref ref-type="aff" rid="I1"></xref></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid" authenticated="false">https://orcid.org/0000-0003-1729-5012</contrib-id><name><surname>Shah</surname><given-names>Reena</given-names></name><email>reena.shah@aku.edu</email><xref ref-type="aff" rid="I1"></xref></contrib></contrib-group><aff id="I1">Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya</aff><author-notes><fn fn-type="other"><p>Academic Editor: Jagdish Butany</p></fn></author-notes><pub-date pub-type="collection"><year>2020</year></pub-date><pub-date pub-type="epub"><day>5</day><month>1</month><year>2020</year></pub-date><volume>2020</volume><elocation-id>4385286</elocation-id><history><date date-type="received"><day>27</day><month>5</month><year>2019</year></date><date date-type="rev-recd"><day>8</day><month>10</month><year>2019</year></date><date date-type="accepted"><day>19</day><month>12</month><year>2019</year></date></history><permissions><copyright-statement>Copyright © 2020 Karishma Sharma et al.</copyright-statement><copyright-year>2020</copyright-year><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Kikuchi-Fujimoto disease (KFD) is a rare form of painful lymphadenopathy, usually cervical, which is more common in Southeast Asia and rarely reported from Africa. Symptoms are usually nonspecific (fever, night sweats, etc.), and can mimic more common diseases such as tuberculosis (TB) in endemic areas. We report a case of a 29-year-old black African woman who was admitted with headache, neck pain, fever, and lymphadenopathy. She was found to have aseptic meningitis, eventually attributed to TB based on cervical node biopsy, although further histology suggested KFD. Blood tests for systemic lupus erythematosus (SLE) were negative; she had already been commenced on anti-TB treatment and had responded well and so was continued with this therapy. She was also later diagnosed with Hashimoto's thyroiditis 3 months after her diagnosis of KFD. Five months after stopping TB treatment, she was readmitted with the same symptoms and associated painless lymphadenopathy. Repeat biopsy was morphologically similar to that of 2017, and repeat evaluation confirmed SLE. She has since been managed by a rheumatologist and continues to do well.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>(a) Lymph node biopsy 2017 (low-power view): partial effacement of architecture with large area of necrosis with no acute inflammatory cell infiltrate in keeping with Kikuchi's disease. (b) Lymph node biopsy 2017 (high-power view): numerous apoptotic bodies with histiocytes. (c) Lymph node biopsy 2019: numerous foci of necrosis with apoptotic bodies with scattered histiocytes. Absence of acute inflammatory infiltrate and hematoxylin bodies in keeping with Kikuchi's disease.</p></caption><graphic xlink:href="CRIM2020-4385286.001"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Laboratory results summarized from 2017 to 2019.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Reference range</th><th align="center" rowspan="1" colspan="1">Aug 2017</th><th align="center" rowspan="1" colspan="1">Sept 2017</th><th align="center" rowspan="1" colspan="1">Jan 2018</th><th align="center" rowspan="1" colspan="1">July 2018</th><th align="center" rowspan="1" colspan="1">Feb 2019</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">White blood cell</td><td align="center" rowspan="1" colspan="1">4–10 (<italic>∗</italic>10<sup>9/L</sup>)</td><td align="center" rowspan="1" colspan="1">2.51</td><td align="center" rowspan="1" colspan="1">3.19</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">2.06</td></tr><tr><td align="left" rowspan="1" colspan="1">Neutrophil count</td><td align="center" rowspan="1" colspan="1">2–7 (<italic>∗</italic>10<sup>9/L</sup>)</td><td align="center" rowspan="1" colspan="1">1.16</td><td align="center" rowspan="1" colspan="1">2.12</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">1.14</td></tr><tr><td align="left" rowspan="1" colspan="1">Lymphocyte count</td><td align="center" rowspan="1" colspan="1">1–3 (<italic>∗</italic>10<sup>9/L</sup>)</td><td align="center" rowspan="1" colspan="1">1.10</td><td align="center" rowspan="1" colspan="1">0.81</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">0.80</td></tr><tr><td align="left" rowspan="1" colspan="1">Hemoglobin</td><td align="center" rowspan="1" colspan="1">11.5–16.5 (g/dl)</td><td align="center" rowspan="1" colspan="1">10.2</td><td align="center" rowspan="1" colspan="1">11</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">11</td></tr><tr><td align="left" rowspan="1" colspan="1">Platelet count</td><td align="center" rowspan="1" colspan="1">150–450 (<italic>∗</italic>10<sup>9/L</sup>)</td><td align="center" rowspan="1" colspan="1">118</td><td align="center" rowspan="1" colspan="1">153</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">85</td></tr><tr><td align="left" rowspan="1" colspan="1">ESR (Erythrocyte sedimentation rate)</td><td align="center" rowspan="1" colspan="1">0–20 (mm/hr)</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">44</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">61</td></tr><tr><td align="left" rowspan="1" colspan="1">CRP (C-reactive protein)</td><td align="center" rowspan="1" colspan="1">0–5 (mg/l)</td><td align="center" rowspan="1" colspan="1">1.63</td><td align="center" rowspan="1" colspan="1">15.1</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">AST (aspartate transaminase)</td><td align="center" rowspan="1" colspan="1">0–35 (U/L)</td><td align="center" rowspan="1" colspan="1">22</td><td align="center" rowspan="1" colspan="1">23.5</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">33.4</td></tr><tr><td align="left" rowspan="1" colspan="1">ALT (alanine transaminase)</td><td align="center" rowspan="1" colspan="1">0–35 (U/L)</td><td align="center" rowspan="1" colspan="1">17.7</td><td align="center" rowspan="1" colspan="1">13.9</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">15.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Creatinine</td><td align="center" rowspan="1" colspan="1">58–98 (micromol/l)</td><td align="center" rowspan="1" colspan="1">65</td><td align="center" rowspan="1" colspan="1">59</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">60</td></tr><tr><td align="left" rowspan="1" colspan="1">HIV Elisa</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td><td align="center" rowspan="1" colspan="1">Neg</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">CSF:</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Cell count</td><td align="center" rowspan="1" colspan="1">0–5 (mm<sup>3</sup>)</td><td align="center" rowspan="1" colspan="1">31.25</td><td align="center" rowspan="1" colspan="1">295</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"><5</td></tr><tr><td align="left" rowspan="1" colspan="1">Neut</td><td align="center" rowspan="1" colspan="1">%</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Lymph</td><td align="center" rowspan="1" colspan="1">%</td><td align="center" rowspan="1" colspan="1">94</td><td align="center" rowspan="1" colspan="1">96</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Glucose</td><td align="center" rowspan="1" colspan="1">2.22–3.89 (mmol/l)</td><td align="center" rowspan="1" colspan="1">2.39</td><td align="center" rowspan="1" colspan="1">3.51</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">2.69</td></tr><tr><td align="left" rowspan="1" colspan="1">Protein</td><td align="center" rowspan="1" colspan="1">0.15–0.45 (g/l)</td><td align="center" rowspan="1" colspan="1">0.52</td><td align="center" rowspan="1" colspan="1">0.56</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">0.44</td></tr><tr><td align="left" rowspan="1" colspan="1">Tb Gene expert</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF adenine deaminase</td><td align="center" rowspan="1" colspan="1">0–5 (U/L)</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">18.41</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">0.29</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF culture</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">No growth</td><td align="center" rowspan="1" colspan="1">No growth</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">No growth</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF viral PCR-herpes + enterovirus</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td></tr><tr><td align="left" rowspan="1" colspan="1">EBV (Epstein-Barr virus)</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">IgG-positive IgM-neg</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Tropical fever screen-<break></break>(i) Malaria antigen<break></break>(ii) Leptospira<break></break>(iii) Rickettsia<break></break>(iv) Dengue<break></break>(v) West Nile virus<break></break>(vi) Chikungunya</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td></tr><tr><td align="left" rowspan="1" colspan="1">Malaria parasite</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Absent</td><td align="center" rowspan="1" colspan="1">Absent</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Blood culture</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">No growth</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">No growth</td></tr><tr><td align="left" rowspan="1" colspan="1">Urine culture</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">No growth</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">No growth</td></tr><tr><td align="left" rowspan="1" colspan="1">ANA (antinuclear antibody)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Positive 1 : 320 speckled</td></tr><tr><td align="left" rowspan="1" colspan="1">ENA</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Positive for SS-A/RO-52</td></tr><tr><td align="left" rowspan="1" colspan="1">Complement 3/4</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Normal</td></tr><tr><td align="left" rowspan="1" colspan="1">Anti-dsDNA</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td></tr><tr><td align="left" rowspan="1" colspan="1">Antiphospholipid antibody</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td></tr><tr><td align="left" rowspan="1" colspan="1">Direct Coombs test</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td></tr><tr><td align="left" rowspan="1" colspan="1">Ferritin</td><td align="center" rowspan="1" colspan="1">13–150 (ng/ml)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Normal</td></tr><tr><td align="left" rowspan="1" colspan="1">Lipid profile</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Normal</td></tr><tr><td align="left" rowspan="1" colspan="1">TSH (thyroid stimulating hormone)</td><td align="center" rowspan="1" colspan="1">0.27–4.2 (pg/ml)</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">1.68</td><td align="center" rowspan="1" colspan="1">49.77</td><td align="center" rowspan="1" colspan="1">25.24</td><td align="center" rowspan="1" colspan="1">4.23</td></tr><tr><td align="left" rowspan="1" colspan="1">T3</td><td align="center" rowspan="1" colspan="1">2–4.4 (pg/ml)</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">2.88</td><td align="center" rowspan="1" colspan="1">1.67</td><td align="center" rowspan="1" colspan="1">2.97</td><td align="center" rowspan="1" colspan="1">1.87</td></tr><tr><td align="left" rowspan="1" colspan="1">T4</td><td align="center" rowspan="1" colspan="1">0.97–1.58 (ng/ml)</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">0.87</td><td align="center" rowspan="1" colspan="1">0.32</td><td align="center" rowspan="1" colspan="1">0.84</td><td align="center" rowspan="1" colspan="1">0.86</td></tr><tr><td align="left" rowspan="1" colspan="1">Anti-TPO antibodies</td><td align="center" rowspan="1" colspan="1"><34 (IU/ml)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">290</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Antithyroglobulin</td><td align="center" rowspan="1" colspan="1"><115 (IU/ml)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">226</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">TSH receptor antibodies</td><td align="center" rowspan="1" colspan="1"><1.22</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">0.468</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Lymph node biopsy</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Refer to Figures <xref ref-type="fig" rid="fig1">1(a)</xref> and <xref ref-type="fig" rid="fig1">1(b)</xref></td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Refer to <xref ref-type="fig" rid="fig1">Figure 1(c)</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Tissue Tb culture</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Neg</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Bone marrow aspirate</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Normocellular</td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>Kenya</li></country></list><tree><country name="Kenya"><noRegion><name sortKey="Sharma, Karishma" sort="Sharma, Karishma" uniqKey="Sharma K" first="Karishma" last="Sharma">Karishma Sharma</name></noRegion><name sortKey="Otieno, Fredrick" sort="Otieno, Fredrick" uniqKey="Otieno F" first="Fredrick" last="Otieno">Fredrick Otieno</name><name sortKey="Shah, Reena" sort="Shah, Reena" uniqKey="Shah R" first="Reena" last="Shah">Reena Shah</name></country></tree></affiliations></record>Pour manipuler ce document 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