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May 2006

Generalized Maculopapules With Fever and Cervical Lymphadenopathy—Diagnosis

Author Affiliations
 

MICHAEL E.MINGMD

Arch Dermatol. 2006;142(5):641-646. doi:10.1001/archderm.142.5.641-g

Histopathologic examination demonstrated subtle vacuolar changes of basal layer, mild papillary dermal edema, and a moderate perivascular infiltrate in the dermis. The infiltrated cells were composed of variable-sized lymphoid cells and histiocytes with a few plasmacytoid cells. Immunohistochemical CD68 staining showed strong cytoplasmic positivity on most of the infiltrates, including large-sized lymphoid cells and plasmacytoid cells as well as histiocytes.

The clinical findings along with the pathologic findings were highly suggestive of KFD. An excisional biopsy specimen of a cervical lymph node demonstrated a mixed infiltrate of histiocytes, plasmacytoid monocytes, and lymphoid cells, with abundant karyorrhexis and necrosis, features typical of KFD. Treatment with oral naproxen (500 mg twice daily), oral hydroxyzine (10 mg 3 times a day), and topical 0.05% desonide lotion (twice daily) was initiated, and all the presenting symptoms slowly subsided over the next 3 weeks. The patient remained asymptomatic during a 6-month follow-up period.

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