One month ago this 9 year old girl developed an intermittent fever and multiple posterior cervical masses. Nine days ago she developed red patches and plaques on her face and extremities associated with headache, projectile vomiting and tonic-clonic seizures. On physical examination she appeared drowsy and diaphoretic with a fever of 39 degrees C, stiff neck, multiple tender 1-2 cm posterior cervical lymph nodes, and diffuse red partially blanching almost confluent patches and papules on the face and extremities. A lymph node biopsy was consistent with histiocytic necrotizing lymphadenitis (Kikuchi's disease), and a skin biopsy showed a perivascular and perifollicular mononuclear cell infiltration, vacuolar degeneration of basal cell layer, presence of necrotic keratinocytes, papillary dermal edema, and karyorrhexis. These changes are typical of Kikuchi's disease, a self-limited inflammatory disorder characterized by fever and cervical lymphadenopathy in young woman. However, the findings are not specific and can be associated with systemic lupus erythematosus and lymphoma..
Diffuse almost confluent partially blanching 1-2 mm papules