A recovery that wasn't

Soon after giving birth to her first child, a 28-year-old woman in Bettendorf, Iowa, began experiencing severe chills followed by high fevers, peaking daily at 102 or 103 degrees Fahrenheit. According to Sanders, the woman suddenly felt like "cold descended on her body as if it were a frigid January," before experiencing waves of heat, heaviness, and fatigue.

Initially, she was treated at an urgent care clinic in Moline, Illinois, with a 10-day course of antibiotics for a presumed infection, but the fevers continued. She also began experiencing pain at the site of her perineal stitches — discomfort that had resolved weeks earlier but now returned, concurrent with the fever.

Concerned, she and her husband traveled to the University of Iowa Health Care Medical Center for a scheduled postpartum check-up. There, clinicians noted that some sutures had opened and become infected. She was admitted and started on intravenous broad-spectrum antibiotics.

No improvement, despite treatment

Surgical cleaning of the area showed mild infection, which responded well to antibiotics. There was no evidence of infection in the cervix or signs of inflammation in her breasts that could affect breastfeeding. Blood and urine cultures were negative, and imaging revealed no deep abscess or source of infection. Still, the fevers persisted.

Daniel Livorsi, an infectious disease specialist, reviewed the case and conducted a full evaluation. Since the patient's fevers started too late to be a complication from her delivery, Livorsi classified her fevers as an FUO or fever of unknown origin.

A clue from imaging — and an answer from pathology

After a week of daily fevers and still no diagnosis, the patient underwent a PET scan, which showed nodules of hyperactive cells in her lymph nodes from her neck to pelvis. According to the report from the radiologists, this activity could be due to widespread inflammation from an infection or autoimmune disorder, or a type of cancer called lymphoma.

The patient "was scheduled to get a biopsy the next day, and that would show what was going on in these hyperactive lymph nodes," Sanders writes.

A needle biopsy of one of the enlarged lymph nodes was performed. The patient and her husband were told to expect results within a week.

When the pathology report came back, the diagnosis was Kikuchi disease — a rare immune disorder that is often mistaken for lymphoma or lupus. Kikuchi disease is believed to be an abnormal immune reaction, potentially in response to a viral infection.  

"She'd had the classic symptoms: fevers, fatigue, and lymph nodes swollen with remnants of destroyed immune cells," Sanders writes. Luckily, Kikuchi disease typically resolves on its own without a need for treatment in a few weeks.

Recovery and relief

When the patient received her diagnosis, it had been four days since her last fever, which suggested that she had recovered from her condition. The patient was soon discharged home with her newborn. Her care team emphasized that no specific treatment was required, and recurrence was unlikely.

Since then, the patient said that she feels great and has not experienced any fevers. "She's tired, of course," Sanders writes. "Her baby is only 4 months old, and even with the help of her husband and parents, caring for an infant is a hard job. But it is, she tells me in a weary, happy voice, a job she loves."