Is implant pacemaker a physicochemical cause triggering Kikuchi-Fujimoto disease?

A 64 year-old Caucasian female of Greek origin was admitted to hospital with painful cervical and axillary lymphodenitis accompanied by fever and night sweats for 10 days. The patient had undergone a pacemaker implantation six weeks before disease onset because of heart conduction abnormalities. A diagnosis of Kikuchi-Fujimoto disease was established after lymph node biopsy. The etiology of the disease is unknown but viral, bacterial, protozoal; and neoplastic as well as physicochemical agents may stimulate a particular immune response. Hereby, we hypothesize that the implant pacemaker can act as a physicochemical agent triggering Kikuchi-Fujimoto disease. We present this case and we discuss various disease aspects. A brief review of the literature is also given.