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Danesh K, Cohen LM, Liu Y, Karlin JN, Rootman DB. Systemic eosinophilic disease presenting as dacryoadenitis. Orbit 2023; 42:107-111. [PMID: 34514933 DOI: 10.1080/01676830.2021.1973514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Eosinophilic disease with orbital involvement is rare. We present two patients with dacryoadenitis associated with local and systemic eosinophilia. A 32-year-old man presented with episodic dacryoadenitis, lower respiratory inflammation and peripheral eosinophilia. Lung and lacrimal gland biopsies demonstrated eosinophilic infiltrate without granuloma, necrosis, or vasculitis. He improved with oral corticosteroids and Mepolizumab, an IL-5 inhibitor. The second case involved a 33-year-old man who similarly presented with episodic dacryoadenitis, pulmonary inflammation and pain/swelling in the hands and feet. Lacrimal gland biopsy demonstrated a predominantly eosinophilic infiltrate without granuloma or vasculitis. Symptoms improved with oral corticosteroids. Although neither patient was provided a definitive diagnosis, both were determined to have an eosinophilic condition on the spectrum of eosinophilic asthma or eosinophilic granulomatosis with polyangiitis.
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Affiliation(s)
- Kayla Danesh
- University of California Los Angeles, Los Angeles, California, USA
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California, USA
| | - Yan Liu
- Department of Pathology and Human Anatomy, Loma Linda University Health, Loma Linda, California, USA
| | - Justin N Karlin
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California, USA
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Han MM, Dermarkarian CR, Del Valle Estopinal MD, Tao JP. Kimura Disease of the Periorbita and Earlobe in a 15-Year-Old Male: A Case Report and Review of the Literature. Ophthalmic Plast Reconstr Surg 2023; 39:26-33. [PMID: 35699221 DOI: 10.1097/iop.0000000000002221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The authors describe a case of Kimura disease (KD) affecting the lacrimal gland, the ipsilateral periorbita, and the contralateral earlobe. The authors also review the literature for characteristics and outcomes of KD affecting the periorbita or earlobe. METHODS The authors review retrospectively a single chart and abstract data from the English language literature. RESULTS A 15-year-old Samoan male presented with a left upper eyelid mass and later the contralateral earlobe and ipsilateral periorbita. Surgical resection was partially effective and normal vision and eye motility were maintained. Histopathology was consistent with KD. Thirty-seven cases of periorbital KD were identified in the literature. The average age of patients with periorbital KD was 31.9 years (standard deviation: 17.8 years), with 81.1% (30/37) of patients being male and 69.4% (25/36) Asian. Over half of periorbital KD patients had lacrimal gland involvement (51.3%; 19/37). Fifteen patients were initially treated with surgery; 3 (20%) had recurrence of the disease. Another 15 patients were initially treated with corticosteroids; 12 (80%) had recurrence of the disease. Ophthalmologic data, when reported, demonstrated that, most patients had no visual (77.8%; 14/18 patients) or motility disturbances (82.4%; 14/17 patients) but most had proptosis 71.4% (10/14). Only 4 cases of earlobe involvement in KD were identified, all in women. CONCLUSIONS In the literature, orbital KD was rare but often affected the lacrimal gland and caused proptosis, commonly in young adult Asian males. Vision and extraocular motility were usually normal. Earlobe involvement was very rare. This unique case of KD that affected the orbit and contralateral earlobe corroborates the prior literature that KD is prone to recurrence but may not adversely affect vision or extraocular motility.
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Agrawal S, Sen S, Sabu S, Modaboyina S, Bajaj MS, Das D. Bilateral orbital Kimura's disease: A case report and brief review of literature. Indian J Ophthalmol 2022; 70:2737-2738. [PMID: 35791229 PMCID: PMC9426089 DOI: 10.4103/ijo.ijo_2648_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sahil Agrawal
- Oculoplasty & Paediatric Ophthalmology Services; Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Seema Sen
- Department of Ocular Pathology; Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Shilpa Sabu
- Oculoplasty & Paediatric Ophthalmology Services; Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Sujeeth Modaboyina
- Oculoplasty & Paediatric Ophthalmology Services; Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Mandeep Singh Bajaj
- Oculoplasty & Paediatric Ophthalmology Services; Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Deepsekhar Das
- Oculoplasty & Paediatric Ophthalmology Services; Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Kakehi E, Kotani K, Otsuka Y, Fukuyasu Y, Hashimoto Y, Sakurai S, Hirotani A, Simizu K, Fujita R, Shoji K, Adachi S, Matsumura M. Kimura's disease: effects of age on clinical presentation. QJM 2020; 113:336-345. [PMID: 31800058 DOI: 10.1093/qjmed/hcz312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/11/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Kimura's disease (KD) is known to be dominant among young Asian men, but it can also occur in middle- and advanced-aged people. The clinical characteristics of KD, especially by age, are not well known. AIM This study was performed to investigate the effects of age on the clinical characteristics of KD. DESIGN We conducted a case series study. METHODS All case studies of patients diagnosed with KD were collected via a PubMed search of studies published until August 2018. The data were analyzed by age group. RESULTS In total, 215 studies were reviewed (238 patients; mean age of 36 years). The male:female ratio was 4:1 overall, 17:1 in patients aged <20 years, 4:1 in patients aged 20-39 years and 2:1 in patients aged ≥40 years (P = 0.01). The percentage of patients with pruritus was 15.4% overall, 3.8% in patients aged <20 years, 15.5% in patients aged 20-39 years and 21.7% in patients aged ≥40 years (P = 0.02). The time to diagnosis was 5.3 years overall, 3.2 years in patients aged <20 years, 4.7 years in patients aged 20-39 years and 7.1 years in patients aged ≥40 years (P < 0.01). CONCLUSIONS The proportion of female patients affected the incidence of pruritus, and the time to diagnosis increased as the patients' age increased. There were no significant age-related differences in region/race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, immunoglobulin E level, initial treatment, recurrence or outcomes. This may be useful information for the diagnosis of KD.
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Affiliation(s)
- E Kakehi
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - K Kotani
- Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Y Otsuka
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - Y Fukuyasu
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - Y Hashimoto
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - S Sakurai
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - A Hirotani
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - K Simizu
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - R Fujita
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - K Shoji
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - S Adachi
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - M Matsumura
- Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Goncalves ACP, Moritz RB, Aldred VL, Monteiro MLR. Bilateral extraocular muscles enlargement from Kimura's disease of the orbit. Indian J Ophthalmol 2017; 64:538-40. [PMID: 24088630 PMCID: PMC5026083 DOI: 10.4103/0301-4738.118424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Kimura's disease (KD) is a rare chronic inflammatory disease of unclear etiology, characterized by subcutaneous nodules, mainly in the head and neck region, frequently associated with regional lymphadenopathy. Orbital involvement is infrequent and when it occurs, usually affects the eyelid or the lacrimal gland. We report a case of a 44-year-old man that presented with bilateral slowly progressive proptosis that was initially misdiagnosed as Graves’ Ophthalmopathy. 15 months of worsening proptosis and the development of facial and temporal swelling led to further investigation. Computed tomography and magnetic resonance imaging showed enlargement of all recti muscles and diffuse orbital infiltration. An orbital biopsy was performed and was consistent with the diagnosis of KD. Long term oral corticosteroid showed marked improvement of proptosis and facial swelling. This case serves to emphasize that KD should be included in the differential diagnosis of inflammatory diseases of the orbit, even when characterized by predominant involvement of the extraocular muscles.
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Affiliation(s)
| | - Rodrigo B Moritz
- Department of Ophthalmology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Vera L Aldred
- Department of Pathology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mário Luiz Ribeiro Monteiro
- Department of Ophthalmology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Kimura's Disease in a Caucasian Female: A Very Rare Cause of Lymphadenopathy. Case Rep Otolaryngol 2014; 2014:415865. [PMID: 24955268 PMCID: PMC4052045 DOI: 10.1155/2014/415865] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/03/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction. Kimura's disease is a rare chronic inflammatory disorder characterized by the head and neck lymphadenopathy often accompanied by eosinophilia and elevated serum IgE. It is benign condition with unknown etiology usually affecting young men of Asian race. Affected Caucasians are very rare. Case Presentation. We report a clinically and histopathologically typical case of this disease in a 40-year-old Caucasian female. In differential diagnosis particular attention has been paid to angiolymphoid hyperplasia with eosinophilia and neoplasms. Conclusion. The diagnosis of Kimura's disease can be very difficult and misleading; it is important not to ignore histopathological features. The presented patient has been under follow-up with no more symptoms of the disease for the last 1.5 years.
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Monzen Y, Kiya K, Nishisaka T. Kimura's Disease of the Orbit Successfully Treated with Radiotherapy Alone: A Case Report. Case Rep Ophthalmol 2014; 5:87-91. [PMID: 24748872 PMCID: PMC3985780 DOI: 10.1159/000360789] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We performed radiotherapy in a 28-year-old patient with Kimura's disease of the orbit. Irradiation with 21.6 Gy was administered to the tumor bed with a single dose of 1.8 Gy in 5 weekly fractions delivered via a high-energy linear accelerator (6-MV X-ray). Complete remission of the tumor and improvements in the neurological findings were achieved. Neither tumor regrowth nor late complications were detected up to 84 months after radiotherapy. Radiotherapy is an effective treatment for Kimura's disease of the orbit.
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Affiliation(s)
- Yoshio Monzen
- Department of Radiology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Katsuzo Kiya
- Department of Neurosurgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takashi Nishisaka
- Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan
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Lee JKS, Almousa R, Thamboo TP, Amrith S. Kimura disease of the eyelid in an Indian man. Clin Exp Ophthalmol 2009; 37:412-4. [DOI: 10.1111/j.1442-9071.2009.02049.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Meningaud JP, Pitak-Arnnop P, Fouret P, Bertrand JC. Kimura’s Disease of the Parotid Region: Report of 2 Cases and Review of the Literature. J Oral Maxillofac Surg 2007; 65:134-40. [PMID: 17174779 DOI: 10.1016/j.joms.2005.10.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2005] [Accepted: 10/19/2005] [Indexed: 10/23/2022]
Affiliation(s)
- Jean-Paul Meningaud
- Department of Maxillofacial Surgery and Stomatology, Teaching Pitié-Salpêtrière Hospital, Paris, France.
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Clinicopathologic study of parotid involvement in 21 cases of eosinophilic hyperplastic lymphogranuloma (Kimura's disease). ACTA ACUST UNITED AC 2006; 102:651-8. [PMID: 17052642 DOI: 10.1016/j.tripleo.2005.11.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 10/28/2005] [Accepted: 11/23/2005] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the clinicopathologic features of eosinophilic hyperplastic lymphogranuloma (Kimura's disease) in the parotid gland. STUDY DESIGN The hematoxylin and eosin sections and clinical data of 60 patients with eosinophilic hyperplastic lymphogranuloma (Kimura's disease), including with parotid involvement, were reviewed. RESULTS Of 60 cases of eosinophilic hyperplastic lymphogranuloma (average age, 42 years; average disease duration, 5.8 years), 35 cases (58%) were clinically seen to involve swelling of the parotid region. Parotid specimens were available in 21 cases and showed different microscopic changes. In mildly affected parotid samples, the histological features included infiltration of lymphocytes and eosinophils around the ducts of the interlobular connective tissues. In the moderately involved glands, the infiltrated area was enlarged and contained lymphoid follicles, resulting in adjacent acinar atrophy that was particularly obvious around the salivary ducts. In severe lesions, most acini were lost and only a few ducts remained. All cases with parotid involvement showed more severe pathological changes in the subcutaneous connective tissues and/or local lymph nodes. The parotid lesions often surrounded a central intraglandular lymph node with characteristic features of the disease; however, the salivary parenchyma was left alone. Nerve fibers affected by inflammatory lymphocytes and eosinophils were seen in 38/60 (63%) cases of eosinophilic hyperplastic lymphogranuloma (Kimura's disease) examined in this study. CONCLUSIONS Eosinophilic hyperplastic lymphogranuloma (Kimura's disease) does not show primary parotid involvement, but instead, pathological changes in the parotid gland are a result of disease spread from the intraparotid lymph nodes and adjacent soft tissues. In addition, our observations suggest that the pruritus often associated with the disease may be due to nerve infiltration by lymphocytes and eosinophils.
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Acocella A, Catelani C, Nardi P. Angiolymphoid hyperplasia with eosinophilia: A case report of orbital involvement. J Oral Maxillofac Surg 2005; 63:140-4. [PMID: 15635569 DOI: 10.1016/j.joms.2004.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Alessandro Acocella
- Division of Maxillo-Facial Surgery, Department of Odontostomathology, Faculty of Medicine, University of Florence, Firenze, Italy.
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