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Atypical Presentation of Kimura’s Disease in a Male Patient: A Case Report and Review of Literature. Case Rep Med 2022; 2022:5103547. [DOI: 10.1155/2022/5103547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Kimura’s disease (KD) is a rare chronic inflammatory condition of unknown aetiology. It is a benign disease that might mimic a neoplastic process. It primarily affects the head and neck region, presenting as deep subcutaneous masses, and is often accompanied by triad regional lymphadenopathy, salivary gland involvement, and high serum immunoglobulin E (IgE) levels. Here, we report the second documented case of KD in Palestine diagnosed in a 28-year-old male patient who presented with lymphadenopathy and increased serum immunoglobulin E and G (IgE and IgG) associated with intermittent abdominal pain, generalised fatigue, hepatomegaly, cardiomyopathy, reactive airway disease, peripheral vasculopathy, peripheral neuropathy, and focal segmental glomerulosclerosis. The patient was managed with steroids and an immunosuppressant (Azathioprine) with a moderate response for two years. In 2021, treatment with Mycophenolate Mofetil was initiated, which was more effective than Azathioprine.
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2
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Figueres L, Bruneau S, Prot-Bertoye C, Brideau G, Néel M, Griveau C, Cheval L, Bignon Y, Dimitrov J, Dejoie T, Ville S, Kandel-Aznar C, Moreau A, Houillier P, Fakhouri F. Hypomagnesemia, Hypocalcemia, and Tubulointerstitial Nephropathy Caused by Claudin-16 Autoantibodies. J Am Soc Nephrol 2022; 33:1402-1410. [PMID: 35728884 PMCID: PMC9257800 DOI: 10.1681/asn.2022010060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/22/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chronic hypomagnesemia is commonly due to diarrhea, alcoholism, and drugs. More rarely, it is caused by genetic defects in the effectors of renal magnesium reabsorption. METHODS In an adult patient with acquired severe hypomagnesemia, hypocalcemia, tubulointerstitial nephropathy, and rapidly progressing kidney injury, similarities between the patient's presentation and features of genetic disorders of renal magnesium transport prompted us to investigate whether the patient had an acquired autoimmune cause of renal magnesium wasting. To determine if the patient's condition might be explained by autoantibodies directed against claudin-16 or claudin-19, transmembrane paracellular proteins involved in renal magnesium absorption, we conducted experiments with claudin knockout mice and transfected mouse kidney cells expressing human claudin-16 or claudin-19. We also examined effects on renal magnesium handling in rats given intravenous injections of IgG purified from sera from the patient or controls. RESULTS Experiments with the knockout mice and in vitro transfected cells demonstrated that hypomagnesemia in the patient was causally linked to autoantibodies directed against claudin-16, which controls paracellular magnesium reabsorption in the thick ascending limb of Henle's loop. Intravenous injection of IgG purified from the patient's serum induced a marked urinary waste of magnesium in rats. Immunosuppressive treatment combining plasma exchange and rituximab was associated with improvement in the patient's GFR, but hypomagnesemia persisted. The patient was subsequently diagnosed with a renal carcinoma that expressed a high level of claudin-16 mRNA. CONCLUSIONS Pathogenic claudin-16 autoantibodies represent a novel autoimmune cause of specific renal tubular transport disturbances and tubulointerstitial nephropathy. Screening for autoantibodies targeting claudin-16, and potentially other magnesium transporters or channels in the kidney, may be warranted in patients with acquired unexplained hypomagnesemia.
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Affiliation(s)
- Lucile Figueres
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
| | - Sarah Bruneau
- Centre de Recherche en Transplantation et Immunologie, Nantes, France.,Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Caroline Prot-Bertoye
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France.,Department of Physiology, Hôpital Européen Georges Pompidou, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Paris, France.,CNRS, Paris, France
| | - Gaëlle Brideau
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France.,CNRS, Paris, France
| | - Mélanie Néel
- Centre de Recherche en Transplantation et Immunologie, Nantes, France.,Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Camille Griveau
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France.,CNRS, Paris, France
| | - Lydie Cheval
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France.,CNRS, Paris, France
| | - Yohan Bignon
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France.,CNRS, Paris, France
| | - Jordan Dimitrov
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
| | - Thomas Dejoie
- Laboratory of Biochemistry, CHU de Nantes, Nantes, France
| | - Simon Ville
- Centre de Recherche en Transplantation et Immunologie, Nantes, France.,Institut de Transplantation Urologie Néphrologie, Nantes, France.,Department of Nephrology, CHU de Nantes, Nantes, France
| | | | - Anne Moreau
- Department of Pathology, CHU de Nantes, Nantes, France
| | - Pascal Houillier
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France .,Department of Physiology, Hôpital Européen Georges Pompidou, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Paris, France.,CNRS, Paris, France
| | - Fadi Fakhouri
- Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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3
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Li W. Kimura's disease in soft palate with clinical and histopathological presentation: A case report. World J Clin Cases 2022; 10:3842-3848. [PMID: 35647156 PMCID: PMC9100734 DOI: 10.12998/wjcc.v10.i12.3842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/10/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Kimura’s disease is an inflammatory disease that is usually found in the deep lymph nodes of the head and neck. While rare, It is most frequently seen in young men. The oral cavity and salivary glands may also be involved. There are no reports on tumor occurring in soft palate. We have encountered a case of Kimura’s disease in the soft palate of an elderly woman.
CASE SUMMARY A 63-year-old elderly Chinese woman with a slowly growing mass in the upper jaw was referred to our service. A biopsy to the mass was taken after the patient was referred to our service. The tumor was diagnosed as benign. We performed cervical lymph node puncture and partial surgical excision of the lesion. The tumor, which showed signs of marked follicular hyperplasia with follicles surrounded by eosinophils and lymphocytes, was located within the soft palate. Kimura’s disease was diagnosed after histopathologic examination of the resected tissue. The etiology of Kimura’s disease is not fully understood. One current model includes T-cells involvement with cytokines also playing a role. The patient was without evidence for recurrence of partially resected area 6 mo later. This report shows that Kimura’s disease is not limited to the head, neck, and salivary gland lymph nodes. We present a case of a tumor in soft palate. This location adds another possible site for consideration during the differential diagnoses of a slowly growing mass.
CONCLUSION The present case illustrates a characteristic description of Kimura’s disease. This case highlights the main differences between Kimura’s disease and angiolymphoid hyperplasia with eosinophilia.
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Affiliation(s)
- Wu Li
- Department of Head and Neck Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410000, Hunan Province, China
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4
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Lee CC, Feng IJ, Chen YT, Weng SF, Chan LP, Lai CS, Lin SD, Kuo YR. Treatment algorithm for Kimura's disease: A systematic review and meta-analysis of treatment modalities and prognostic predictors. Int J Surg 2022; 100:106591. [DOI: 10.1016/j.ijsu.2022.106591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
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5
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Ramachandran PV, Healy CM, Lambert EM, Guerra D, Curry CV, Vogel TP. Case Report: Hyper IgE, but Not the Usual Suspects-Kimura Disease in an Adolescent Female. Front Pediatr 2021; 9:674317. [PMID: 34354968 PMCID: PMC8329340 DOI: 10.3389/fped.2021.674317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/21/2021] [Indexed: 01/13/2023] Open
Abstract
Elevated immunoglobulin E (IgE) levels can be associated with infectious, allergic and inflammatory disorders, and rarely as a manifestation of an inborn error of immunity. Here we report the case of an adolescent female who presented with a gradually enlarging neck mass, lymphadenopathy, eosinophilia and highly elevated IgE levels. Laboratory and histopathologic evaluation revealed an unlikely diagnosis of Kimura Disease. We discuss the differential diagnosis of a neck mass with prominent eosinophils on histology, and review support for T-helper type 2 (Th2) cell activation and hyper-IgE in Kimura Disease.
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Affiliation(s)
- Prasanna Venkatesh Ramachandran
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.,Pediatrician-Scientist Program, Baylor College of Medicine, Houston, TX, United States.,Texas Children's Hospital, Houston, TX, United States
| | - C Mary Healy
- Texas Children's Hospital, Houston, TX, United States.,Division of Infectious Disease, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Elton M Lambert
- Texas Children's Hospital, Houston, TX, United States.,Division of Otolaryngology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | | | - Choladda V Curry
- Texas Children's Hospital, Houston, TX, United States.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States
| | - Tiphanie P Vogel
- Texas Children's Hospital, Houston, TX, United States.,Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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6
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Rush ML, Mauro A, Bhansali P. Kimura disease: a case report of a rare illness presenting as a common complaint. ACTA ACUST UNITED AC 2020; 6:393-396. [PMID: 30808157 DOI: 10.1515/dx-2018-0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/28/2019] [Indexed: 12/29/2022]
Abstract
Background Kimura is an uncommon inflammatory cause of pediatric head and neck masses due to eosinophilic infiltration of unclear etiology. Kimura can present similarly to infectious lymphadenitis, a much more common pediatric complaint. This case explores the role of anchoring bias when faced with an illness that at first appears to fit a common illness script that led to a delayed diagnosis. Case presentation A 7-year-old boy presented with acute onset of pre-auricular lymphadenopathy and fevers initially thought to be most consistent with infectious cervical lymphadenopathy. Despite treatment with broad spectrum antibiotics and multiple evaluations for underlying abscess requiring surgical drainage, the patient did not improve and remained febrile. Eventually, excisional lymph node biopsy was obtained and a pathologic diagnosis of Kimura disease was made. Conclusions This case illustrates an uncommon pediatric diagnosis which presented similarly to infectious cervical lymphadenitis without additional laboratory features consistent with Kimura. We highlight the role of anchoring bias and care fragmentation leading to repeat imaging and delayed biopsy in the eventual diagnosis of a rare illness.
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Affiliation(s)
| | - Alexandra Mauro
- Children's National Medical Center, Washington, DC, USA.,Walter Reed National Military Medical Center and George Washington University, Washington, DC, USA
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7
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Dinesh KP, Raniele D, Michels K, Avasare RS, Larsen CP, Kayton R, Khalighi MA, Andeen NK. Anti-LRP2 Nephropathy With Abundant IgG4-Positive Plasma Cells: A Case Report. Am J Kidney Dis 2019; 74:132-137. [PMID: 30876746 DOI: 10.1053/j.ajkd.2018.12.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/17/2018] [Indexed: 12/24/2022]
Abstract
In older adults, the most common kidney biopsy diagnoses include pauci-immune crescentic glomerulonephritis, membranous nephropathy, and focal segmental glomerulosclerosis. Recently, investigators described a small series of older patients (aged 66-80 years) with acute kidney injury and a kidney biopsy demonstrating tubular basement membrane (TBM) immune deposits of polytypic immunoglobulin G (IgG) and C3, acute tubular injury, and tubulointerstitial inflammation. They identified a circulating antibody against kidney tubular low-density lipoprotein (LDL) receptor-related protein 2 (LRP2; also known as megalin) in patients' sera and colocalization of LRP2 with IgG in TBM deposits. We present a rare case of anti-LRP2 nephropathy/anti-brush border antibody disease and describe the novel feature of abundant IgG4-positive interstitial plasma cells. Along with the combination of TBM deposits, tubulointerstitial nephritis (TIN), and segmental glomerular subepithelial immune deposits seen in both entities, this newly described feature adds to the morphologic overlap with IgG4-related TIN. Identification of large TBM deposits using light microscopy and IgG staining of apical aspects of proximal tubules using immunofluorescence microscopy can point to the correct diagnosis of anti-LRP2 nephropathy and prompt confirmatory studies. Particularly in older patients with immune complex-mediated TIN who lack clinical, laboratory, radiographic, and/or characteristic histologic features of IgG4-TIN or other autoimmune, infectious, or drug-related injury, a diagnosis of anti-LRP2 nephropathy should be considered.
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Affiliation(s)
| | | | | | - Rupali S Avasare
- Division of Nephrology, Department of Medicine, Oregon Health & Science University, Portland, OR
| | | | - Robert Kayton
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Mazdak A Khalighi
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Nicole K Andeen
- Department of Pathology, Oregon Health & Science University, Portland, OR.
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8
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Dokania V, Patil D, Agarwal K, Thakur P, Prajapati P. Kimura's Disease without Peripheral Eosinophilia: An Unusual and Challenging Case Simulating Venous Malformation on Imaging Studies-Case Report and Review of literature. J Clin Diagn Res 2017; 11:ME01-ME04. [PMID: 28764210 DOI: 10.7860/jcdr/2017/28603.10063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/16/2017] [Indexed: 11/24/2022]
Abstract
Kimura's Disease (KD) is a rare chronic inflammatory disorder presenting as multiple painless solitary subcutaneous nodules, predominantly in the head and neck region and frequently associated with regional lymphadenopathy and/or salivary gland involvement. Because of painless nature and indolent course, there is usually a delay in the patient's presentation. KD may radiologically mimic other chronic inflammatory conditions like tuberculosis, vascular malformations and neoplasms. Clinical correlation and histological evaluation along with elevated peripheral eosinophil and serum IgE level are considered important for confirmatory diagnosis. We report a case of painless swelling over right submandibular region extending to the right superficial parotid. The haematological reports were within normal limits. Ultrasound (USG), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiogram (MRA) favoured a diagnosis of venous malformation. However, histopathological examination of excised lesion confirmed a diagnosis of KD. This case proves the possibility of the KD even in the absence of peripheral eosinophilia and/ or elevated serum IgE level, and may mimic venous malformation on imaging studies. Therefore, KD must find a place in the differentials of solitary painless neck swelling even in the absence of peripheral eosinophilia and/or elevated IgE level.
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Affiliation(s)
- Vivek Dokania
- Resident, Department of Ear, Nose and Throat, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
| | - Digvijay Patil
- Professor, Department of Oncosurgery, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
| | - Ketan Agarwal
- Resident, Department of Ear, Nose and Throat, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
| | - Prajakta Thakur
- Student, Department of Clinical Research and Data Management, James Lind Institute, Hyderabad, Telangana, India
| | - Piyush Prajapati
- Resident, Department of Medicine, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
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9
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Alnasrallah B, Yehia M. Kimura disease in a Maori man with nephrotic syndrome. Intern Med J 2016; 46:1453. [PMID: 27981775 DOI: 10.1111/imj.13285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/14/2016] [Indexed: 12/19/2022]
Affiliation(s)
- B Alnasrallah
- Department of Nephrology, Auckland City Hospital, Auckland, New Zealand
| | - M Yehia
- Department of Nephrology, Auckland City Hospital, Auckland, New Zealand
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10
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Rodrigues G, Ravi B. Synchronous Kimura lesions at two different sites-a diagnostic dilemma! Quant Imaging Med Surg 2016; 6:214-7. [PMID: 27190775 PMCID: PMC4858467 DOI: 10.21037/qims.2015.08.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/03/2015] [Indexed: 11/06/2022]
Abstract
Kimura disease (KD) is a rare, chronic, benign inflammatory disorder of unknown etiology mimicking neoplastic disease and is characterized by multiple subcutaneous nodules and masses, primarily in the cervical region, accompanied by peripheral eosinophilia and lymphadenopathy. A 35-year-old male presented with a 2-year history of swelling in the right preauricular region and right thigh. Investigations showed a peripheral eosinophilia. CT of cervical region revealed parotid neoplasm and a fine needle aspiration was inconclusive. The thigh swelling felt vascular and a CT angiogram was done which revealed a diffuse vascular lesion. A superficial parotidectomy and an excision of the right thigh swelling were done. Histopathologies of both specimens were reported to have features suggestive of KD. The patient was evaluated for systemic manifestations and found to have no abnormalities. The patient has been disease free on follow-up after 2 years. This case is being presented for the rarity of its incidence and the nature of its presentation.
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Affiliation(s)
- Gabriel Rodrigues
- Department of General Surgery, Kasturba Medical College, Manipal University, Manipal 576104, India
| | - Bharadwaj Ravi
- Department of General Surgery, Kasturba Medical College, Manipal University, Manipal 576104, India
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11
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Hu YC, Wang R, Lv XA. Kimura disease associated with IgA nephropathy. Kaohsiung J Med Sci 2014; 30:213-4. [PMID: 24656163 DOI: 10.1016/j.kjms.2013.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/22/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ying-Chun Hu
- Department of Nephrology, Taian City Central Hospital, Shandong University, Jinan, China.
| | - Rong Wang
- Department of Nephrology, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xue-Ai Lv
- Department of Nephrology, Taian City Central Hospital, Taian, China
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12
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Müller-Richter UDA, Moralis A, Reuther T, Kochel M, Reichert TE, Driemel O. Kimura's disease in a white man. Head Neck 2011; 33:138-40. [PMID: 19885857 DOI: 10.1002/hed.21260] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Kimura's disease is a rare inflammatory disease that mainly affects Asians and most often occurs in the deep lymph nodes of the head and neck. We report on a rare case of Kimura's disease in the hard palate of a white man. METHOD A 56-year-old white man was seen with a rapidly growing mass in the upper jaw. A complete tumor resection with hemimaxillectomy was performed. The tumor, which showed signs of inflammation, was located within the bone and the soft tissue. RESULTS Kimura's disease was diagnosed by histopathologic examination of the resected tumor. CONCLUSION This case demonstrates that Kimura's disease, though rare, is not limited to the Asian population. We present a case of a tumor in a white man. This adds another possibility for uncertain differential diagnoses of rapidly growing tumor masses.
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Affiliation(s)
- Urs D A Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Würzburg 97070, Germany.
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13
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Fouda MA, Gheith O, Refaie A, El-Saeed M, Bakr A, Wafa E, Abdelraheem M, Sobh M. Kimura disease: a case report and review of the literature with a new management protocol. Int J Nephrol 2011; 2010:673908. [PMID: 21423602 PMCID: PMC3056317 DOI: 10.4061/2010/673908] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 11/15/2010] [Indexed: 11/20/2022] Open
Abstract
Kimura disease (KD) is a chronic inflammatory disorder with angiolymphatic
proliferation, usually affecting young men of Asian race but is rare in other races. The etiology of KD is still unknown. It is often accompanied by nephrotic
syndrome. Herein, we present an atypical manifestation of Kimura disease
occurring in a Caucasian man with steroid-responsive early membranous glomerulonephritis.
Kimura disease can present atypically in a middle-aged Caucasian man with
secondary steroid-responsive nephrotic syndrome. Steroid, endoxan, and MMF can be used safely and successfully in such situation. The diagnosis of
KD can be difficult and misleading, and patients with this disease are often evaluated using avoidable procedures by just not being aware of KD.
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14
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Choi WJ, Hur J, Ko JY, Yeo KY, Kim JS, Yu HJ. An Unusual Clinical Presentation of Kimura's Disease Occurring on the Buttock of a Five-year-old Boy. Ann Dermatol 2010; 22:57-60. [PMID: 20548883 DOI: 10.5021/ad.2010.22.1.57] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 06/21/2009] [Accepted: 06/23/2009] [Indexed: 11/08/2022] Open
Abstract
Kimura's disease is a rare inflammatory disorder of unknown etiology primarily seen in young Asian males. It is characterized by painless subcutaneous masses, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E (IgE) levels. Clinically, the subcutaneous nodules occur predominantly in the head and neck. However, we report the case of a five-year-old boy presenting with an asymptomatic solitary brown pigmented nodule on the left buttock diagnosed with Kimura's disease. Here we describe the diagnosis and treatment of this unusual case.
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Affiliation(s)
- Won Jun Choi
- Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
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15
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Anaesthesiological implications of Kimura's disease: a case report. J Med Case Rep 2009; 3:7316. [PMID: 19830181 PMCID: PMC2726503 DOI: 10.4076/1752-1947-3-7316] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Accepted: 01/23/2009] [Indexed: 12/29/2022] Open
Abstract
Introduction Kimura's disease is a chronic inflammatory condition belonging to the angio-lymphatic proliferative group of disorders, usually affecting young men of Asian race, but is rare in Western countries. It is a benign but locally injurious disease, of unknown aetiology, whose classical clinical features are a tumour-like swelling, usually in the head and neck, with or without satellite lymphadenopathy, often accompanied by eosinophilia and elevated serum IgE. Case presentation We report the case of a 33-year-old Caucasian woman with an atypical localization of Kimura's disease, discussing the anaesthesiological implications and reviewing the current literature on Kimura's disease. Conclusions The diagnosis of Kimura's disease can be difficult and misleading, and anaesthesiological precautions could be ignored. Patients with this disease are often evaluated for other disorders: unnecessary diagnostic tests and investigations, or even surgery, may be avoided by just being aware of Kimura's disease.
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16
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Dixit MP, Nguyen C, Carson T, Guedes B, Dixit NM, Bell JM, Wang Y. Non-steroidal anti-inflammatory drugs-associated acute interstitial nephritis with granular tubular basement membrane deposits. Pediatr Nephrol 2008; 23:145-8. [PMID: 17879100 DOI: 10.1007/s00467-007-0585-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Revised: 07/12/2007] [Accepted: 07/16/2007] [Indexed: 01/28/2023]
Abstract
Acute tubulo-interstitial nephritis (ATIN) is an important cause of acute renal failure resulting from a variety of insults, including immune complex-mediated tubulo-interstitial injury, but drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) are a far more frequent cause. Overall, as an entity, ATIN remains under-diagnosed, as symptoms resolve spontaneously if the medication is stopped. We report on a 14-year-old boy who developed acute renal failure 2 weeks after aortic valve surgery. He was put on aspirin following surgery and took ibuprofen for fever for nearly a week prior to presentation. He then presented to the emergency department feeling quite ill and was found to have a blood urea nitrogen (BUN) concentration of of 147 mg/dl, creatinine of 15.3 mg/dl and serum potassium of 8.7 mEq/l. Dialysis was immediately initiated. A kidney biopsy showed inflammatory infiltrate consistent with ATIN. However, in the tubular basement membrane (TBM), very intense granular deposits of polyclonal IgG and C3 were noted. He needed dialysis for 2 weeks and was treated successfully with steroids for 6 months. His renal recovery and disappearance of proteinuria took a year. In conclusion, this is a first report of NSAIDs-associated ATIN, showing deposits of granular immune complex present only in the TBM and not in the glomeruli.
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Affiliation(s)
- Mehul P Dixit
- Florida Children's Kidney Center, Department of Pediatrics, Florida Children's Hospital, 615 E. Princeton, Suite 500, Orlando, FL 32803, USA.
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