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Kim WJ, Kim HK. Current concepts of Kimura disease: pathophysiology and evolution of treatment. Arch Craniofac Surg 2022; 23:249-255. [PMID: 36596747 PMCID: PMC9816637 DOI: 10.7181/acfs.2022.01053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
Kimura disease (KD) is a chronic inflammatory disorder that frequently involves the subcutaneous tissue of the head and neck regions. It often manifests as regional lymphadenopathy or salivary gland enlargement in the affected area. The histologic architecture of the lymph nodes in KD patients is preserved, while the affected tissues show follicular hyperplasia and eosinophilic infiltration. No single modality has been adopted as an optimal treatment for KD. This article concentrates on the fundamental features of KD and reviews current approaches to its treatment.
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Affiliation(s)
- Woo Ju Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University School of Medicine, Gwangmyeong,
Korea
| | - Han Koo Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul,
Korea
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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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Pulmonary embolism as the initial clinical presentation of Kimura disease: case report and literature review. Blood Coagul Fibrinolysis 2016; 26:414-8. [PMID: 25699606 DOI: 10.1097/mbc.0000000000000278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pulmonary embolism is clinically critical in that if misdiagnosed or delayed, the mortality is very high. The recognition of its risk factor or underlying disease is important for prevention of recurrence. Kimura disease is a rare, chronic inflammatory disease, which is seldom associated with thrombosis. We reported a 47-year-old male case presenting with pleural pain and dyspnoea and was found to have pulmonary embolism. After successful management of pulmonary embolism, he was noticed to have eosinophilia and lymphadenopathy. Pathologic examination of a resected lymph node has confirmed the diagnosis of Kimura disease. The patient was treated with corticosteroid and cyclosporine A, with a significant improvement of the symptoms and signs of Kimura disease and no recurrence of any thromboembolism. Associated literatures were reviewed to explore the pathogenesis underlying the thrombotic event in Kimura disease cases. It is suggested that hypereosinophilia may play a key role in thrombosis formation. The control of hypereosinophilia may contribute to the prevention of thrombosis and its recurrence in patients with Kimura disease.
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Lee S, Yi YJ, Ah Jo H, Huh H, Kim KH, Ki Kim D, Lee H. Remission of secondary membranous nephropathy in a patient with Kimura disease after surgical resection. Kidney Res Clin Pract 2014; 33:157-60. [PMID: 26877967 PMCID: PMC4714177 DOI: 10.1016/j.krcp.2014.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/16/2014] [Accepted: 06/23/2014] [Indexed: 11/25/2022] Open
Abstract
Kimura disease (KD) is an eosinophilic, granulomatous, benign, chronic inflammatory disease with an unknown etiology. A 33-year-old woman visited our hospital because of a palpable, left subclavian mass, a left scapulo-anterior pseudoaneurysm, and nephrotic syndrome. Her subclavian lymph node biopsy examination result was consistent with KD, and results of a renal biopsy indicated secondary membranous nephropathy. After renal histological examination confirmed nephropathy, treatment with prednisolone and cyclosporine was initiated, which was maintained for over 1 year. However, this therapy only provided a transient improvement in proteinuria. One year after commencing the treatment, both proteinuria and azotemia aggravated as the left axillary mass doubled in size. Finally, the mass was surgically excised, following which the azotemia rapidly normalized and proteinuria resolved within 1 month. This case shows that tumor resection in a patient with KD with secondary nephropathy may resolve secondary renal manifestations. Furthermore, reversible renal dysfunction may be caused by unknown secreted molecules.
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Affiliation(s)
- Sunhwa Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong Jin Yi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung Ah Jo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyuk Huh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Hwan Kim
- Department of Thoracic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Shehwaro N, Langlois AL, Gueutin V, Debchi L, Charlotte F, Rouvier P, Rottembourg J, Izzedine H. La maladie de Kimura : une cause méconnue de syndrome néphrotique à lésions glomérulaires minimes de l’adulte. Nephrol Ther 2014; 10:46-50. [DOI: 10.1016/j.nephro.2013.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/01/2013] [Accepted: 09/10/2013] [Indexed: 10/25/2022]
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Praeger AJ, Tsui A, Hardy TG. Kimura disease: rare cause of a slowly progressive orbital mass. Clin Exp Ophthalmol 2013; 42:385-7. [PMID: 24119195 DOI: 10.1111/ceo.12242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Adrian J Praeger
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Clinical overview of cutaneous features in hypereosinophilic syndrome. Curr Allergy Asthma Rep 2013; 12:85-98. [PMID: 22359067 DOI: 10.1007/s11882-012-0241-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The hypereosinophilic syndromes (HES) are a heterogeneous group of disorders defined as persistent and marked blood eosinophilia of unknown origin with systemic organ involvement. HES is a potentially severe multisystem disease associated with considerable morbidity. Skin involvement and cutaneous findings frequently can be seen in those patients. Skin symptoms consist of angioedema; unusual urticarial lesions; and eczematous, therapy-resistant, pruriginous papules and nodules. They may be the only obvious clinical symptoms. Cutaneous features can give an important hint to the diagnosis of this rare and often severe illness. Based on advances in molecular and genetic diagnostic techniques and on increasing experience with characteristic clinical features and prognostic markers, therapy has changed radically. Current therapies include corticosteroids, hydroxyurea, interferon-α, the tyrosine kinase inhibitor imatinib mesylate, and (in progress) the monoclonal anti-interleukin-5 antibodies. This article provides an overview of current concepts of disease classification, different skin findings, and therapy for HES.
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Hernandez-Bautista V, Yamazaki-Nakashimada MA, Vazquez-García R, Stamatelos-Albarrán D, Carrasco-Daza D, Rodríguez-Lozano AL. Treatment of Kimura disease with intravenous immunoglobulin. Pediatrics 2011; 128:e1633-5. [PMID: 22106083 DOI: 10.1542/peds.2010-1623] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Kimura disease is an uncommon chronic inflammatory condition of unknown etiology and is characterized by painless subcutaneous nodules, usually affecting the head and neck, eosinophilia, and markedly elevated immunoglobulin E levels. Several reports have described the main modalities of treatment; both corticosteroids and surgery have provided good results, but occasionally corticosteroids cannot be tapered as the disease flares up. We report here the case of an 8-year-old boy diagnosed with Kimura disease who was successfully treated with 1 dose of intravenous immunoglobulin as a steroid-sparing agent.
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Effective treatment of Kimura’s disease with leflunomide in combination with glucocorticoids. Clin Rheumatol 2011; 30:859-65. [DOI: 10.1007/s10067-011-1689-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
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Zhang C, Hu J, Feng Z, Jin T. Kimura's disease presenting as the middle mediastinal mass. Ann Thorac Surg 2009; 87:314-6. [PMID: 19101326 DOI: 10.1016/j.athoracsur.2008.06.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 06/14/2008] [Accepted: 06/17/2008] [Indexed: 10/21/2022]
Abstract
Kimura's disease usually located in the periauricular area most frequently; however, we believe that there have been no reports about kimura's disease presenting as middle mediastinal mass. we describe the diagnosis and treatment of kimura's disease in the middle mediastinum.
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Affiliation(s)
- Chong Zhang
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Iwai H, Nakae K, Ikeda K, Ogura M, Miyamoto M, Omae M, Kaneko T, Yamashita T. Kimura disease: diagnosis and prognostic factors. Otolaryngol Head Neck Surg 2007; 137:306-11. [PMID: 17666261 DOI: 10.1016/j.otohns.2007.03.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 03/15/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To establish a preoperative diagnostic system and examine prognostic factors for Kimura disease. STUDY DESIGN Retrospective study. SETTING Hospital records were reviewed for nine cases of Kimura disease treated in our department. Preoperative eosinophil counts for 74 cases with untreated malignancy in the parotid gland were also examined. RESULTS Parotid swelling with inhomogeneities and subcutaneous invasion on magnetic resonance imaging and eosinophils > 10.5 percent in Asian patients clearly indicates Kimura disease. Eosinophils > 50 percent, serum IgE levels > 10,000 IU/mL, and multifocal lesions outside salivary glands are prognostic factors suggesting disease recurrence. CONCLUSIONS A preoperative decision based on our diagnostic criteria and prognostic factors should lead to better therapeutic outcomes for Kimura disease, for which a definitive treatment policy has never been determined.
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Affiliation(s)
- Hiroshi Iwai
- Department of Otolaryngology, Kansai Medical University, Osaka, Japan.
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Leiferman KM, Gleich GJ, Peters MS. Dermatologic Manifestations of the Hypereosinophilic Syndromes. Immunol Allergy Clin North Am 2007; 27:415-41. [PMID: 17868857 DOI: 10.1016/j.iac.2007.07.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Skin is a commonly affected organ in hypereosinophilic syndromes (HES). Cutaneous lesions may be an important presenting sign, may be extremely debilitating, and often reflect disease activity in HES. Recognition of dermatologic manifestations is important in approaching diagnosis and treatment of HES. This article reviews cutaneous involvement in HES and other eosinophil-associated skin diseases.
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Affiliation(s)
- Kristin M Leiferman
- Department of Dermatology, 4B454 School of Medicine, University of Utah Health Sciences Center, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132-2409, USA.
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Olowu WA, Adelusola KA, Senbanjo IO, Adenowo OA, Badmos KB. Hypertension, erythrocyturia and proteinuria in childhood non-Hodgkin's lymphoma. Nephrology (Carlton) 2006; 11:165-70. [PMID: 16756627 DOI: 10.1111/j.1440-1797.2006.00568.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM The objectives were to determine the prevalence and outcome of hypertension, significant microerythrocyturia and proteinuria among children with acute renal failure (ARF) due to Burkitt-type non-Hodgkin's lymphoma (BNHL). METHODS A retrospective analysis of clinical and laboratory data of children with BNHL/ARF was undertaken. RESULTS Nine of 23 (39.13%) BHNL/ARF children aged 5-14 years were found to have significant microerythrocyturia and proteinuria as urinary markers of glomerulonephritis (GN). Eight of nine were hypertensive with hypertensive encephalopathy (HTE) in three, and congestive heart failure (CCF)/pulmonary oedema in six. Three of nine patients (33.3%) died from these complications; two from CCF and one from a combination of CCF and HTE. A fourth death was due to uraemia. Treatments with cytotoxic drugs and anti-tumour lysis syndrome therapy resulted in normotension, improved clinical outcome and normalisation of laboratory features of ARF and GN in all five (55.6%) survivors. CONCLUSION We conclude that all the children with BNHL/ARF had enlarged kidneys and evidence of glomerular disease. The mechanism of the glomerular disease is unclear. It is associated with a high mortality rate.
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Affiliation(s)
- Wasiu A Olowu
- Paediatric Nephrology/Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
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