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Loganathan SK, Mondal S, Basu S, Thangaraj A, Vignesh P, Nada R, Suri D. Membranous nephropathy with Kimura's disease: A case report and review of literature. Int J Rheum Dis 2024; 27:e15265. [PMID: 39030988 DOI: 10.1111/1756-185x.15265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
Kimura's disease (KD) is a chronic inflammatory disorder characterized by nontender lymphadenopathy involving the head and neck region. Renal involvement in KD is rare, especially in children. We report a 12-year-old boy who had been previously treated for classical KD and had presented with anasarca and oliguria after 4 years. There were no swellings or lymphadenopathy. The kidney biopsy revealed membranous nephropathy. Remission was achieved with oral prednisolone and tacrolimus therapy. This patient highlights the need to regularly monitor patients with KD for the evolution of renal diseases, even if lymphadenopathy regresses. Serial monitoring for eosinophilia, inflammatory markers, and urine examination is needed to help identify subclinical disease early and prompt initiation of specific therapy.
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Affiliation(s)
- Sathish Kumar Loganathan
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjib Mondal
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suprit Basu
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Abarna Thangaraj
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pandiarajan Vignesh
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepti Suri
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Brito MT, Baptista D, Pereira E, Fonseca E, Almeida JS. Kimura's Disease: A Literature Review Based on a Clinical Case. Cureus 2023; 15:e50463. [PMID: 38222219 PMCID: PMC10786330 DOI: 10.7759/cureus.50463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Kimura's disease (KD) was first described in 1937. It is a rare, benign, and chronic immune-mediated inflammatory disorder affecting the subcutaneous tissue, salivary glands, and lymph nodes. The disease is more common in the second to third decades of life in middle-aged Southeast Asian countries. The cause of Kimura's disease remains unknown; some authors believe it is related to an autoimmune or delayed-type hypersensitivity reaction. It commonly presents as a solitary painless lymph node in the head and neck or generalized lymphadenopathy (67%-100%) associated with peripheral eosinophilia and elevated IgE levels. Renal involvement may occur in some patients. Diagnosis is made by histology. A 21-year-old Caucasian man with no relevant medical history presented with a non-tender swelling of the left hemiface without other associated symptoms. Laboratory investigations revealed a leukocyte count with eosinophilia (2.29×10^9/L- 26.5%) and elevated total IgE and IgG4. He had no renal dysfunction. He underwent surgical resection of the lesion in the jugal, infraorbital, and left nasolabial regions, and the anatomopathological examination revealed the characteristics of Kimura's disease. Three months after surgery, an MRI showed an increase in the size of the mass, and he was started on corticosteroids. Six months after surgery, he presented with a slight increase in the size of the mass and was started on Ciclosporin, which allowed a progressive reduction in the dose of corticosteroid with evidence of a progressive reduction in swelling. Ciclosporin was stopped due to toxic serum levels, and he was started on mycophenolate mofetil. The dose was increased because of the increase in facial mass; on mycophenolate mofetil 2500mg/day, the patient remains stable. KD is a chronic disorder of unknown etiology that mainly affects young people in Southeast Asia and is rare in Western countries, as in the case of this young man. Studies have shown no significant differences in region or race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, or IgE levels between age groups. There is no consensus on the optimal treatment for KD; several treatments have been used, including surgery, systemic corticosteroids, immunosuppressants, and radiation. Due to the tendency to relapse and the rarity of the disease, there is no consensus on treatment options for relapse.
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Affiliation(s)
- Maria Teresa Brito
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Diana Baptista
- Pathologic Anatomy, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Edite Pereira
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Elsa Fonseca
- Pathologic Anatomy, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Jorge S Almeida
- Medicine, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, PRT
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
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3
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Shang B, Hsiao C, Tsao T, Liao Y, Lin W, Lee W, Lue K. Clinical effects of dupilumab: A novel treatment for Kimura disease. Immun Inflamm Dis 2023; 11:e1084. [PMID: 38018601 PMCID: PMC10632088 DOI: 10.1002/iid3.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Kimura disease (KD) is a rare chronic inflammatory disorder involving the Th2 pathway. Although medical treatment with steroids or other immunosuppressants is available, they may cause developmental issues in the pediatric population. Surgical intervention has also been suggested; however, it is associated with high recurrence rates. CASE PRESENTATION A 14-year-old boy presented with left retroauricular lymph node enlargement at the age of 5 years. At the age of 7 years, he was diagnosed with nephrotic syndrome which subsided after steroid treatment for approximately 6 years. The retroauricular lymph node was surgically excised, and KD was confirmed. However, recurrent enlargement of the left retroauricular and neck lymph nodes occurred after 2 years. Persistently high IgE levels and fluctuating eosinophil counts were observed following steroid treatment. Dupilumab was prescribed because of the difficulty in tapering the steroid dosage. A loading dose of 600 mg was administered, followed by a maintenance dose of 300 mg every 2 weeks. The IgE level decreased after 3 months, and a low eosinophil count was maintained after steroid discontinuation. Follow-up computed tomography revealed a decrease in the size of the lymph nodes with no side effects such as conjunctivitis. CONCLUSION Traditional treatments have raised developmental concerns in the pediatric population and are associated with high recurrence rates. Dupilumab targets the Th2 pathway and provides effective results, with few adverse effects. Dupilumab may be a therapeutic option for KD and other diseases involving the Th2 pathway.
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Affiliation(s)
- Bing‐Shiau Shang
- Department of PediatricsChung Shan Medical University HospitalTaichung CityTaiwan
- Department of MedicineChung Shan Medical UniversityTaichung CityTaiwan
- Institute of MedicineChung Shan Medical University HospitalTaichung CityTaiwan
| | | | - Teng‐Fu Tsao
- Department of MedicineChung Shan Medical UniversityTaichung CityTaiwan
- Department of Medical ImagingChung Shan Medical University HospitalTaichung CityTaiwan
| | - Yuan‐Ya Liao
- Department of MedicineChung Shan Medical UniversityTaichung CityTaiwan
- Department of SurgeryChung Shan Medical University HospitalTaichung CityTaiwan
| | - Wea‐Lung Lin
- Department of PathologyChung Shan Medical University HospitalTaichung CityTaiwan
- Department of PathologyChung Shan Medical UniversityTaichung CityTaiwan
| | - Wen‐I Lee
- Department of Pediatrics, Division of Allergy, Asthma, Immunology and RheumatologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
- Primary Immunodeficiency Care and Research InstituteChang Gung University College of Medicine and Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Ko‐Huang Lue
- Department of PediatricsChung Shan Medical University HospitalTaichung CityTaiwan
- Department of MedicineChung Shan Medical UniversityTaichung CityTaiwan
- Department of Biological Science & TechnologyNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
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Ravi GC, Nitha T, Greeshma PG, Uthaiah S, Famida PA, Nair RR, Aniketh VR. Kimura Disease in an Adult Indian Female, A Rare Presentation: A Novel Treatment with a Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:2394-2399. [PMID: 37636677 PMCID: PMC10447749 DOI: 10.1007/s12070-023-03664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/03/2023] [Indexed: 03/31/2023] Open
Abstract
Kimura disease (KD) is a chronic inflammatory disorder, which is quite rare and has an unclear and much debated etiology. KD is characterized by painless, nodular, subcutaneous swellings along with lymphadenopathy, encountered in the head and neck region more often. It is also known to affect major salivary glands. It is also associated with elevated Immunoglobulins (IgE) and peripheral blood and tissue eosinophilia. Kimura disease generally affects young Asian males. There is considerable difficulty in arriving at clinical diagnosis and often it is frustrating to both patients and the treating physicians because of the difficulty in its management. We are presenting and reporting a case of Kimura disease in a young adult Indian female patient who presented with a swelling in the left parotid region. We have successfully managed this patient medically with a unique combination of drugs, most of which have already been tried and reported in literature by various authors.
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Affiliation(s)
- G. C. Ravi
- Department of Otorhinolaryngology, Sri Siddhartha Institute of Medical Sciences, T Begur, Nelamangala Taluk, Bangalore Rural District, 562123 India
- Bangalore, India
| | - T. Nitha
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
| | - P. G. Greeshma
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
| | | | - P. A. Famida
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
| | - Reshma Radhakrishnan Nair
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
| | - V. R. Aniketh
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
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5
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A Rare Kimura's Disease in the Oral Cavity with Severe Sleep Apnea: Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121810. [PMID: 36557012 PMCID: PMC9783615 DOI: 10.3390/medicina58121810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Kimura's disease (KD) is a rare chronic inflammatory disorder that commonly occurs in Asian males. It mainly presents as painless subcutaneous masses or lymphadenopathy in the head and neck region. The incidence of KD in the oral cavity is quite rare. We reported a rare case of a 53-year-old male who had KD in his soft palate, hard palate and bilateral tonsils associated with severe sleep apnea. This patient underwent radiotherapy and exhibited a good response to the treatment. Throughout the 12-month follow-up period, the patient's condition remained satisfactory. Of the other 14 reviewed cases of KD in the oral cavity, the lesions can occur in the buccal mucosa, hard and soft palate, and mouth floor with specific clinical features. We further summarized their manifestations and treatments in order to guide the future identification and management of KD with lesions in the oral cavity.
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6
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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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7
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Mulla F, Bomanwar N, Sakhare S, Pinto CJ. Kimura's disease of the left arm. BMJ Case Rep 2022; 15:e250758. [PMID: 35944940 PMCID: PMC9367184 DOI: 10.1136/bcr-2022-250758] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/04/2022] Open
Abstract
Kimura's disease is a rare, benign entity that causes subcutaneous angioblastic lymphoid hyperplasia with eosinophilia. It usually presents with subcutaneous lymphoid swellings with regional lymphadenopathy and salivary gland masses. Kimura's disease is frequently associated with renal involvement, which includes proteinuria and nephrotic syndrome as the most common presentations. This report presents a case of a man in his early 20s with a swelling in the medial aspect of the distal left arm with two previous episodes of nephrotic syndrome. Multiple enlarged axillary lymph nodes and epitrochlear nodes were noted. Ultrasonography revealed a mixed echogenic mass with enlarged lymph nodes. MRI showed a heterogeneous hyperintense lesion. Image-guided fine-needle aspiration showed multiple lymphocytes and eosinophils suggestive of Kimura's disease. The swelling was surgically excised under general anaesthesia. Histopathology of the excised mass confirmed the diagnosis of Kimura's disease.
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Affiliation(s)
- Fahad Mulla
- Department of General Surgery, Kingsway Hospitals, Nagpur, India
| | - Nitin Bomanwar
- Department of Surgical Oncology, Kingsway Hospitals, Nagpur, India
| | - Sonika Sakhare
- Department of General Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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Sugimoto K, Enya T, Morimoto Y, Oshima R, Miyazaki K, Okada M. Kimura's disease with recurrent bilateral lacrimal gland involvement in a male Japanese child successfully treated with cyclosporine A. Allergy Asthma Clin Immunol 2021; 17:48. [PMID: 34001253 PMCID: PMC8130254 DOI: 10.1186/s13223-021-00549-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background Kimura’s disease (KD) is a rare chronic inflammatory disease of unknown etiology. Clinically, KD is characterized by nodular subcutaneous masses, that are typically localized to the neck and head. Involvement of the lacrimal glands and limbs is uncommon and seldom reported. Case presentation We report a case of a 4-year-old Japanese boy presenting with bilateral upper eyelid swelling with nodular subcutaneous lesions and peripheral eosinophilia. Based on clinical, histopathological, and laboratory findings, the patient was diagnosed with KD. An itchy subcutaneous mass on the left arm developed at the age of 14 years. Treatment with steroids was effective. However, as the steroids were tapered after the patient developed side effects, the masses relapsed within a few months. Treatment with cyclosporine A was then initiated, which led to an improvement of clinical features and serial levels of cytokines. Conclusions We report a rare case of KD with a peculiar clinical presentation. The patient responded well to treatment with cyclosporine A.
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Affiliation(s)
- Keisuke Sugimoto
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Takuji Enya
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yuichi Morimoto
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Rina Oshima
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kohei Miyazaki
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Mitsuru Okada
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
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9
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Ho J, Walter S, Harvey RJ. Eosinophilic chronic rhinosinusitis and concurrent Kimura's disease treated with mepolizumab. BMJ Case Rep 2021; 14:14/1/e232627. [PMID: 33461987 PMCID: PMC7813409 DOI: 10.1136/bcr-2019-232627] [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: 01/21/2023] Open
Abstract
Kimura's disease is a rare, benign, chronic inflammatory disorder characterised by its eosinophilic infiltrate. Patients often present with one or more progressively enlarging subcutaneous lymph nodes in the head and neck region or enlarging salivary glands. We describe the case of a 26-year-old man presenting with severe peripheral eosinophilia and upper airway inflammatory symptoms, who later developed cervical lymphadenopathy and formally diagnosed with Kimura's disease. Based on our English-language MEDLINE literature search, to our knowledge this is the first case report describing treatment of Kimura's disease with mepolizumab.
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Affiliation(s)
- Jacqueline Ho
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia,St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie Walter
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia,Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
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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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Zhang G, Li X, Sun G, Cao Y, Gao N, Qi W. Clinical analysis of Kimura's disease in 24 cases from China. BMC Surg 2020; 20:1. [PMID: 31898499 PMCID: PMC6941305 DOI: 10.1186/s12893-019-0673-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/26/2019] [Indexed: 11/23/2022] Open
Abstract
Background We reviewed details of Chinese Kimura’s disease (KD) cases. A full clinical analysis was subsequently performed to improve the accuracy of clinical diagnosis and treatment of KD. Methods A total of 24 patients with pathologically confirmed KD treated between March 2008 and March 2018 were reviewed retrospectively for clinical and histopathological analysis. Results In the 24 KD cases, 20 were male and 4 were female with the age of onset ranging from 5 to 65 years. Lesion diameter ranged from 0.6 cm to 7 cm with unilateral involvement being more popular (79%). Imaging examination had a high detection rate for KD involving the parotid gland and subcutaneous but had low specificity. Microscopic analysis indicated that KD mainly involved subcutaneous soft tissue and lymph nodes. The prominent feature of lymphoid tissue was germinal center hyperplasia surrounded by several lobules associated with hyperplastic vascular structures. Out of the 24 patients, 11 experienced recurrence of disease after treatment (surgical resection: 46.2%, surgical resection followed by oral corticosteroids: 71.4% and surgical resection combined with radiotherapy: 0%). Conclusions Our analysis revealed clinical, imaging, and histological characteristics of KD. A better understanding of the disease will help clinicians reduce misdiagnosis and improve the diagnostic rate upon patient first clinical visit.
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Affiliation(s)
- Guoliang Zhang
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xumao Li
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Guangbin Sun
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yitan Cao
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Nan Gao
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Weidong Qi
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China.
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12
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Ren S, Li XY, Wang F, Zhang P, Zhang Y, Li GS, Wang L, Zhong X. Nephrotic syndrome associated with Kimura's disease: a case report and literature review. BMC Nephrol 2018; 19:316. [PMID: 30409112 PMCID: PMC6225567 DOI: 10.1186/s12882-018-1123-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 10/26/2018] [Indexed: 12/23/2022] Open
Abstract
Background Kimura’s disease (KD) is a rare chronic inflammatory disorder with a high incidence of renal involvement. In this report, we present a case study of KD-associated nephrotic syndrome combined with minimal change disease (MCD) and acute renal tubular injury. Meanwhile, the clinical and histopathological characteristics of 26 patients with KD presenting with renal involvement were retrospectively evaluated. Case presentation Here, we report a case study of a 59-year-old male patient with KD confirmed by a lymph node biopsy. He developed widespread edema and decreased urine output. A palpable swollen mobile and non-tender lymph node behind the left ear was observed upon admission. A renal biopsy revealed minimal-change lesions and acute renal tubular injury. The patient received hemodialysis because of the oliguria and renal insufficiency, and an initial dose of 40 mg/d methylprednisolone and then continued treatment with 40 mg/d prednisolone. He exhibited a good clinical response to the steroid after 6 weeks of treatment. Of the other 26 patients included in the review, 13 patients presented with mesangial proliferative glomerulonephritis, 4 with membranous nephropathy, 3 with MCD, 3 with focal segmental glomerulosclerosis, 2 with IgA nephropathy and 1 with acute tubular injury. With the exception of 2 patients who progressed to end-stage renal disease and received hemodialysis, the majority of patients responded well to treatment with corticosteroids alone. Conclusions MCD combined with acute renal tubular injury is rare in patients with KD presenting with renal involvement. Corticosteroids may be a beneficial treatment for renal injury in patients with KD.
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Affiliation(s)
- Song Ren
- Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No.32, West Section 2, Ring 1 Road, Chengdu, 610072, Sichuan, China
| | - Xin Yi Li
- Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No.32, West Section 2, Ring 1 Road, Chengdu, 610072, Sichuan, China
| | - Fang Wang
- Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No.32, West Section 2, Ring 1 Road, Chengdu, 610072, Sichuan, China
| | - Ping Zhang
- Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No.32, West Section 2, Ring 1 Road, Chengdu, 610072, Sichuan, China
| | - Yuan Zhang
- Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No.32, West Section 2, Ring 1 Road, Chengdu, 610072, Sichuan, China
| | - Gui Sen Li
- Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No.32, West Section 2, Ring 1 Road, Chengdu, 610072, Sichuan, China
| | - Li Wang
- Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No.32, West Section 2, Ring 1 Road, Chengdu, 610072, Sichuan, China
| | - Xiang Zhong
- Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No.32, West Section 2, Ring 1 Road, Chengdu, 610072, Sichuan, China.
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Matsuo T, Tanaka T, Kinomura M. Nephrotic syndrome during the tapering of oral steroids after pathological diagnosis of Kimura disease from a lacrimal gland mass: case report and review of 10 Japanese patients. J Clin Exp Hematop 2018; 57:147-152. [PMID: 29279552 DOI: 10.3960/jslrt.17028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A 42-year-old man with eosinophilia and high serum immunoglobulin E (IgE) developed a lacrimal gland mass on the left side. Excisional biopsy revealed hyperplasia of lymphoid follicles, and infiltration with lymphocytes and eosinophils around lacrimal gland acini, leading to the pathological diagnosis of Kimura disease. IgE-positive cells were mainly found along follicular dendritic cells, and a small number of IgG4-positive cells was present. One month after oral prednisolone was started at 40 mg daily and tapered to 10 mg daily, he developed lower leg edema on both sides and marked proteinuria (10.8 g/day). Renal biopsy showed no glomerular abnormalities, no immunoglobulin deposition, and no tubulointerstitial infiltration with eosinophils, leading to the diagnosis of minimal change nephrotic syndrome. Proteinuria subsided in response to an increased dose of prednisolone to 30 mg daily. Proteinuria relapsed three times in the following 5 years when oral prednisolone was tapered. In conclusion, Kimura disease manifested as an orbital mass and did not relapse. However, nephrotic syndrome relapsed frequently with background eosinophilia and high serum IgE. This study reviewed the clinical features of 10 Japanese patients with Kimura disease associated with proteinuria.
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Affiliation(s)
- Toshihiko Matsuo
- Department of Ophthalmology, Okayama University Hospital and Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Takehiro Tanaka
- Department of Pathology Okayama University Hospital and Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Masaru Kinomura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Hospital and Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Ye P, Ma DQ, Yu GY, Gao Y, Peng X. Comparison of the efficacy of different treatment modalities for Kimura's disease. Int J Oral Maxillofac Surg 2016; 46:350-354. [PMID: 27614905 DOI: 10.1016/j.ijom.2016.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/18/2016] [Accepted: 08/19/2016] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate the clinical features of Kimura's disease in the head and neck region and to compare the local recurrence rate between three therapies used for the treatment of this disease. The clinicopathological information of 46 hospitalized patients suffering from Kimura's disease in the head and neck region over a 10-year period was reviewed retrospectively. All lesions were clinically observed in the head and neck region. These 46 patients underwent a total of 58 treatments; nine patients underwent multiple treatments due to local recurrence. Of the 58 treatments, 32 involved surgical excision alone, 24 involved surgical excision and postoperative low-dose radiotherapy (20-40Gy), one was a combination of ultrasound-guided core needle biopsy and radiotherapy, and one was a combination of incisional biopsy and subsequent radiotherapy. During the follow-up period, nine patients suffered 16 local recurrences. The recurrence rate of surgical excision combined with low-dose radiotherapy was much lower than that of surgical excision alone or radiotherapy alone (both P<0.05). It is concluded that Kimura's disease is a benign condition with a good prognosis, and surgical excision combined with postoperative low-dose radiotherapy is associated with the lowest local recurrence rate in the treatment of this disease.
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Affiliation(s)
- P Ye
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - D-Q Ma
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - G-Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Y Gao
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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15
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Comparison of Local Recurrence Rate of Three Treatment Modalities for Kimura Disease. J Craniofac Surg 2016; 27:170-4. [PMID: 26674917 DOI: 10.1097/scs.0000000000002337] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Eosinophilic hyperplastic lymphogranuloma, also known as Kimura disease, is a benign and chronic inflammatory condition, predominantly involving the head and neck region. Surgical excision, radiotherapy (RA), surgical resection combined with low-dose postoperative radiotherapy and oral corticosteroids are 4 treatment modalities reported to control this disease effectively. Local recurrence, however, is common and the optimum treatment for Kimura disease is controversial. Thus, the present meta-analysis was performed to identify the treatment modality associated with the lowest local recurrence. Electronic databases (Cochrane Library, Wiley Online Library, PubMed, Chinese National Knowledge Infrastructure, and Wanfang Data) were searched. Data were also obtained from other sources such as related references and communication with the relevant authors. Two reviewers screened the literature according to preselected criteria. All studies involving different treatments for Kimura disease were collected. After data extraction and research quality assessment, the meta-analysis of 22 studies involving 570 patients was conducted using STATA 12.1 software. Meta-analysis revealed that administration of RA or surgical excision alone were inferior in controlling local recurrence compared with surgical resection combined with postoperative RA (risk ratio (RR) = 2.72; 95% confidence interval (CI), 1.47-5.04 and RR = 4.72; 95% CI, 2.53-8.82). Surgical excision alone did not show significant advantage in controlling local recurrence compared with RA alone (RR = 2.13; 95% CI, 0.88-5.17). Surgical resection combined with postoperative RA is superior to either surgery or RA alone in treating Kimura disease. More large scale prospective randomized controlled trials, however, should be conducted to assess the long-term effects and safety issues.
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Miki H, Tsuboi H, Kaneko S, Takahashi H, Yokosawa M, Asashima H, Hirota T, Hagiwara S, Umeda N, Kondo Y, Nishimura B, Sugano M, Matsumoto I, Sumida T. A case of refractory Kimura disease with a buccal bulky mass successfully treated with low-dose cyclosporine A: report and review of the literature. Allergol Int 2016; 65:212-214. [PMID: 26666475 DOI: 10.1016/j.alit.2015.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/17/2015] [Accepted: 10/22/2015] [Indexed: 11/25/2022] Open
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18
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Tsai IJ, Chou CH, Yang YH, Lin WC, Lin YH, Chow LP, Lee HH, Kao PG, Liau WT, Jou TS, Tsau YK. Inhibition of Rho-associated kinase relieves C5a-induced proteinuria in murine nephrotic syndrome. Cell Mol Life Sci 2015; 72:3157-71. [PMID: 25790939 PMCID: PMC11113791 DOI: 10.1007/s00018-015-1888-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 02/14/2015] [Accepted: 03/13/2015] [Indexed: 02/05/2023]
Abstract
Childhood nephrotic syndrome is mainly caused by minimal change disease which is named because only subtle ultrastructural alteration could be observed at electron microscopic level in the pathological kidney. Glomerular podocytes are presumed to be the target cells whose protein sieving capability is compromised by a yet unidentified permeability perturbing factor. In a cohort of children with non-hereditary idiopathic nephrotic syndrome, we found the complement fragment C5a was elevated in their sera during active disease. Administration of recombinant C5a induced profound proteinuria and minimal change nephrotic syndrome in mice. Purified glomerular endothelial cells, instead of podocytes, were demonstrated to be responsible for the proteinuric effect elicited by C5a. Further studies depicted a signaling pathway involving Rho/Rho-associated kinase/myosin activation leading to endothelial cell contraction and cell adhesion complex breakdown. Significantly, application of Rho-associated kinase inhibitor, Y27632, prevented the protein leaking effects observed in both C5a-treated purified endothelial cells and mice. Taken together, our study identifies a previously unknown mechanism underlying nephrotic syndrome and provides a new insight toward identifying Rho-associated kinase inhibition as an alternative therapeutic option for nephrotic syndrome.
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Affiliation(s)
- I-Jung Tsai
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Chou Lin
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lu-Ping Chow
- Graduate Institute of Biochemistry and Molecular Biology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiao-Hui Lee
- Department of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Gang Kao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wan-Ting Liau
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzuu-Shuh Jou
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yong-Kwei Tsau
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
A 7-year-old Korean boy was referred for a nontender mass in the left arm. He had a 5-year history of a poorly defined painless mass on the medial side of the left elbow. The ultrasonogram of the left arm indicated an ill-defined, lobulating solid mass involving the deep soft tissue layer. The fat-suppressed T2-weighted magnetic resonance image showed a poorly marginated, homogeneous high-signal intensity mass. On further follow-up of 1 year and 6 months, the mass showed no change in size and nature. At surgery, a poorly demarcated inflammatory mass was dissected from a branch of the superficial radial nerve and excised completely. There was no recurrence and any dysfunction, except temporary localized hypoesthesia of the medial aspect of the left arm at the 3.6-year follow-up.
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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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Soeria-Atmadja S, Oskarsson T, Celci G, Sander B, Berg U, Gustafsson B. Maintenance of remission with cyclosporine in paediatric patients with Kimura's disease - two case reports. Acta Paediatr 2011; 100:e186-9. [PMID: 21388449 DOI: 10.1111/j.1651-2227.2011.02259.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Here we report two paediatric cases of Kimura's disease, which is a rare, chronic inflammatory disorder with undetermined aetiology. The first patient was a 17-year-old boy presenting with a swelling behind his right ear and a nephrotic syndrome. The second patient was a 9-year-old boy presenting with a left-sided preauricular swelling. Both displayed peripheral blood eosinophilia, raised levels of serum IgE and typical histological findings. Initial response to prednisolone was excellent but both relapsed as medication was tapered or discontinued. Adding cyclosporine to the regimen resulted in prolonged remission in both patients. CONCLUSION We support the use of cyclosporine for maintaining remission in paediatric patients with Kimura's disease.
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Affiliation(s)
- Sandra Soeria-Atmadja
- Department of Hematology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Greaves WO, Wang SA. Selected topics on lymphoid lesions in the head and neck regions. Head Neck Pathol 2011; 5:41-50. [PMID: 21287407 PMCID: PMC3037466 DOI: 10.1007/s12105-011-0243-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 01/17/2011] [Indexed: 12/14/2022]
Abstract
Lymphoid tissue located in the head and neck region include multiple regional lymph node chains as well as mucosa associated lymphoid tissue of the conjunctiva, buccal and nasopharyngeal cavities (Waldeyer's ring), and thyroid and salivary glands. This region is a rich source of antigenic stimuli including infectious agents coming from the outside environment. Many reactive conditions that affect lymphoid tissue in this region may mimic neoplasia. In fact, distinguishing between benign and malignant lymphoid proliferations in the head and neck region is a relatively frequent diagnostic challenge and in many instances, this distinction is not straightforward. It therefore behooves the practicing pathologist to be able to recognize the benign lymphoproliferative disorders that affect this region so as to effectively guide the appropriate clinical management of such patients. Kimura disease, Epstein Barr lymphadenitis, HIV associated salivary gland disease and chronic sialadenitis are benign conditions that not infrequently affect lymphoid tissue in the head and neck region and that share certain overlapping features with malignant lymphoma. In this brief review, we discuss these conditions and highlight clinicopathological features that may help distinguish them from neoplastic lymphoproliferations that may share similar features.
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Affiliation(s)
- Wesley O. Greaves
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Unit 72, 1515 Holcombe Boulevard, Houston, TX 77030-4009 USA
| | - Sa A. Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Unit 72, 1515 Holcombe Boulevard, Houston, TX 77030-4009 USA
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Takaoka H, Takano H, Nakagawa K, Kobayashi Y, Hiroshima K, Komuro I. Buerger's disease-like vasculitis associated with Kimura's disease. Int J Cardiol 2010; 140:e23-6. [DOI: 10.1016/j.ijcard.2008.11.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 11/16/2008] [Indexed: 10/21/2022]
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Noel N, Meignin V, Rosenstingl S, Ronco P, Boffa JJ. Nephrotic syndrome associated with immune thrombocytopenia revealing Kimura's disease in a non-Asian male. NDT Plus 2009; 2:452-4. [PMID: 25949378 PMCID: PMC4421322 DOI: 10.1093/ndtplus/sfp099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 07/08/2009] [Indexed: 11/23/2022] Open
Abstract
We report the case of a young Caucasian man presenting with diffuse oedema and nephrotic syndrome. Clinical examination revealed multiple lymphadenopathies. Histological examination was consistent with the diagnosis of Kimura's disease. A renal biopsy showed focal segmental glomerulosclerosis. Immune thrombocytopenia and signs of humoral autoimmunity were discovered. Corticosteroid treatment induced remission of nephrotic syndrome but relapses occurred 12 and 18 months after onset of treatment while the patient was receiving 20 mg prednisone once a day. To our knowledge, this is the first case of Kimura's disease and nephrotic syndrome associated with B-cell autoreactivity.
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Affiliation(s)
- Nicolas Noel
- Department of Nephrology, AP-HP , Hôpital Tenon , F-75020
| | | | - Sophie Rosenstingl
- Department of Internal Medicine , Hôpital de Coulommiers , Coulommiers , France
| | - Pierre Ronco
- Department of Nephrology, AP-HP , Hôpital Tenon , F-75020
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Sun QF, Xu DZ, Pan SH, Ding JG, Xue ZQ, Miao CS, Cao GJ, Jin DJ. Kimura disease: review of the literature. Intern Med J 2009; 38:668-72. [PMID: 18808562 DOI: 10.1111/j.1445-5994.2008.01711.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Kimura disease (KD) is a rare, chronic inflammatory disease of unknown cause and is characterized by painless s.c. swellings and lymphadenopathy commonly affecting the head and neck region. Much therapeutics has been used to treat KD, but is not satisfactory because of frequent relapse. Imatinib has been reported previously to be useful for treatment of hypereosinophilic syndrome and may work by selectively blocking protein-tyrosine kinases, such as platelet-derived growth factor receptor, and c-Kit. We carried out immunohistochemical examination of platelet-derived growth factor receptor-alpha and c-Kit in tissues from patients with KD. The results were positive and suggested that Imatinib might be an effective drug for the treatment of the disease. We have also briefly reviewed the epidemiology, aetiology, clinical manifestations, laboratory and pathological examinations, differential diagnoses, treatment and prognosis of KD in this manuscript.
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Affiliation(s)
- Q-F Sun
- Department of Infectious Diseases, The Third Affilated Hospital to Wenzhou Medical College, Wenzhou, Zhejiang, China.
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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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Sato S, Kawashima H, Kuboshima S, Watanabe K, Kashiwagi Y, Takekuma K, Hoshika A. Combined treatment of steroids and cyclosporine in Kimura disease. Pediatrics 2006; 118:e921-3. [PMID: 16908621 DOI: 10.1542/peds.2006-0487] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Kimura disease is a rare but distinctive chronic eosinophilic inflammatory disorder that is characterized by tumor-like lesions in the soft tissue and lymph nodes of the head and neck or parotid gland. Recently, many immunopathogenetic features of underlying T lymphocytes and related cytokines have been noted in Kimura disease. However, few previous studies have investigated the serial levels of cytokines in children. In this report we describe an 11-year-old Japanese boy with relapsing Kimura disease. Before the diagnosis of Kimura disease, the patient had a swelling on his left neck. Steroids were effective, but the tumor relapsed within a few months as the steroids were tapered. He was treated with steroids and cyclosporine. This treatment was done by measuring serial levels of serum soluble interleukin-2 receptor, interleukin-4, interleukin-5, and eosinophil cationic protein. These results suggest the activation of T-helper cells and T-helper 2 cytokines, that after activated B cells and eosinophilic infiltration play an important role in Kimura disease, and that cyclosporine suppresses the activity of this disease.
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Affiliation(s)
- Satoshi Sato
- Department of Pediatrics, Tokyo Medical University, Nishishinjuku, Tokyo, Japan.
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Connelly A, Powell HR, Chan YF, Fuller D, Taylor RG. Vincristine treatment of nephrotic syndrome complicated by Kimura disease. Pediatr Nephrol 2005; 20:516-8. [PMID: 15690191 DOI: 10.1007/s00467-004-1754-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Revised: 10/13/2004] [Accepted: 10/20/2004] [Indexed: 11/27/2022]
Abstract
Kimura disease is a rare inflammatory condition of unknown aetiology. It typically presents in young Asian males with the triad of non-tender subcutaneous swellings in the head and neck region, peripheral eosinophilia and raised serum IgE. About 16% of cases have associated renal disease. We present the case of a 10-year-old boy with a past history of steroid responsive, frequently relapsing nephrotic syndrome who developed a right submandibular swelling and eosinophilia. Kimura disease was diagnosed on the basis of clinical and histological findings. The condition recurred during relapses of nephrotic syndrome. Because of poor adherence with oral medication, our patient was treated with intravenous vincristine with synchronous remissions of his nephrotic syndrome and Kimura swellings on each occasion.
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Affiliation(s)
- Annette Connelly
- Department of Nephrology, Royal Children's Hospital, Parkville 3052, Melbourne, Victoria, Australia
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Green SE, Linton SM, Harding JR, Attanoos R. Raynaud's phenomenon associated with Kimura's disease. Rheumatology (Oxford) 2004; 44:559-61. [PMID: 15613401 DOI: 10.1093/rheumatology/keh525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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30
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Minimal Change Nephrotic Syndrome with IgM Deposits in Kimura's Disease: A Case Report and Literature Review. Int J Organ Transplant Med 2004. [DOI: 10.1016/s1561-5413(09)60166-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ray V, Boisseau-Garsaud AM, Hillion G. [Kimura's disease on the hard palate in a patient from Martinique]. Rev Med Interne 2003; 24:253-6. [PMID: 12706782 DOI: 10.1016/s0248-8663(03)00076-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We report an observation of Kimura's disease (angiolymphoid hyperplasia with eosinophilia) in a Black patient from West Indies, in a rare localisation on hard palate. EXEGESIS A 46-year-old male patient from French West Indies (Martinique) presented with a tumor of hard palate evolving from 2 years with locoregional lymph nodes. He had a history of chronic urticaria, prurigo, rhinitis and alopecia areata. Pathological examination of the tumor was consistent with the diagnosis of Kimura's disease. Blood tests showed hypereosinophilia, elevation of IgG and IgE. The serology of Toxocara canis with Western blott was positive. Corticosteroid therapy (0.7 mg/kg/d) and albendazole (800 mg/d) allowed regression of the tumor, lymph nodes, and urticaria. The remaining tumor was surgically excised. CONCLUSION Kimura's disease was first described in Japanese young men, between 20 and 40 years old, with subcutaneous nodules on head and neck area. Involvement of oral mucosa is rare, and the occurence in West Indian patients has been rarely reported.
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Affiliation(s)
- V Ray
- Service de médecine interne, centre hospitalier universitaire de Fort-de-France, 97261 cedex, Fort-de-France, Martinique
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