Eosinophilic vasculitis affecting multiple middle-sized arteries in a patient with Kimura's disease: A case report and literature review

Cervical Recurrence from an Intraparotid Kimura Disease

Introduction

Kimura disease is a rare, benign, chronic, lymphoproliferative disorder of unknown etiology that affects the skin and lymph nodes and mostly observed in males of Asia.

Case Report

We report a 55-year-old man who presented neck and intraparotid lymphadenopathy. Surgical removal of the growth confirmed the histological diagnosis of Kimura disease.

Discussion

Kimura disease is endemic in the Far East (China and Japan) but exceptional in Europe; < 200 cases have been reported in the literature, with less than 40 involving a parotid region. The histological characteristics of Kimura disease are lymphocyte follicular hyperplasia, eosinophilic tissue infiltration, fibrocollagenous deposition and vascular proliferation. Main treatment is surgical, but recurrence is frequent.

Conclusion

Kimura disease is a rare condition, but should be considered in the case of cervical mass associated with hypereosinophilia and/or strongly elevated IgE levels, especially in Far Eastern patients.

Development of Eosinophilic Temporal Arteritis and Digital Ischemia in a Patient with Hypereosinophilic Syndrome

We describe a case of eosinophilic temporal arteritis in a 61-year-old woman with hypereosinophilic syndrome, who developed subcutaneous nodules in the temporal areas and digital cyanosis with small nodules on the sides of her fingers. Ultrasound revealed occlusion and corkscrew-like changes of the temporal and digital arteries, respectively. Temporal artery biopsy revealed eosinophilic vasculitis without giant cell formation. Angiography showed occlusion of the ulnar and digital arteries. Administration of low-dose corticosteroid improved the temporal artery swelling and digital cyanosis. More reports of similar cases are required to characterize this type of non-giant cell eosinophilic vasculitis that affects the peripheral arteries.

Kimura's disease: effects of age on clinical presentation

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.