Kimura's disease: an uncommon cause of head and neck masses with potentially serious sequelae

Kimura's disease and its masquerade with a malignancy: A case report

Kimura's disease is an uncommon chronic condition that often masquerades as a malignancy. It is reported predominantly in males of South-East Asia in their second and third decade of life. Most of the patients present with increased eosinophilia, follicular hyperplasia and high levels of IgE circulating in their blood. In this case, we report a patient of 29 years age who presented with complaints of left parotid and left post-auricular swellings. It was painless and growing gradually in size over the period of 8 years. It was asymptomatic during the whole period of the disease. Patient was diagnosed on histology and subsequent immunohistochemistry reports. Treatment in this patient included parotidectomy and lymph node dissection. It was followed by local radiation to prevent recurrence. It can be concluded that Kimura's disease may vary in its presentation but a few features remain characteristic. No reports of malignant change have been reported as of yet making its prognosis quite favorable for the patient. Surgery remains the choice of treatment but for more effective approach, it should be followed by radiation.

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In a patient presenting with neck mass along with history of weight loss, Kimura's Disease should be suspected.

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Multidisciplinary approach is required for prompt diagnosis and treatment in such cases.

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More knowledge on Kimura's disease will help physicians in coming up with a better management plan in future.

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.

Kimura's disease of the parotid gland with cutaneous features in a Caucasian female patient

Kimura's disease is a rare disease of unknown aetiology, commonly presenting with slow-growing head and neck subcutaneous nodules, lymphadenopathy, eosinophilia and elevated immunoglobulin E. This report describes a very rare case of a 41-year-old female, of White-British ethnicity, with a new diagnosis of Kimura's disease of the parotid gland and associated cutaneous features. The patient was investigated for 3 years before a diagnosis of Kimura's disease was reached. A superficial parotidectomy was undertaken and no recurrence was observed in the 20 months following surgery. Kimura's disease is easily misdiagnosed, owing to lack of clinical awareness. This case report highlights the troubling symptomatology as well as complexities of diagnosis and management of Kimura's disease. A high level of clinical suspicion is required, for patients of any ethnicity and sex presenting with features consistent with the disease, in order for prompt diagnosis, investigation and management to be achieved.