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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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Misra D, Kiran AS, Dora A, Srivani N, Reddy LS. Kimura's Disease in Temporal Bone: A Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:2793-2797. [PMID: 38883553 PMCID: PMC11169285 DOI: 10.1007/s12070-023-04454-1] [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: 10/11/2023] [Accepted: 12/19/2023] [Indexed: 06/18/2024] Open
Abstract
To publish a rare case of Kimura's Disease in Temporal Bone. A 27 year-old male presenting with history of right ear pain and discharge for 2 months was thoroughly evaluated by clinical evaluation, hematological, radiological and histopathological study. Clinical examination revealed a bulge in posterior-inferior quadrant right side of tympanic membrane. HRCT temporal bone revealed a heterogeneous attenuating focal lesion is noted in the region of right middle ear cavity, mastoid antrum mastoid air cells in continuation with the superior aspect of right jugular foramen with erosions and bone destructions, involving the mastoid air cells and sinus plate. Patient was managed surgically with right side canal wall down mastoidectomy and Type 1 Tympanoplasty. Histopathological examination showed focal ulcerated stratified epithelium, dilated elongated congested blood vessels and hemorrhage. Diagnosis was made as Kimura's disease.
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Affiliation(s)
- Deeptabha Misra
- Department of ENT, Government ENT Hospital, Hyderabad, Telengana India
| | | | - Aseesh Dora
- Department of ENT, Government ENT Hospital, Hyderabad, Telengana India
| | - N Srivani
- Department of Pathology, Osmania Medical College, Hyderabad, Telengana India
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Battesti G, Jachiet M, Lepelletier C, Petit A, Vignon-Pennamen MD, Cassius C, de Masson A, Battistella M, Bagot M, Bouaziz JD, Mahévas T. Two cases of dupilumab-responsive Kimura disease. Clin Exp Dermatol 2024; 49:502-506. [PMID: 38149974 DOI: 10.1093/ced/llad455] [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: 08/04/2023] [Revised: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
Kimura disease (KD) is a rare, chronic angiolymphoproliferative inflammatory disease appearing to be mostly restricted to the skin and soft tissue. Cutaneous involvement of KD includes head and/or neck nodules showing suggestive histological features, frequently associated with an atopic dermatitis-like or prurigo-like presentation. KD is challenging to treat, with high rate of recurrence using current therapeutic strategies. Evidence for involvement of a T-helper type 2 (Th2) immune response in KD pathogenesis has been found in previous studies. Consequently, this study aimed to determine the efficacy and safety of dupilumab, a human monoclonal antibody that inhibits signalling of key Th2 cytokines, interleukin (IL)-4 and IL-13, within a single-centre cohort of patients with cutaneous KD. Two adults with a diagnosis of refractory (failure of at least one treatment line) cutaneous-restricted KD based on clinical, biological, histological, molecular and imaging findings received dupilumab for KD, and showed dramatic response with a good safety profile.
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Affiliation(s)
- Gilles Battesti
- Departments of Dermatology
- Université Paris Cité, Paris, France
| | | | | | | | | | - Charles Cassius
- Departments of Dermatology
- Université Paris Cité, Paris, France
| | - Adèle de Masson
- Departments of Dermatology
- Université Paris Cité, Paris, France
| | - Maxime Battistella
- Université Paris Cité, Paris, France
- Pathology, Saint-Louis Hospital, Paris, France
| | - Martine Bagot
- Departments of Dermatology
- Université Paris Cité, Paris, France
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Luo SY, Zhou KY, Wang QX, Deng LJ, Fang S. Kimura's disease treated with dupilumab: A case report and literature review. Int Immunopharmacol 2024; 131:111895. [PMID: 38508096 DOI: 10.1016/j.intimp.2024.111895] [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: 02/10/2024] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Kimura's disease (KD) is a rare chronic inflammatory disorder characterised by painless, deep subcutaneous nodules that most commonly affect the head and neck region of Asian men. Due to high relapse rates and side effects of current therapies, the treatment of KD is challenging. OBJECTIVES To present a case of KD that was successfully treated with dupilumab and to review the literature with a focus on the evaluation of the efficacy and safety of dupilumab in KD. METHODS A review of the available literature on the treatment of KD with dupilumab was performed and a new case was analyzed. To gain further insight into this promising therapy, literature review of 8 articles published between January 2016 and January 2024 were included in this study using the PubMed database. RESULTS Our patient with KD was successfully treated with dupilumab 300 mg every 2 weeks, at an initial dose of 600 mg. The treatment was well tolerated. In the past, only nine patients with KD treated with dupilumab have been reported and reviewed, half of whom had failed prior treatment. All patients achieved significant efficacy after treatment with dupilumab, with no relapses during an average follow-up of 10.4 months (ranged from 4 to 16 months). CONCLUSION Dupilumab may be an emerging alternative treatment option for KD patients. Larger randomized controlled studies are needed to confirm these findings.
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Affiliation(s)
- Si-Yu Luo
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai-Yi Zhou
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin-Xiao Wang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Jia Deng
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sheng Fang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Suga K, Kiuchi M, Kageyama T, Kokubo K, Tanaka S, Iwata A, Suzuki K, Hirahara K, Nakajima H. Single-cell RNA sequencing of peripheral blood mononuclear cells from Kimura disease patient successfully treated with dupilumab. Allergol Int 2023; 72:610-613. [PMID: 37349231 DOI: 10.1016/j.alit.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Kensuke Suga
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Kiuchi
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takahiro Kageyama
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Kota Kokubo
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeru Tanaka
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Arifumi Iwata
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kotaro Suzuki
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kiyoshi Hirahara
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan; Chiba University Synergy Institute for Futuristic Mucosal Vaccine Research and Development (cSIMVa), Chiba, Japan.
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Lee CC, Yu KH, Chan TM. Kimura's disease: A clinicopathological study of 23 cases. Front Med (Lausanne) 2022; 9:1069102. [PMID: 36643844 PMCID: PMC9835107 DOI: 10.3389/fmed.2022.1069102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Kimura's disease (KD) is an uncommon lymphoproliferative fibroinflammatory disorder. Patients present with head and neck subcutaneous nodules with or without lymphadenopathy. Peripheral blood eosinophilia and elevated serum immunoglobulin E (IgE) levels are typical. This study was designed to delineate the clinicopathological features, pattern of care, and disease course of 23 Taiwanese patients with KD. Methods We retrospectively analyzed the clinical data of 23 consecutive cases (16 male and 7 female; age at diagnosis: 12-77 years) of KD diagnosed at our institution from 2015 to 2020. Results The median time from presentation to diagnosis was 1 month. Twenty-one patients presented with unilateral or bilateral head and neck masses. The remaining two presented with right flank and right arm lesions, respectively. Peripheral blood eosinophilia was observed in nine, and elevated IgE levels were observed in four. All were diagnosed using either excisional or core-needle biopsy. Seven patients underwent fine needle aspiration without a diagnostic yield. Salivary gland and lymph node involvement was observed in three and seven patients, respectively. Most lesions showed tissue eosinophilia (100%) and florid follicular hyperplasia (78.26%). Three cases had histological KD-IgG4-RD overlap and three had comorbid IgG4-RD were recognized. Thirteen patients underwent surgical resection, one received adjuvant therapy, and two received prednisolone monotherapy. Conclusion KD should be considered in patients with subcutaneous masses, eosinophilia, and elevated IgE levels. Biopsy remains the gold standard of diagnosis. Increased recruitment of IgG4+ plasma cells is a common feature. Consideration of IgG4-RD in all KD patients may be prudent.
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Affiliation(s)
- Chih-Chun Lee
- Department of Medical Education, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tien-Ming Chan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan,*Correspondence: Tien-Ming Chan,
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Yang B, Yu H, Jia M, Yao W, Diao R, Li B, Wang Y, Li T, Ge L, Wang H. Successful treatment of dupilumab in Kimura disease independent of IgE: A case report with literature review. Front Immunol 2022; 13:1084879. [PMID: 36591252 PMCID: PMC9794988 DOI: 10.3389/fimmu.2022.1084879] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Kimura disease (KD) is a rare and benign chronic inflammatory disease of unknown cause. It is characterized by subcutaneous granuloma of soft tissues in the head and neck region, increased eosinophil count, and elevated serum IgE. Currently, no definitive treatments are recommended. A 57-year-old Chinese man was diagnosed with KD after 7 years of slow subcutaneous masses growth. The patient underwent treatment of oral glucocorticoids for 1 year, but the masses recurred as the dosage was tapered down. Subsequent anti-IgE therapy of omalizumab administered subcutaneously at 450 mg/day at a 4-week interval did not show improvement. The size of masses and serum IgE and circulating eosinophils did not decrease significantly after 19 cycles of continuous treatment. Ultimately, switched strategy of dupilumab was applied at an initial dose of 600 mg, followed by 300 mg every 2 weeks for 4 months. This treatment demonstrated dramatical effects with reduced masses in each area and fast dropdown of eosinophil counts, while the high level of serum IgE remained without changes. Recently, different biologics including anti-IgE, anti-IL-5, and anti-IL-4/IL-13 have been applied to treat KD with satisfied results and help to explore the pathogenesis of this rare disease. To our knowledge, this is the first report that demonstrates the effects of two different biologics in the same patient and reveals the impressive clinical efficacy of dupilumab to treat KD independent of IgE. Therefore, further investigation of the underlying mechanism and the development of diagnosis and treatment of KD is valuable.
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Affiliation(s)
- Boyun Yang
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hanxiao Yu
- Clinical Research Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Minyue Jia
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wo Yao
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ran Diao
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bohui Li
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yongfang Wang
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ting Li
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liuya Ge
- Outpatient Care Department, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huiying Wang
- Department of Allergy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,*Correspondence: Huiying Wang,
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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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Chang SY, Lee CC, Chang ML, Teng WC, Hsiao CY, Yu HH, Hsieh MJ, Chan TM. Comparison of Clinical Manifestations and Pathology between Kimura Disease and IgG4-Related Disease: A Report of Two Cases and Literature Review. J Clin Med 2022; 11:jcm11236887. [PMID: 36498461 PMCID: PMC9740894 DOI: 10.3390/jcm11236887] [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] [Received: 10/05/2022] [Revised: 11/06/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Kimura disease (KD) is a rare, chronic proliferative condition presenting as a subcutaneous mass predominantly located in the head and neck region; it is characterized by eosinophilia and elevated serum IgE levels. IgG4-related disease (IgG4RD) is a fibroinflammatory condition characterized by swelling in single or multiple organs and the infiltration of IgG4 plasma cells. Herein, we presented two cases. Case 1 is a 38-year-old man with a painless mass in his right postauricular region, and Case 2 is a 36-year-old man with painless lymphadenopathy in his bilateral postauricular region. After surgical excision, they showed good recovery with no relapse. Although Cases 1 and 2 shared several overlapping pathological manifestations, there were a few differences that allowed the differentiation of KD and IgG4RD.
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Affiliation(s)
- Sing-Ya Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chih-Chun Lee
- Department of Medical Education, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan
| | - Ming-Ling Chang
- Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Wen-Chieh Teng
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chao-Yang Hsiao
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Han-Hua Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Meng-Ju Hsieh
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tien-Ming Chan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence:
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Tojima I, Murao T, Nakamura K, Arai H, Matsumoto K, Shimizu S, Kouzaki H, Shimizu T. Increased blood group 2 innate lymphoid cells are associated with the clinical severity of Kimura disease. Allergol Int 2022; 72:339-342. [PMID: 36283928 DOI: 10.1016/j.alit.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ichiro Tojima
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan.
| | - Takuya Murao
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Keigo Nakamura
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Hiroyuki Arai
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Koji Matsumoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Shino Shimizu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Hideaki Kouzaki
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Takeshi Shimizu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan
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Fan R, Xu G, Chen Y, Lv J, Zhang Z. Kimura disease with Allergic Bronchopulmonary Aspergillosis: a case report. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:58. [PMID: 35761347 PMCID: PMC9238044 DOI: 10.1186/s13223-022-00683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 05/03/2022] [Indexed: 12/04/2022]
Abstract
Background Kimura disease (KD) is a rare chronic idiopathic condition of unknown etiology that is prevalent in Asian males. It often causes subcutaneous lumps and enlarged lymph nodes, especially in head and neck region. But KD is also a systemic disease that can involve multiple organs, such as the kidneys and skin. Case presentation We report a 62-year-old Chinese man who presented with paroxysmal cough, enlarged inguinal lymph nodes, recurrent skin itching, and elevated IgE antibodies specific to A. fumigatus. After a comprehensive review, the final diagnosis for this patient was KD with Allergic Bronchopulmonary Aspergillosis (ABPA). Conclusions The age of onset and the location of the lump involved were not characteristic for the illness. This case report described the patient’s diagnosis and treatment process. This case report serves to arouse the attention of multidisciplinary team to explore the potential relationship between KD and ABPA. It will contribute to preventing the misdiagnosis and missed diagnosis of KD.
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Affiliation(s)
- Ruiyun Fan
- Department of Pulmonary and Critical Care, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, 215002, Jiangsu Province, China
| | - Guopeng Xu
- Department of Pulmonary and Critical Care, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, 215002, Jiangsu Province, China
| | - Ying Chen
- Department of Pulmonary and Critical Care, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, 215002, Jiangsu Province, China
| | - Jinghuan Lv
- Department of Pathology, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, 215002, Jiangsu Province, China
| | - Zhongwei Zhang
- Department of Pulmonary and Critical Care, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, 215002, Jiangsu Province, China.
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Yang B, Liao H, Wang M, Long Q, Zhong H, Luo L, Liu Z, Cheng X. Kimura's disease successively affecting multiple body parts: a case-based literature review. BMC Ophthalmol 2022; 22:154. [PMID: 35366827 PMCID: PMC8977031 DOI: 10.1186/s12886-022-02378-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Kimura’s disease is a rare, benign, chronic inflammatory disease that presents as painless, solid masses mainly affecting the deep subcutaneous areas of the head and neck, especially the salivary glands, parotid glands and nearby lymph nodes. It is characterized by elevated peripheral blood eosinophil and Immunoglobulin E (IgE) levels. Case presentation A 31-year-old Asian male presented with an orbital space-occupying lesion lasting for 1.5 years. Ten years prior, surgical excision of bilateral fossa cubitalis and groin masses was performed, and the pathological examination showed "lymphoproliferative disease". One year later, masses reappeared near the surgical sites; they grew slowly and shrank after glucocorticoid treatment. At this point, admission examinations showed in the peripheral blood an eosinophil proportion of 13.4%, a total IgE level of 26,900.00 IU/mL, prurigo present on the whole body, and multiple palpable masses near the bilateral fossa cubitalis and groin. The left eyeball was exophthalmic. The left elbow mass was excised, and the pathological examination confirmed Kimura’s disease. Oral glucocorticoid therapy is taken and tapering regularly. The eosinophil count returned to normal, the IgE level gradually decreased, the orbital space-occupying lesion and elbow and groin masses shrank significantly, and the whole-body skin prurigo disappeared. Currently, the patient has been in a stable condition for eighteen months. Conclusion Our case provides a novel insight that Kimura’s disease should be involved in the differential diagnosis of inflammatory lesion mass of orbit and also supports systemic regular glucocorticoid as a valuable therapy of such condition, but close follow-up and long-term observation are crucial.
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Huang HY, Yang CY, Yao WT, Chen YF, Yu CM, Tung KY, Tsai MF. Kimura Disease of the Thigh Treated With Surgical Excision and Dupilumab. Ann Plast Surg 2022; 88:S110-S113. [PMID: 35225857 DOI: 10.1097/sap.0000000000003106] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Kimura disease (KD) is a rare, chronic inflammatory disorder presenting with solitary or multiple masses. Treatment options include surgical excision, corticosteroids, and radiotherapy; however, optimal therapy remains to be established. Moreover, efficacy of a humanized monoclonal antibody, dupilumab (Dupixent), requires to be demonstrated. Here, we present a 36-year-old male patient with an enlarging mass in the left medial thigh and chronic eczema over the abdomen and lower legs. Kimura disease was diagnosed after surgical excision. Postoperative treatment with dupilumab was applied with an initial dose of 600 mg followed by 300 mg every 2 weeks for 8 months. No recurrence of KD was observed in the 1-year follow-up. The eczematous lesions improved greatly. To our knowledge, this is the first report of using dupilumab for treating KD.
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Affiliation(s)
- Hsuan-Yu Huang
- From the Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei
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Affiliation(s)
- Yuichi Teraki
- Department of Dermatology, Saitama Medical University, Saitama Medical Center, Saitama, Japan
| | - Akane Terao
- Department of Dermatology, Saitama Medical University, Saitama Medical Center, Saitama, Japan
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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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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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Miyagaki T, Nakajima K, Kuroda E, Takeuchi S, Kadono T. Recurrent angiolymphoid hyperplasia with eosinophilia with CCR4 expression. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_58_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Sangwan A, Goyal A, Bhalla AS, Kumar A, Sharma R, Arava S, Dawar R. Kimura Disease: A Case Series and Systematic Review of Clinico-radiological Features. Curr Probl Diagn Radiol 2020; 51:130-142. [PMID: 33250297 DOI: 10.1067/j.cpradiol.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022]
Abstract
Kimura disease is a rare chronic inflammatory disorder mostly reported in males in second to third decades from south-east Asia. Head and neck is the most commonly involved region. The usual presentation is painless facial swelling with salivary gland involvement and regional lymphadenopathy. The diagnosis can be suspected on imaging but needs to be proven on histopathology. We describe three histopathology proven cases of Kimura disease and emphasize the specific clinic-radiological findings which can help in early identification of the condition and its differentiation from other diseases with similar presentation. Gray scale Ultrasound, contrast-enhanced ultrasound, and contrast-enhanced Magnetic Resonance Imaging (CE-MRI) were done in all patients and Computed Tomography (CT) was done in one. The salient imaging features were ill-defined solid mass in the subcutaneous location of the facial region which was heteroechoic on Gray scale Ultrasound, heterogeneously hyperintense on T2W MRI and without much diffusion restriction. There was involvement of salivary glands with ipsilateral cervical adenopathy. The lesion showed avid contrast enhancement on contrast-enhanced ultrasound and CE-MRI. We also present a systematic literature review of clinico-radiological features in Kimura disease in the head and neck. The articles with histopathologically proven cases and satisfactory description of imaging findings were included and we have compared the findings in our cases with published literature. In addition, we have included examples of radiological mimics of this disease. Certain imaging findings are highly suggestive and can aid in early diagnosis of Kimura disease which helps in early initiation of treatment with better patient prognosis.
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Affiliation(s)
- Ankit Sangwan
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Ashu S Bhalla
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Atin Kumar
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Raju Sharma
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rakesh Dawar
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Kimura Disease Presenting with Buccal Mass: A Case Report and Literature Review. Head Neck Pathol 2020; 15:657-662. [PMID: 32712881 PMCID: PMC8134605 DOI: 10.1007/s12105-020-01206-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
A 52-year-old man with a 2-year history of left buccal swelling was admitted to our department. An elastic hard oral mass was palpated under the intact buccal mucosa. A CT scan with enhancement revealed a solid mass measuring 2.0 × 1.5 × 1.3 cm between the left masseter muscle and the maxilla. Laboratory examination showed elevated peripheral blood eosinophil count of 1070/μL (12.3%) and serum immunoglobulin (Ig)E level of 1374 IU/mL. Histologic examination of transorally excised mass revealed lymphoid follicular hyperplasia with reactive germinal centers and eosinophilic infiltration with eosinophilic micro-abscesses in the germinal centers. Abundant IgE deposition in a reticular fashion was observed in the germinal centers and c-kit positive mast cells was observed in the paracortical area in the excised mass. The patient was diagnosed with Kimura disease (KD) and treated with oral prednisolone, tapering from 10 mg/day for approximately 8 months. Eosinophil count and serum IgE level decreased to 435/μL (5%) and 520 IU/dL, respectively. He is free from symptoms at the time of this submission. KD, a rare, benign, and chronic inflammatory disorder, occurs predominantly in young male adults in Asia. Patients with KD who presents with buccal mass are relatively rare. Immunohistologic analyses suggested that an allergic reaction played an important role in the etiology of KD in this case.
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20
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Treatment of Kimura's disease with oral corticosteroid and methotrexate. An Bras Dermatol 2019; 95:115-117. [PMID: 31889595 PMCID: PMC7058860 DOI: 10.1016/j.abd.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 03/01/2019] [Indexed: 11/25/2022] Open
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21
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Li X, Wang J, Li H, Zhang M. Misdiagnosed recurrent multiple Kimura's disease: A case report and review of the literature. Mol Clin Oncol 2018; 10:352-356. [PMID: 30847173 PMCID: PMC6388464 DOI: 10.3892/mco.2018.1793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/07/2018] [Indexed: 11/05/2022] Open
Abstract
Kimura's disease (KD) is a rare condition, with only a few cases reported to date, mainly in Asian patients. We herein present the case of a 48-year-old man with KD who presented with recurrent masses in the right parotid gland and neck region over a 15-year period. The masses were not accompanied by pain, or significant functional or neurosensory dysfunction. The results of the laboratory tests revealed an increased eosinophil count and markedly elevated serum IgE levels. On magnetic resonance imaging examination, a widespread abnormal signal was detected in the area of the lesions; the contrast-enhanced scan revealed inhomogeneous enhancement, with partial involvement of the sternocleidomastoid muscle and the parotid gland. The patient underwent surgical resection of the right parotid and neck masses, and the postoperative pathological examination revealed eosinophilic hyperplastic lymphogranuloma, also referred to as KD. This presented case and review of the relevant literature aim to improve our understanding of KD in order to increase the accuracy of diagnosis, reduce the misdiagnosis rate and ensure proper treatment of this rare disease.
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Affiliation(s)
- Xuesheng Li
- Department of Prosthodontics, Hainan Stomatological Hospital, Haikou, Hainan 570105, P.R. China
| | - Jing Wang
- Department of Stomatology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, P.R. China
| | - Hongbo Li
- Department of Stomatology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, P.R. China
| | - Ming Zhang
- Department of Stomatology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, P.R. China
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22
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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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Glibbery N, Muscat K, Cascarini L. Kimura's disease of the parotid gland with cutaneous features in a Caucasian female patient. J Surg Case Rep 2018; 2018:rjy067. [PMID: 29657706 PMCID: PMC5890462 DOI: 10.1093/jscr/rjy067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/15/2018] [Accepted: 04/04/2018] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Natalia Glibbery
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Kenneth Muscat
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Luke Cascarini
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
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24
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Shah K, Tran AN, Magro CM, Zang JB. Treatment of Kimura disease with mycophenolate mofetil monotherapy. JAAD Case Rep 2017; 3:416-419. [PMID: 28932783 PMCID: PMC5594227 DOI: 10.1016/j.jdcr.2017.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kalee Shah
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Anh N Tran
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Cynthia M Magro
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Julie B Zang
- Department of Dermatology, Weill Cornell Medicine, New York, New York
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25
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Natural protective immunity against grass pollen allergy is maintained by a diverse spectrum of response types. J Allergy Clin Immunol 2017; 140:1746-1749.e11. [PMID: 28867457 DOI: 10.1016/j.jaci.2017.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/15/2017] [Accepted: 07/24/2017] [Indexed: 12/24/2022]
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26
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Chen QL, Li CX, Shao B, Gong ZC, Liu H, Ling B, Abasi K, Hu LL, Wang B, Yin XP. Expression of the interleukin-21 and phosphorylated extracellular signal regulated kinase 1/2 in Kimura disease. J Clin Pathol 2017; 70:684-689. [PMID: 28108473 PMCID: PMC5537556 DOI: 10.1136/jclinpath-2016-204096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/14/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the expressions of interleukin (IL)-21 and phosphorylated extracellular signal regulated kinase 1/2 (pERK1/2) in Kimura disease (KD) and to correlate the findings with clinical and prognostic variables. METHODS Immunohistochemical analysis of IL-21 and pERK1/2 was performed in 18 cases of KD and five gender- and age-matched control samples. Clinical data were extracted and patients followed up for a mean period of 32.1 months. RESULTS After a mean follow-up period of 32.1 months (range 1-102 months), recurrence was diagnosed as the end point for seven patients-that is, a 44% (7/16) cumulative recurrence rate. In comparison with gender- and age-matched controls, patients showed strong in situ expressions of IL-21 and pERK1/2, respectively (p<0.05). Patients with strong IL-21 staining intensity and overexpression of pERK1/2 had a lower recurrence rate than those with moderate staining intensity (p=0.049, p=0.019, respectively). However, differences were not statistically significant by gender, age, eosinophils, location, multiplicity, laterality, size, duration and primary outbreak. pERK1/2 was the independent prognostic factor (p=0.020), while age, gender, eosinophils, multiplicity, laterality, size, duration, primary outbreak and expression of IL-21 were not. CONCLUSIONS This study suggests that the IL-21/pERK1/2 pathway is activated in KD, and pERK1/2 might be considered as a potential prognostic indicator in KD.
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Affiliation(s)
- Qing-Li Chen
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
| | - Chen-Xi Li
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
| | - Bo Shao
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
| | - Zhong-Cheng Gong
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
| | - Hui Liu
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
| | - Bin Ling
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
| | - Keremu Abasi
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
| | - Lu-Lu Hu
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
| | - Bing Wang
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
| | - Xiao-Peng Yin
- Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, Urumqi, China
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27
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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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28
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Ito S, Oda T, Matsuo A, Takechi H, Uchida T, Watanabe A, Kono T, Shimazaki H, Tamai S, Oshima N, Kumagai H. Observation of Angiolymphoid Hyperplasia with Eosinophilia (ALHE) at Three Arterial Sites and Its Association with Membranous Nephropathy. Intern Med 2015; 54:1933-9. [PMID: 26234240 DOI: 10.2169/internalmedicine.54.4031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case involving the systemic presentation of angiolymphoid hyperplasia with eosinophilia (ALHE) in association with membranous nephropathy (MN). A 34-year-old Japanese man presented with leg edema and bilateral temporal nodules. He had a history of Buerger's disease and recurrent coronary stenosis. A renal biopsy performed to assess nephrotic syndrome revealed MN. Furthermore, a temporal nodule was excised, and ALHE was diagnosed. We reevaluated the coronary and posterior tibial artery specimens obtained in his twenties and presumed that these lesions were also vascular tumors arising from ALHE. The association of ALHE and MN is quite rare.
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Affiliation(s)
- Seigo Ito
- Department of Nephrology and Endocrinology, National Defense Medical College, Japan
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29
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Kimura disease complicated with bowel infarction and multiple arterial thromboses in the extremities. J Clin Rheumatol 2014; 20:38-41. [PMID: 24356478 DOI: 10.1097/rhu.0000000000000064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Kimura disease (KD) is a chronic inflammatory disease characterized by slowly growing subcutaneous nodules in the face and the neck region. Although a concomitant hypercoagulable state can accompany KD, massive thromboses in patients with KD have rarely been reported. Here, we report a case of KD complicated with bowel infarction and multiple arterial thromboses in the upper and lower extremities. The patient underwent bowel resection and was successfully treated with corticosteroid and anticoagulation.
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30
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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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Yang TH, Chou YH, Kao WY, Cherng SC. Kimura Disease Simulating Hodgkin's Lymphoma on (18)F FDG PET-CT: Report of a Case. Nucl Med Mol Imaging 2014; 48:313-6. [PMID: 26396638 DOI: 10.1007/s13139-014-0285-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/26/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 16-year-old male patient presenting with several mass lesions on the left side of his neck that had been there for weeks. Whole-body (18)F-fluorodeoxyglucose positron emission tomography and computed tomography ((18)F FDG PET-CT) revealed multiple focal areas of increased uptake of fluorodeoxyglucose (FDG) on the left side of the neck, left supraclavicular fossa, left axilla, and mediastinum, simulating the imaging findings of Hodgkin's lymphoma. Subsequent incisional biopsy of lymph nodes in the left supraclavicular fossa with histologic examination confirmed the diagnosis of Kimura disease. The differential diagnoses should include Kimura disease when evaluating regional or generalized lymphadenopathy seen on (18)F FDG PET-CT because it also may show prominent uptake of FDG.
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Affiliation(s)
- Tsung-Han Yang
- Department of Nuclear Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist., New Taipei City, 231 Taiwan Republic of China
| | - Yu-Hsiang Chou
- Department of Nuclear Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist., New Taipei City, 231 Taiwan Republic of China
| | - Woei-Yau Kao
- Division of Hematology-Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei City, 231 Taiwan Republic of China ; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Shiou-Chi Cherng
- Department of Nuclear Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist., New Taipei City, 231 Taiwan Republic of China ; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
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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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Okura T, Miyoshi KI, Irita J, Enomoto D, Nagao T, Kukida M, Tanino A, Kudo K, Higaki J. Kimura's disease associated with membranous nephropathy with IgG4 and phospholipase A2 receptor-positive staining of the glomerular basement membrane. Intern Med 2014; 53:1435-40. [PMID: 24990336 DOI: 10.2169/internalmedicine.53.2042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Kimura's disease is a granulomatous disease of unknown origin that develops in the dermis, subcutaneous tissue and lymph nodes. Kimura's disease is frequently complicated by nephropathy, particularly membranous nephropathy (MN). It has recently been suggested that glomerular immunoglobulin (IgG)4 deposition may play a role in the pathogenesis of idiopathic MN. These IgG4 antibodies are thought to react with antigens, primarily the phospholipase A2 receptor (PLA2R) expressed on the podocyte cell membrane. We herein report a case of Kimura's disease with MN in which a renal biopsy specimen revealed positive staining for anti-IgG4 and anti-PLA2R antibodies.
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Affiliation(s)
- Takafumi Okura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
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Kimura's disease or IgG4-related disease? A case-based review. Clin Rheumatol 2013; 34:385-9. [PMID: 24352754 DOI: 10.1007/s10067-013-2462-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 12/08/2013] [Indexed: 12/18/2022]
Abstract
Kimura's disease usually presents with benign painless soft tissue swelling around the head and neck areas with eosinophilia and high immunoglobulin E (IgE) levels. IgG4-related disease is characterized by fibrosis and sclerosis of the involved organs, with infiltration of IgG4-positive plasma cells. There are some similar clinical manifestations of these two diseases, with eosinophilia or high IgE levels often found in patients with IgG4-related disease. However, the relation between these two diseases is not well known. We report a 23-year-old man who had multiple neck lumps for longer than 1 year. He had remarkable eosinophilia and elevated serum IgE levels. Biopsy of his lymph nodes suggested the diagnosis of both Kimura's disease and IgG4-related disease. In this article, we discuss the relationship between Kimura's disease and IgG4-related disease. We also suggest a possible model ("allergen-specific immunotherapy") to illustrate our view that an increase in IgG4-positive plasma cells is an epiphenomenon of Kimura's disease.
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Chopinaud M, Morice C, Comoz F, Petit A, Battistella M, Stefan A, Verneuil L. Un cas de maladie de Kimura dans une forme atypique. Ann Dermatol Venereol 2013; 140:699-703. [DOI: 10.1016/j.annder.2013.04.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/21/2013] [Accepted: 04/08/2013] [Indexed: 12/31/2022]
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Increased CD45RO+ CD62L+ CD4+ T-cell subpopulation responsible for Th2 response in Kimura's disease. Hum Immunol 2013; 74:1097-102. [PMID: 23747992 DOI: 10.1016/j.humimm.2013.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 05/06/2013] [Accepted: 06/01/2013] [Indexed: 11/23/2022]
Abstract
Kimura's disease is characterized by subcutaneous masses, eosinophilia, and markedly elevated serum immunoglobulin E, suggesting that T helper (Th)2 cells may play a role in the pathogenesis. We investigated Th2 cytokine synthesis by mononuclear cells and possible Th1/Th2 subpopulations in Kimura's disease. Peripheral blood samples were obtained from seven patients with Kimura's disease and CD4(+) T-cell subpopulations separated by CD45RO and CD62L were isolated. Purified cells were stimulated with PHA or anti-CD3 mAb, and the cytokine levels were measured by Cytometric Bead Array kit. Peripheral blood mononuclear cells in the majority of the patients produced Th2 cytokines such as interleukin (IL)-3, IL-4, IL-5, IL-13 or GM-CSF higher than those of controls. The ratio of CD45RO(+) CD62L(+) cells in CD4(+) T cells was increased in six out of seven patients compared to age-matched controls. Especially, patient 1 had remarkably increased levels of CD45RO(+) CD62L(+) population in CD4(+) T cells. In addition, IL-4 production levels by CD45RO(+) CD62L(+) CD4(+) T cells of patients 1 and 2 were higher than those of their CD45RO(+) CD62L(-) CD4(+) T cells, in the same manner as those by a normal control. Taken together, the synthesis of Th2 cytokines and CD62L-positive subpopulation in CD45RO(+) CD4(+) T cells, which may represent characteristics of Th2, are increased in patients with Kimura's disease, suggesting that deviation to Th2 may involve in pathogenesis of the disease.
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Jun R, Liu XK, Zeng K. Successful treatment of angiolymphoid hyperplasia with eosinophilia and Kimura's disease in the same patient with surgery. Dermatol Ther 2013; 27:36-8. [PMID: 24502310 DOI: 10.1111/dth.12040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Until now, there have only been two cases describing the coexistence of angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimura's disease in one patient. Herein, we report the previous case of recurrent ALHE and Kimura's disease that was successfully treated with surgery.
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Affiliation(s)
- Ren Jun
- Department of Dermatology, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China; Department of Dermatology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
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Horikoshi T, Motoori K, Ueda T, Shimofusa R, Hanazawa T, Okamoto Y, Ito H. Head and neck MRI of Kimura disease. Br J Radiol 2011; 84:800-4. [PMID: 21849365 DOI: 10.1259/bjr/42012793] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of our study was to describe the MR appearance of Kimura disease and to interpret the differences in appearance from malignant parotid gland tumours. METHODS MR studies of seven patients with Kimura disease were reviewed. The MR studies included T(1) weighted, T(2) weighted, short tau inversion-recovery, diffusion-weighted (DW) and dynamic contrast-enhanced imaging. RESULTS Typical Kimura disease featured subcutaneous lesions, continuously infiltrated parotid lesions from the subcutaneous lesions with or without intraparotid lymphadenopathies, and reactive cervical lymphadenopathies. The subcutaneous lesions showed gradual upward enhancement on dynamic contrast-enhanced MR images. Reactive lymph nodes showed early enhancement on contrast-enhanced MR images and marked high intensity and low apparent diffusion coefficient values on DW images. CONCLUSION An indication for making the diagnosis of Kimura disease should be the subcutaneous tissue of the head and neck showing gradual upward enhancement on dynamic contrast-enhanced MRI and a lack of high intensity on DW images, associated with reactive lymph nodes.
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Affiliation(s)
- T Horikoshi
- Department of Radiology, Chiba University Hospital, Chiba City, Chiba, Japan
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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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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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Head and neck lesions of Kimura's disease: Exclusion of human herpesvirus-8 and Epstein-Barr virus by in situ hybridisation and polymerase chain reaction. An immunohistochemical study. J Craniomaxillofac Surg 2010; 38:266-70. [DOI: 10.1016/j.jcms.2009.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Revised: 07/23/2009] [Accepted: 08/19/2009] [Indexed: 12/11/2022] Open
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Maleki D, Sayyah A, Rahimi-Rad MH, Gholami N. Kimura's disease with eosinophilic panniculitis--treated with cyclosporine: a case report. Allergy Asthma Clin Immunol 2010; 6:5. [PMID: 20236545 PMCID: PMC2846923 DOI: 10.1186/1710-1492-6-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Accepted: 03/17/2010] [Indexed: 02/07/2023] Open
Abstract
Kimura's disease is a rare, benign, slow growing chronic inflammatory swelling with a predilection for the head and neck region and almost always with peripheral blood eosinophilia and elevated serum IgE levels. Here, we report a 25-year-old male patient with asthma, Reynaud phenomenon, eosinophilic panniculitis, bilateral inguinal lymphadenopathy and peripheral blood eosinophilia. He responded initially to oral prednisolone with the subsidence of peripheral blood eosinophilia, asthma and the Reynaud phenomenon. But with tapering of prednisolone symptoms reappeared and hereby he was treated with cyclosporine. He has been symptom free for 6 months of follow up while taking cyclosporine 25 mg orally per day. Eosinophilia has resolved. This case shows that in addition to previously reported associations, Kimura disease may be associated with eosinophilic panniculitis and that cyclosporine could be effective in its treatment.
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Affiliation(s)
- Davood Maleki
- Department of Internal Medicine, Urmia University of Medical Sciences, Imam Khomeini Hospital, Ershad street, Urmia, Iran
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Obata Y, Furusu A, Nishino T, Ichinose H, Ohnita A, Iwasaki K, Taguchi T, Kohno S. Membranous nephropathy and Kimura's disease manifesting a hip mass. A case report with literature review. Intern Med 2010; 49:1405-9. [PMID: 20647657 DOI: 10.2169/internalmedicine.49.2977] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of Kimura's disease with membranous nephropathy. A 15-year-old Japanese boy was referred to our hospital with proteinuria and a subcutaneous mass in the hip. Renal biopsy demonstrated secondary membranous nephropathy (MN) with mild mesangial proliferation and some electron-dense deposits in the mesangium. Laboratory tests revealed eosinophilia and a high level of serum IgE, which are common findings in Kimura's disease. A biopsy of the mass in the hip was performed and Kimura's disease was diagnosed. Treatment with oral prednisolone resulted in a decrease of proteinuria and regression of the subcutaneous mass. Kimura's disease should be included in the differential diagnosis of secondary MN.
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Affiliation(s)
- Yoko Obata
- The Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
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Abstract
Eosinophilic esophagitis (EoE) is a newly recognized disease and is an emerging entity throughout developing and developed countries, including the United States. Therefore, understanding the causes, natural history, diagnosis, and management is important for future therapeutic interventions. The pathogenesis of EoE is still not clear, but a growing body of evidence has established that this condition represents a T-cell-mediated immune response involving several proinflammatory mediators and chemoattractants known to regulate eosinophilic accumulation in the esophagus, such as IL-4, IL-5, IL-3 and eotaxin-1, -2, and -3. Determining the mechanism or mechanisms through which human esophageal-derived factors ultimately induce the functional abnormalities observed, and to which antigens patients who have EoE are sensitized that lead to the manifestation of symptoms, is of significant interest.
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Affiliation(s)
- Anil Mishra
- Department of Pediatrics, Division of Allergy and Immunology, 3333 Burnnet Avenue, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA.
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Abstract
Kimura's disease is a rare, chronic inflammatory disease of unknown cause. It is characterized by painless subcutaneous swellings and lymphadenopathy, commonly affecting the head and neck region. This is associated with peripheral blood eosinophilia and raised serum IgE. It has distinct histological features of lymphoid follicles, eosinophilic infiltrate, fibrosis and vascular proliferation. The disease usually has a benign, indolent course. Traditionally, therapeutic options have included surgery, radiotherapy and steroids but response has been less than satisfactory. Recently, cyclosporine has been reported to be effective in the treatment of Kimura's disease. In this article, we present a middle-aged Chinese female with Kimura's disease for 20 years and her favourable response to cyclosporine.
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Affiliation(s)
- Yi-Shi Wang
- Division of Dermatology, Department of Laboratory Medicine, Changi General Hospital, Singapore
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Filo V, Galbavý S, Borecká D, Novotná V, Filová A, Nováková V. Disseminated angiolymphoid hyperplasia with eosinophilia successfully treated with levamisol. J DERMATOL TREAT 2009. [DOI: 10.1080/09546630050517225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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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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Isomoto H, Shikuwa S, Mizuta Y, Kohno S. Clinical Challenges and Images in GI: image 3. Colonic involvement in Kimura disease. Gastroenterology 2008; 135:743, 1020. [PMID: 18694752 DOI: 10.1053/j.gastro.2008.07.055] [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] [Indexed: 12/02/2022]
Affiliation(s)
- Hajime Isomoto
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
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50
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Liacouras CA, Bonis P, Putnam PE, Straumann A, Ruchelli E, Gupta SK, Lee JJ, Hogan SP, Wershil BK, Rothenberg ME, Ackerman SJ, Gomes I, Murch S, Mishra A, Furuta GT. Summary of the First International Gastrointestinal Eosinophil Research Symposium. J Pediatr Gastroenterol Nutr 2007; 45:370-91. [PMID: 17873754 DOI: 10.1097/mpg.0b013e318142b4f8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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