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Jain H, Kumar A, Singh V, Sivasami K. Paradoxical development of Kimura's disease in a patient treated with mepolizumab for bronchial asthma. BMJ Case Rep 2024; 17:e259311. [PMID: 39074947 DOI: 10.1136/bcr-2023-259311] [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] [Indexed: 07/31/2024] Open
Abstract
A male patient in his early 30s was diagnosed with bronchial asthma 3 years previously. He responded well to inhaled corticosteroids and long-acting beta-agonists. Approximately 18 months from the onset, the patient reported worsening symptoms. These symptoms included severe functional limitations, requiring frequent exposure to high-dose prednisolone. Mepolizumab was added to the treatment, leading to optimal control of bronchial asthma. Despite receiving seven doses of mepolizumab at monthly intervals, the patient developed cervical and postauricular lymphadenopathy and subcutaneous swelling of soft tissue. A cervical lymph node biopsy confirmed the diagnosis of Kimura disease. Following treatment with oral glucocorticoids and methotrexate, the patient experienced a complete resolution of symptoms. He has been in remission and off oral prednisolone for the last 13 months. In this case, we highlight the development of Kimura disease in a patient undergoing mepolizumab treatment.
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Affiliation(s)
- Harsh Jain
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Abhishek Kumar
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Vikram Singh
- Department of Pathology, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Kartik Sivasami
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, Delhi, India
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2
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Barbosa GSB, Neves PDMDM, Mohrbacher S, Abdo ANR, Cavalcante LB, de Menezes Y, Sato VAH, Oliveira ÉDS, Pereira LVB, Bales AM, Frediani MM, Chocair PR, Cuvello-Neto AL. Overlap of membranous nephropathy and IgA nephropathy in a patient with Kimura's disease: a case report and literature review. Front Immunol 2024; 15:1404954. [PMID: 39072328 PMCID: PMC11272546 DOI: 10.3389/fimmu.2024.1404954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction Kimura's disease (KD) is a rare chronic inflammatory disorder characterized by subcutaneous lymphoid hyperplasia with peripheral eosinophilia. Kidney involvement is reported in 15%-18% of adult patients with KD, in many cases as nephrotic syndrome. We present a case of overlapping membranous nephropathy and IgA nephropathy associated with KD. Case report A 27-year-old man was admitted with a history of bilateral leg edema for the last 2 months and concomitant progressive increase of cervical mass and fever. Laboratory findings were as follows: peripheral leukocyte count, 10,080/mm³; eosinophils, 3,200/mm³ (31.7%); serum creatinine, 0.83 mg/dL; and eGFR: 140 mL/min per 1.73 m2. Urinalysis revealed the presence of hematuria and proteinuria and the following results: 24-h proteinuria, 12.9 g; serum albumin, 1.3 g/dL; and elevated IgE level, 750 kU/L. Serologies for hepatitis B, hepatitis C, HIV, and VDRL were all negative. Complement C3 and C4 levels were normal. No monoclonal protein was detected in blood and urine. Parasite infestation was discarded. A biopsy of the cervical lymph node revealed eosinophilic lymphoid hyperplasia, suggesting KD. A kidney biopsy revealed findings consistent with the overlapping of membranous nephropathy with IgA nephropathy. The patient was treated for KD with prednisone 1 mg/kg/d with progressive dose tapering and posterior association of methotrexate 15 mg/week. A renin-angiotensin system inhibitor was prescribed for nephrotic syndrome. The cervical mass regressed, and proteinuria achieved partial remission, with an increase in serum albumin level and normalization of eosinophils and IgE levels. Conclusion Although uncommon, kidney involvement must be considered in patients with KD. Glomerular diseases are the most frequent form of kidney injury.
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Affiliation(s)
- Géssica Sabrine Braga Barbosa
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Precil Diego Miranda de Menezes Neves
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Sara Mohrbacher
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | - Yara de Menezes
- Pathology Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Victor Augusto Hamamoto Sato
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Érico de Souza Oliveira
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Leonardo Victor Barbosa Pereira
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Alessandra Martins Bales
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Marcella Martins Frediani
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Pedro Renato Chocair
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Américo Lourenço Cuvello-Neto
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
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3
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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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4
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Wen-Chieh T, Kuan-Hui Y, Li-Yu L, Chih-Chun L, Shao-Chieh C, Sing-Ya C, Tien-Ming C. Kimura's disease as a mimicker of cavernous hemangioma: A case report and literature review. Int J Rheum Dis 2024; 27:e14858. [PMID: 37551115 DOI: 10.1111/1756-185x.14858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 06/24/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
Kimura's disease (KD) is an immune-mediated disorder which mainly affects Asian men. It appears as head and neck subcutaneous masses, with inflammatory infiltrate and elevated serum immunoglobulin E levels. The clinical presentation of KD resembles that of various diseases. Here, we report the case of a 30-year-old Filipino man with KD mimicking cavernous hemangioma who was treated by surgery. Careful survey for possible KD cases is crucial. Misdiagnoses are prone to futile interventions and unwanted effects. Surgery with adjuvant therapy is superior to other forms of KD treatment.
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Affiliation(s)
- Teng Wen-Chieh
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu Kuan-Hui
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou branch, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lee Li-Yu
- Department of Pathology, Chang Gung Memorial Hospital, Linkou branch, and Chang Gung University, Taoyuan, Taiwan
| | - Lee Chih-Chun
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang Shao-Chieh
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chang Sing-Ya
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chan Tien-Ming
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou branch, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Brito MT, Baptista D, Pereira E, Fonseca E, Almeida JS. Kimura's Disease: A Literature Review Based on a Clinical Case. Cureus 2023; 15:e50463. [PMID: 38222219 PMCID: PMC10786330 DOI: 10.7759/cureus.50463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Kimura's disease (KD) was first described in 1937. It is a rare, benign, and chronic immune-mediated inflammatory disorder affecting the subcutaneous tissue, salivary glands, and lymph nodes. The disease is more common in the second to third decades of life in middle-aged Southeast Asian countries. The cause of Kimura's disease remains unknown; some authors believe it is related to an autoimmune or delayed-type hypersensitivity reaction. It commonly presents as a solitary painless lymph node in the head and neck or generalized lymphadenopathy (67%-100%) associated with peripheral eosinophilia and elevated IgE levels. Renal involvement may occur in some patients. Diagnosis is made by histology. A 21-year-old Caucasian man with no relevant medical history presented with a non-tender swelling of the left hemiface without other associated symptoms. Laboratory investigations revealed a leukocyte count with eosinophilia (2.29×10^9/L- 26.5%) and elevated total IgE and IgG4. He had no renal dysfunction. He underwent surgical resection of the lesion in the jugal, infraorbital, and left nasolabial regions, and the anatomopathological examination revealed the characteristics of Kimura's disease. Three months after surgery, an MRI showed an increase in the size of the mass, and he was started on corticosteroids. Six months after surgery, he presented with a slight increase in the size of the mass and was started on Ciclosporin, which allowed a progressive reduction in the dose of corticosteroid with evidence of a progressive reduction in swelling. Ciclosporin was stopped due to toxic serum levels, and he was started on mycophenolate mofetil. The dose was increased because of the increase in facial mass; on mycophenolate mofetil 2500mg/day, the patient remains stable. KD is a chronic disorder of unknown etiology that mainly affects young people in Southeast Asia and is rare in Western countries, as in the case of this young man. Studies have shown no significant differences in region or race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, or IgE levels between age groups. There is no consensus on the optimal treatment for KD; several treatments have been used, including surgery, systemic corticosteroids, immunosuppressants, and radiation. Due to the tendency to relapse and the rarity of the disease, there is no consensus on treatment options for relapse.
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Affiliation(s)
- Maria Teresa Brito
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Diana Baptista
- Pathologic Anatomy, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Edite Pereira
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Elsa Fonseca
- Pathologic Anatomy, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Jorge S Almeida
- Medicine, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, PRT
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
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Negre GCMP, Regala FG, Ang CY, Tumalad MA. Kimura Disease: A case report with bilateral upper lid masses and a right parotid mass. Orbit 2023; 42:624-629. [PMID: 35436175 DOI: 10.1080/01676830.2022.2058022] [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: 10/10/2021] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
A 38-year-old male presented with bilateral upper eyelid masses and a right parotid mass. Nineteen years before the consultation, the patient experienced swelling at both upper eyelids. Formerly diagnosed by an ophthalmologist, corticosteroid, an anti-inflammatory medication, was prescribed for the patient, which resulted in partial resolution of the lid swelling. However, he was lost to follow-up, and progressive enlargement of the lids was observed with the development of a right parotid mass. The visual acuity of the patient was classified as counting fingers, three feet bilaterally. A detailed examination was difficult owing to the obstructive nature of the masses. However, ocular structures appeared intact. An excisional biopsy with a reconstruction of bilateral upper lids was performed. Histopathologic findings revealed a lymphoproliferative lesion suggestive of Kimura disease (KD). The patient was subsequently referred to rheumatology for management, where they started a regimen of oral steroids and antihistamines.
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Affiliation(s)
| | - Fatima G Regala
- Department of Health Eye Center, East Avenue Medical Center, Quezon City, Metro Manila, Philippines
| | - Charmaine Y Ang
- Department of Health Eye Center, East Avenue Medical Center, Quezon City, Metro Manila, Philippines
| | - Marco A Tumalad
- Department of Health Eye Center, East Avenue Medical Center, Quezon City, Metro Manila, Philippines
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Almohawes EA, Zakareia Y, Dumiati ZA, Zaki WA, Alfudhili KM. A rarely described Kimura's disease of the breast. BJR Case Rep 2023; 9:20220160. [PMID: 37780976 PMCID: PMC10513005 DOI: 10.1259/bjrcr.20220160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/19/2023] [Accepted: 08/13/2023] [Indexed: 10/03/2023] Open
Abstract
Kimura's disease is a rare chronic inflammatory disease of unknown aetiology. The majority of cases are reported in middle-aged Asian males and rarely seen in other ethnicities. Patients classically present with chronic single or multiple painless subcutaneous masses, lymphadenopathies, hypereosinophilia and elevated serum immunoglobulin E. The disease usually affects the head and neck area, however, rare involvement of other locations such as axilla, upper limbs, popliteal region and abdomen has been reported. Here, we report a rarely encountered Kimura's disease of the breast and axillary lymph nodes in a middle-aged female. In this report, we will describe the main clinical, radiological and pathological features to raise the awareness about this indolent disease.
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Affiliation(s)
- Eman A. Almohawes
- Medical Imaging Department, Security Forces Hospital-Dammam, Dammam, Saudi Arabia
| | - Yasser Zakareia
- Medical Imaging Department, Radiology Registrar, Prince Sultan Armed Forces Hospital, Al Madinah, Saudi Arabia
| | - Zainab A. Dumiati
- Medical Imaging Department, Security Forces Hospital-Dammam, Dammam, Saudi Arabia
| | - Wael A. Zaki
- General Surgery Department, Consultant Surgeon, Security Forces Hospital-Dammam, Dammam, Saudi Arabia
| | - Khalid M. Alfudhili
- Medical Imaging Department, Security Forces Hospital-Dammam, Dammam, Saudi Arabia
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8
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Bhatia A, Das S, Deka A, Sarma N, Tamuli P, Chakraborty S. Kimura Disease-A Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:2507-2510. [PMID: 37636657 PMCID: PMC10447794 DOI: 10.1007/s12070-023-03817-y] [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: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 08/29/2023] Open
Abstract
Kimura Disease, an eosinophilic hyperplastic granulomatous disease of idiopathic origin is most commonly seen in young males. It mostly presents with deep subcutaneous tissue swelling along with enlargement of salivary glands and regional lymphadenopathy. Diagnosis is mainly based on histopathological findings and raised serum IgE and hypereosinophilia. The radiological investigation of choice is Magnetic Resonance Imaging. Management strategy includes surgery and steroid therapy. Chemotherapeutic agents are also frequently used by some centres. Relapse and recurrence stands to be a common problem with management of this disease process. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03817-y.
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Affiliation(s)
| | - Subhadeep Das
- Department of ENT, NEIGRIHMS, Shillong, 793018 India
| | - Anuradha Deka
- Department of ENT, NEIGRIHMS, Shillong, 793018 India
| | - Nayana Sarma
- Department of ENT, NEIGRIHMS, Shillong, 793018 India
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Han Q, Han J, Wang W, Gao J, Qiao Y, Jia J, Zhang K, Zheng Z, Zhu P. Case report: Kimura's disease with minimal degenerative glomerulopathy without eosinophil infiltration responds to mycophenolate mofetil treatment. Front Med (Lausanne) 2023; 9:1069553. [PMID: 36698834 PMCID: PMC9868591 DOI: 10.3389/fmed.2022.1069553] [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: 10/14/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Kimura's disease (KD) is a rare chronic progressive immune inflammatory disease. The etiology is unknown and manifests as a chronic inflammatory process, which is more common in young Asian men. The clinical manifestations are painless subcutaneous swelling of the head and neck and periauricular lymphadenopathy, which is slow growing and has a benign course. KD may involve the kidney, and pathological examination revealed eosinophil infiltration in the renal tissue. Proteinuria has been reported in 12-16% of KD cases, and about 60-70% of KD patients will develop nephrotic proteinuria. KD is easily confused with nephrotic syndrome, because KD does not have specific clinical manifestations, laboratory and imaging, and early misdiagnosis is easy. We report a case of KD that was biopsy-proven to have minimal lesion glomerulopathy after ~11 years. In this report, we describe a clinical case of KD with nephrotic syndrome, but there's no eosinophil infiltration in the kidneys. The clinical manifestations of KD recurrence were bilateral eyelid edema, bilateral lower limb swelling, and massive proteinuria in response to mycophenolate mofetil treatment (1.5 g).
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Affiliation(s)
- Qing Han
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Jie Han
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Weitao Wang
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Jie Gao
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Youzhen Qiao
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Junfeng Jia
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Zhaohui Zheng
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China,*Correspondence: Zhaohui Zheng ✉
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China,Ping Zhu ✉
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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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11
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Sahu P, Jain S, Kaushal M. Kimura’s disease: A short study of cytomorphologic features with its differential diagnosis and review of literature. Cytojournal 2022; 19:50. [PMID: 36128469 PMCID: PMC9479607 DOI: 10.25259/cytojournal_77_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
Kimura’s disease (KD) is a chronic inflammatory disorder of unknown etiology, endemic in Asia. The typical clinical manifestations include a triad of painless unilateral cervical lymphadenopathy or subcutaneous masses predominantly in the head-and-neck region, blood and tissue eosinophilia, and elevated serum immunoglobulin (Ig) E levels. Many conditions including benign and malignant may mimic KD clinically. This study reports cytologic features of seven cases of KD which were studied and correlated with histology, Ig profile, and peripheral blood examination. KD shows a good response to medical treatment; hence, fine-needle aspiration cytology in conjunction with other laboratory findings lowers the need for additional biopsy procedures for early diagnosis as well as diagnosis of recurrent lesions.
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Affiliation(s)
- Priya Sahu
- Department of Pathology, ABVIMS, and Dr. Ram Manohar Lohia Hospital, New Delhi, India,
| | - Swasti Jain
- Department of Pathology, ABVIMS, and Dr. Ram Manohar Lohia Hospital, New Delhi, India,
| | - Manju Kaushal
- Department of Pathology, ABVIMS, and Dr. Ram Manohar Lohia Hospital, New Delhi, India,
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Bilateral Dacryoadenitis and Central Nervous System Involvement in a Child With Kimura Disease. Ophthalmic Plast Reconstr Surg 2022; 38:e106-e108. [DOI: 10.1097/iop.0000000000002150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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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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14
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Szeto VG, Chin-Yee B, Dehghani M, Rizkalla K, Licskai C, Hsia CC. Successful treatment of Kimura disease with benralizumab. Ann Hematol 2022; 101:2099-2100. [PMID: 35622096 DOI: 10.1007/s00277-022-04873-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Vivian G Szeto
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Benjamin Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre and Western University, Room E6-219A, 800 Commissioners Road East London, London, ON, N6A 5W9, Canada
| | - Mina Dehghani
- Department of Medicine, Division of Hematology, London Health Sciences Centre and Western University, Room E6-219A, 800 Commissioners Road East London, London, ON, N6A 5W9, Canada
| | - Kamilia Rizkalla
- Department of Pathology, Victoria Hospital, London Health Sciences Centre and Western University, London, ON, Canada
| | - Christopher Licskai
- Department of Medicine, Division of Respirology, London Health Sciences Centre and Western University, London, ON, Canada
| | - Cyrus C Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre and Western University, Room E6-219A, 800 Commissioners Road East London, London, ON, N6A 5W9, Canada.
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15
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Alanazi FM, Alobaid AS, Alahmadi RM, AlGhamdi F. Kimura Disease: An Unusual Presentation of Parotid Mass in a Sickle Cell Disease Patient. Cureus 2022; 14:e24787. [PMID: 35676993 PMCID: PMC9167805 DOI: 10.7759/cureus.24787] [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] [Accepted: 05/06/2022] [Indexed: 11/05/2022] Open
Abstract
Kimura disease (KD) is a rare benign chronic inflammatory condition of unknown cause, usually affecting young men of the Asian race. It is frequently associated with nephrotic syndrome. In this report, we present an uncommon case of KD in a 40-year-old Saudi man with sickle cell disease who presented with swelling on the right side of his face. CT scan of the head and neck showed the asymmetrical appearance of both parotid glands: the right side appeared heterogeneously enlarged, with adjacent moderate-to-significant fat stranding. Histologically, hyperplastic changes in lymphoid tissue were observed. The patient underwent superficial parotidectomy and was then followed up till the healing of the surgical site with no complications.
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16
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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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17
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Alshaibani AK, Al-Mulla AH, Mohammed MA, Alhamoud M, Al-Hassan SA. Isolated Kimura Disease Presenting as a Brow Mass in a Saudi Male: A Rare Case Report. Cureus 2022; 14:e23000. [PMID: 35415044 PMCID: PMC8993031 DOI: 10.7759/cureus.23000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/05/2022] Open
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18
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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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19
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Jo YR, Woo H, Lim DH, Kim JH. Dupilumab therapy in a 12-year-old boy with Kimura disease, allergic rhinitis, and IgG3 deficiency. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yoo Ri Jo
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Hyeonjin Woo
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jeong Hee Kim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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20
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Wang X, Ng CS, Yin W. A comparative study of Kimura's disease and IgG4-related disease: similarities, differences and overlapping features. Histopathology 2021; 79:801-809. [PMID: 34101896 DOI: 10.1111/his.14428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
Abstract
AIMS To compare the fibroinflammatory diseases Kimura's disease (KD) and immunoglobulin (Ig)G4-related disease (IgG4RD) and to explore their possible relationship. METHODS AND RESULTS Forty-six cases of KD and 29 IgG4RD from our institution diagnosed from 2011 to 2020 were studied. They were compared with each other on clinical, pathological and immunohistological features. There were similar clinical features, except that IgG4RD affected an older patient population, with more frequent salivary gland involvement and KD affected head and neck lymph nodes, and showed blood eosinophilia more frequently than IgG4RD. IgG4RD exhibited frequent storiform fibrosis and obliterative phlebitis, while KD showed more frequent tissue eosinophilia, eosinophilic abscess, germinal centre eosinophilic deposit and vascularisation. Twenty to 30% of KD had more than 50 IgG4+ plasma cells (PC) per high-power field (HPF) and IgG4/IgG+ PC ratio exceeding 40%. These parameters, however, occurred in 100% of IgG4RD. Significantly more KD had >10 IgE+ PC/HPF and lymphoid germinal centre IgE reticular staining compared to IgG4RD. All these histological and immunohistological features are overlapping in the two diseases, although they differed with statistical significance. CONCLUSION Our study confirmed that there is significant overlap in clinical, pathological and immunohistological features between KD and IgG4RD. It is important to recognise these overlapping features, and correlation with a clinicopathological picture is required in differential diagnoses. The overlapping features also suggest a possible close relationship between KD and IgG4RD, which could represent different facets of a continuous fibroinflammatory disease spectrum.
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Affiliation(s)
- Xingen Wang
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Chi-Sing Ng
- Department of Pathology, St Teresa's Hospital, Hong Kong, China
| | - Weihua Yin
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
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21
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Kimura's Disease: A Rare Cause of Unilateral Tonsillar Enlargement. Case Rep Otolaryngol 2021; 2021:8815317. [PMID: 33505749 PMCID: PMC7808821 DOI: 10.1155/2021/8815317] [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: 09/04/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Kimura's disease is a rare inflammatory disorder of unknown cause, commonly seen in young Asian males. Case Report. A 61-year-old male patient presented with a history of right tonsillar mass and cervical lymphadenopathy. The patient underwent hematological investigation and imaging followed by resection of tonsillar mass. Based on histopathological and subsequent immunohistochemistry reports, the case was diagnosed as Kimura's disease of the tonsil. Discussion. Kimura's disease commonly presents as painless subcutaneous masses in the head and neck region or cervical lymphadenopathy. Kimura's disease presenting as a tonsillar mass is a very rare condition. Patients usually have peripheral eosinophilia and elevated levels of serum IgE. The diagnosis is based on the clinical and histopathologic findings in a biopsy of the mass and/or lymph node along with elevated peripheral eosinophil and serum IgE level. Conclusion The clinical presentation of Kimura's disease is highly variable. Kimura's disease should be considered as a differential diagnosis in patients presenting with a tonsillar mass. A high index of suspicion along with histopathological examination helps in the early diagnosis and management. Surgical excision is the treatment of choice.
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22
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Ho J, Walter S, Harvey RJ. Eosinophilic chronic rhinosinusitis and concurrent Kimura's disease treated with mepolizumab. BMJ Case Rep 2021; 14:14/1/e232627. [PMID: 33461987 PMCID: PMC7813409 DOI: 10.1136/bcr-2019-232627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Kimura's disease is a rare, benign, chronic inflammatory disorder characterised by its eosinophilic infiltrate. Patients often present with one or more progressively enlarging subcutaneous lymph nodes in the head and neck region or enlarging salivary glands. We describe the case of a 26-year-old man presenting with severe peripheral eosinophilia and upper airway inflammatory symptoms, who later developed cervical lymphadenopathy and formally diagnosed with Kimura's disease. Based on our English-language MEDLINE literature search, to our knowledge this is the first case report describing treatment of Kimura's disease with mepolizumab.
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Affiliation(s)
- Jacqueline Ho
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia,St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie Walter
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia,Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
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23
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Luo Y, Hu XM, Li J, Li HY, Yi XM, Peng QF. Renal involvement without infiltration of eosinophil in Kimura's disease. Ren Fail 2021; 43:156-158. [PMID: 33441037 PMCID: PMC7808737 DOI: 10.1080/0886022x.2020.1865170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ying Luo
- Department of Nephrology, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Xiu-Mei Hu
- Department of Nephrology, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Jie Li
- Department of Nephrology, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Hong-Yan Li
- Department of Nephrology, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Xiang-Meng Yi
- Department of Nephrology, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Qing-Feng Peng
- Department of Nephrology, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
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24
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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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25
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Management of a Buccal Space Mass: A Clinical Case Report. Case Rep Otolaryngol 2020; 2020:6828453. [PMID: 33457031 PMCID: PMC7787848 DOI: 10.1155/2020/6828453] [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: 03/15/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background Buccal space tumors constitute rare pathologies with significant histological diversity. They may pose serious diagnostic and therapeutic challenges for the head and neck surgeon. Methods A case of buccal space tumor diagnosed and treated in a tertiary center is presented. Clinical presentation, imaging, and surgical approach are discussed, followed by review of the literature. Results A 79-year-old male patient with a slowly growing painless mass on the right cheek presented to a head and neck reference center. Imaging revealed a tumor of the right buccal space with nonspecific characteristics. Imaging studies revealed extended infiltration of the masseter muscle as well as the anterior border of the parotid gland. FNA biopsy was performed but was nondiagnostic. The decision of surgical excision with a modified parotidectomy incision was taken. The lesion was completely excised with preservation of neighboring facial nerve branches and ipsilateral Stensen's duct. The postoperative course was uneventful. Histological examination showed CLL/Lymphoma, and the patient was referred to the hematology department for staging and further management. Conclusion Differential diagnosis of buccal space masses is very diverse. Despite challenges in the diagnostic and therapeutic approach, these entities may be managed surgically with minimal morbidity.
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26
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Sousa CP, Fonseca E, Viamonte B, Lobo JC, Madureira A. Kimura's disease: a rare cause of facial mass in a caucasian male patient. BJR Case Rep 2020; 6:20200099. [PMID: 33299599 PMCID: PMC7709070 DOI: 10.1259/bjrcr.20200099] [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: 06/12/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/05/2022] Open
Abstract
Kimura's disease is an uncommon inflammatory disorder of unclear aetiology, mainly affecting young Asian descent males among their second and fourth decades of life. The disease typically emerges as a long-standing and painless subcutaneous mass lesion in the head and neck region, frequently associated with swelling of major salivary glands, particularly the parotid gland, and regional lymphadenopathy. Peripheral eosinophilia and high serum immunoglobulin E are also characteristic findings. We report a case and describe the imaging and pathological features of the disease in a 19-year-old Caucasian male, with review of the literature.
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Affiliation(s)
- Célia Peixoto Sousa
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Elsa Fonseca
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Bárbara Viamonte
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - João Calheiros Lobo
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - António Madureira
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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27
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Kakehi E, Kotani K, Yoshida T, Nakai T, Sakurai S, Hirotani A, Simizu K, Nozaki T, Shoji K, Adachi S, Matsumura M. Older-age onset of Kimura's disease. Ther Adv Hematol 2020; 11:2040620720962596. [PMID: 33117518 PMCID: PMC7570770 DOI: 10.1177/2040620720962596] [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] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
A 60-year-old man was admitted to our hospital with bilateral post auricular masses, first noticed 1 year earlier. Blood tests showed eosinophilia and high immunoglobulin E (IgE) levels, and cervical computed tomography showed 10-mm soft tissue masses with scattered lymphadenopathy. The tumors showed intermediate and high signal intensity on T1- and T2-weighted cervical magnetic resonance imaging, respectively. After mass resection, the tumors were diagnosed as Kimura’s disease (KD). Generally, KD affects young men; however, even in older patients, KD should be included as a differential diagnosis for head and neck tumors in patients with eosinophilia and high IgE.
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Affiliation(s)
- Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - Kazuhiko Kotani
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Tsubasa Yoshida
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Tsubasa Nakai
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Shigehisa Sakurai
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Akane Hirotani
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Kaduyo Simizu
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Takafumi Nozaki
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Keisuke Shoji
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Seiji Adachi
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Masami Matsumura
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
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28
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Hashida Y, Higuchi T, Nakajima S, Nakajima K, Ujihara T, Kabashima K, Sano S, Daibata M. Human Polyomavirus 6 Detected in Cases of Eosinophilic Pustular Folliculitis. J Infect Dis 2020; 223:1724-1732. [PMID: 32989462 DOI: 10.1093/infdis/jiaa607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Human polyomaviruses (HPyVs) have been associated with several cutaneous inflammatory conditions. More investigation is needed to identify further presentations of cutaneous pathology associated with HPyVs. Our aim was to investigate the possible association of skin-tropic HPyVs with folliculitis, particularly eosinophilic pustular folliculitis (EPF). METHODS This study included 55 Japanese patients, comprising 13 patients with EPF and 42 patients with suppurative folliculitis. HPyV DNAs were detected by quantitative polymerase chain reaction. Expression of viral antigen and geographically related viral genotypes were also assessed. RESULTS Human polyomavirus 6 (HPyV6) DNA was found in 9 of 13 (69%) patients with EPF, a rate significantly higher than that found in suppurative folliculitis (1/42; 2%). Of the 7 HPyV6 DNA-positive EPF specimens analyzed, 4 were positive for HPyV6 small tumor antigen. All the HPyV6 strains detected in this study were of the Asian/Japanese genotype. CONCLUSIONS The predominant detection of HPyV6 DNA and the expression of viral antigen suggest a possible association between HPyV6 infection and EPF in a subset of patients. Worldwide studies are warranted to determine whether Asian/Japanese genotype HPyV6 is associated preferentially with the incidence and pathogenesis of this eosinophil-related skin disease that has an ethnic predilection for the East Asian population.
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Affiliation(s)
- Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kochi, Japan
| | - Saeko Nakajima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kimiko Nakajima
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takako Ujihara
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kochi, Japan.,Science Research Center, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Singapore Immunology Network and Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kochi, Japan
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29
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Bi S, Gu J, Hu C. Kimura's disease mimicking thoracic spine dumbbell neurogenic tumor: a case report and literature review. BMC Surg 2020; 20:209. [PMID: 32957960 PMCID: PMC7507290 DOI: 10.1186/s12893-020-00870-0] [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] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/13/2020] [Indexed: 02/08/2023] Open
Abstract
Background Kimura’s disease is a rare, benign chronic inflammatory disease of unknown etiology that mostly affects Asians. The disease typically presents as subcutaneous masses in the head or neck region that are predominantly found in the preauricular and submandibular areas. Case presentation A 7-year-old boy presenting with paralysis of both lower extremities and a thoracic spine dumbbell mass was initially diagnosed with a neurogenic tumor, but the pathological and laboratory examinations confirmed the diagnosis of Kimura’s disease. The paralysis symptom disappeared rapidly, but the patient had developed a recurrent mass in the cervical vertebral canal at the 9-month follow-up. Conclusion To our knowledge, no prior published literature has revealed Kimura’s disease cases that mimic dumbbell neurogenic tumors. Here, we report such a case of Kimura’s disease for the first time and provide a brief review of the literature.
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Affiliation(s)
- Siwei Bi
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jun Gu
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Leshan, China
| | - Chenggong Hu
- Department of Critical Care Medicine, West China Hospital of Sichuan University, No 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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30
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Steroid-dependent Kimura Disease in a Child Treated with Cetirizine and Montelukast. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1946-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Ahmed Brahim A, Iziki O, Abada R, Mohamed R, Mohamed M. Buccal region's Kimura disease in a pediatric patient: A case report and review of the literatture. Int J Surg Case Rep 2020; 72:584-586. [PMID: 32698293 PMCID: PMC7332501 DOI: 10.1016/j.ijscr.2020.05.075] [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: 01/09/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/30/2022] Open
Abstract
Kimura disease is a chronic inflammatory disease. The occurrence of kimura disease in the oral cavity is extremely rare. The Etiology Of The Kimura Disease Is Unknown. The diagnosis of kimura disease is confirmed by surgical biopsy. Treatment of kimura disease is variable.
Introduction Kimura disease is a chronic inflammatory disorder that mainly manifests as a swelling in the neck region AlGhamdi et al. (2016). However, its occurrence in the oral cavity is extremely rare Lee et al. (2017). It usually affects young men of Asian race but it is rare in other races Fouda et al. (2010). We report an extremely rare case of Kimura disease of the buccal region in a pediatric patient. The treatment consists of surgery combined with systemic steroid therapy. Discussion The etiology of KD is unknown. Although the presence of eosinophilia and increased IgE, tumor necrosis factor (TNF)-a, interleukin (IL)-4, IL-5, IL-13 levels, and mast cells in peripheral blood, as well as in the affected tissue, were observed in patients Sun et al. (2008). No specific antigens have been identified. The optimal management strategy for KD has not yet been established. The treatment is variable Fouda et al. (2010) and Su et al. (2019). It includes surgical excision, regional, or systemic steroid therapy, and radiotherapy Sun et al. (2008). Conclusion KD is a rare chronic inflammatory disorder of unknown etiology Fouda et al. (2010) and Kim and Szeto (1937). The diagnosis can be only confirmed by histopathological features.
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Affiliation(s)
- Ahmedou Ahmed Brahim
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, street mausolée imm 10, app 9, quartiers des hopitaux, Casablanca, Morocco.
| | - Omar Iziki
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, street mausolée imm 10, app 9, quartiers des hopitaux, Casablanca, Morocco
| | - Reda Abada
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, street mausolée imm 10, app 9, quartiers des hopitaux, Casablanca, Morocco
| | - Roubal Mohamed
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, street mausolée imm 10, app 9, quartiers des hopitaux, Casablanca, Morocco
| | - Mahtar Mohamed
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, street mausolée imm 10, app 9, quartiers des hopitaux, Casablanca, Morocco
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Eh Dam VSK, Mohamad S, Mohamad I. Kimura Disease with Parotid Swelling and Cervical Lymphadenopathy: A Case Report and Literature Review. Medeni Med J 2020; 35:170-174. [PMID: 32733768 PMCID: PMC7384504 DOI: 10.5222/mmj.2020.84594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/18/2020] [Indexed: 11/05/2022] Open
Abstract
Kimura disease (KD) is a rare chronic benign inflammatory disorder of unknown etiology that is prevalent in Asian males. The head and neck region, especially the parotid glands and cervical lymph nodes, are most commonly affected. Diagnosis is based on clinicopathological features, while radiology findings are nonspecific. Although various treatment strategies have been proposed, there is a high recurrence rate. Combination therapy has been found to produce better results than monotherapy. We present a case of KD with huge parotid and cervical lymph node involvement that was treated with a combination of surgery and corticosteroids administered perioperatively.
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Affiliation(s)
- V Sha Kri Eh Dam
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head and Neck Surgery, Kelantan, Malaysia
| | - Sakinah Mohamad
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head and Neck Surgery, Kelantan, Malaysia
| | - Irfan Mohamad
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head and Neck Surgery, Kelantan, Malaysia
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Kakehi E, Kotani K, Otsuka Y, Fukuyasu Y, Hashimoto Y, Sakurai S, Hirotani A, Simizu K, Fujita R, Shoji K, Adachi S, Matsumura M. Response to: Kimura's disease: effects of age on clinical presentation. QJM 2020; 113:383. [PMID: 32091606 DOI: 10.1093/qjmed/hcaa035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Kakehi
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - K Kotani
- Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Y Otsuka
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - Y Fukuyasu
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - Y Hashimoto
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - S Sakurai
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - A Hirotani
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - K Simizu
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - R Fujita
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - K Shoji
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - S Adachi
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - M Matsumura
- Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Kakehi E, Kotani K, Otsuka Y, Fukuyasu Y, Hashimoto Y, Sakurai S, Hirotani A, Simizu K, Fujita R, Shoji K, Adachi S, Matsumura M. Kimura's disease: effects of age on clinical presentation. QJM 2020; 113:336-345. [PMID: 31800058 DOI: 10.1093/qjmed/hcz312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/11/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Kimura's disease (KD) is known to be dominant among young Asian men, but it can also occur in middle- and advanced-aged people. The clinical characteristics of KD, especially by age, are not well known. AIM This study was performed to investigate the effects of age on the clinical characteristics of KD. DESIGN We conducted a case series study. METHODS All case studies of patients diagnosed with KD were collected via a PubMed search of studies published until August 2018. The data were analyzed by age group. RESULTS In total, 215 studies were reviewed (238 patients; mean age of 36 years). The male:female ratio was 4:1 overall, 17:1 in patients aged <20 years, 4:1 in patients aged 20-39 years and 2:1 in patients aged ≥40 years (P = 0.01). The percentage of patients with pruritus was 15.4% overall, 3.8% in patients aged <20 years, 15.5% in patients aged 20-39 years and 21.7% in patients aged ≥40 years (P = 0.02). The time to diagnosis was 5.3 years overall, 3.2 years in patients aged <20 years, 4.7 years in patients aged 20-39 years and 7.1 years in patients aged ≥40 years (P < 0.01). CONCLUSIONS The proportion of female patients affected the incidence of pruritus, and the time to diagnosis increased as the patients' age increased. There were no significant age-related differences in region/race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, immunoglobulin E level, initial treatment, recurrence or outcomes. This may be useful information for the diagnosis of KD.
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Affiliation(s)
- E Kakehi
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - K Kotani
- Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Y Otsuka
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - Y Fukuyasu
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - Y Hashimoto
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - S Sakurai
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - A Hirotani
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - K Simizu
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - R Fujita
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - K Shoji
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - S Adachi
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - M Matsumura
- Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Sinha P, Bhattacharjee S, Sood A, Bhatia JK, Sandhu S. A Rare Case of Kimura Disease. Indian J Dermatol 2020; 65:155-158. [PMID: 32180608 PMCID: PMC7059481 DOI: 10.4103/ijd.ijd_424_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Preema Sinha
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India. E-mail:
| | - Saikat Bhattacharjee
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India. E-mail:
| | - Aradhana Sood
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India. E-mail:
| | - Jasvinder Kaur Bhatia
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India. E-mail:
| | - Sunmeet Sandhu
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India. E-mail:
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Ebrahimi M, Mohebbi A, Rabbani A, Ghamari A, Nasri M, Saberian M. Dyspnea and Cough: A Rare Report of the Kimura Disease. Endocr Metab Immune Disord Drug Targets 2020; 20:963-966. [PMID: 32133969 DOI: 10.2174/1871530320666200305130935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Known as a rare disease, Kimura disease is a chronic, allergic and inflammatory process. It may overlap other allergic conditions, as well. CASE PRESENTATION This study is going to present a 36-year-old woman, with cough, dyspnea and bone pain. Other differential diagnoses were excluded during the investigations. The definite diagnosis was made by excisional biopsy and pathological investigations. CONCLUSION This was a rare medical condition with remarkable diagnostic challenge.
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Affiliation(s)
- Mehran Ebrahimi
- Department of Immunology, Growth and Development Research Centre, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohebbi
- Department of Endocrinology, Growth and Development Research Centre, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Rabbani
- Department of Endocrinology, Growth and Development Research Centre, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Ghamari
- Department of Cardiology, Growth and Development Research Centre, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasri
- Department of Endocrinology, Growth and Development Research Centre, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Saberian
- Department of Oncology, Faculty of Medicine, Growth and Development Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Aubert H, Hamidou M, Barbarot S, Piriou N, Lefebvre M, Néel A. [Cutaneous hypereosinophilia… Hypereosinophilic syndromes]. Ann Dermatol Venereol 2020; 147:155-166. [PMID: 31948698 DOI: 10.1016/j.annder.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/30/2019] [Accepted: 11/07/2019] [Indexed: 11/27/2022]
Affiliation(s)
- H Aubert
- Clinique dermatologique, CHU de Nantes, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre de compétence syndromes hyperéosinophiliques, CHU de Nantes, 44000 Nantes, France.
| | - M Hamidou
- Centre de compétence syndromes hyperéosinophiliques, CHU de Nantes, 44000 Nantes, France; Service de médecine interne, CHU de Nantes, 44000 Nantes, France
| | - S Barbarot
- Clinique dermatologique, CHU de Nantes, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre de compétence syndromes hyperéosinophiliques, CHU de Nantes, 44000 Nantes, France
| | - N Piriou
- Service de cardiologie, CHU de Nantes, 44000 Nantes, France
| | - M Lefebvre
- Service de maladies infectieuses et tropicales, CHU de Nantes, 44000 Nantes, France
| | - A Néel
- Centre de compétence syndromes hyperéosinophiliques, CHU de Nantes, 44000 Nantes, France; Service de médecine interne, CHU de Nantes, 44000 Nantes, France
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38
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Hashida Y, Higuchi T, Tanaka M, Shibata Y, Nakajima K, Sano S, Daibata M. Prevalence and Viral Loads of Cutaneous Human Polyomaviruses in the Skin of Patients With Chronic Inflammatory Skin Diseases. J Infect Dis 2020; 219:1564-1573. [PMID: 30357388 DOI: 10.1093/infdis/jiy618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Human skin microorganisms have been associated with various skin diseases. However, most studies have focused on bacterial communities, and little is known about normally resident skin viruses such as the Polyomaviridae and their association with cutaneous disorders. METHODS We investigated the infection levels of Merkel cell polyomavirus (MCPyV), human polyomavirus 6 (HPyV6), and human polyomavirus 7 (HPyV7), using triplet skin swabs collected from lesional and nonlesional skins of 86 Japanese patients with inflammatory skin diseases and mycosis fungoides, and from 149 healthy control individuals. RESULTS This age-matched case-control study provides the first analyses of the loads of polyomaviruses in association with various skin diseases. The viral loads were significantly higher for HPyV6/HPyV7 and lower for MCPyV in patients with psoriasis. The viral load variation was observed not only at lesion sites, but also at clinically unaffected skin sites in most of the patients. The viral strains tested were all of the Asian/Japanese genotype. CONCLUSIONS Our findings suggest a covariation in the infection levels of cutaneous polyomaviruses in certain inflammatory skin conditions. Worldwide prospective longitudinal studies are warranted to understand the influence of such alterations on the pathogenesis of inflammatory skin disorders.
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Affiliation(s)
- Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Japan
| | - Moe Tanaka
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Japan
| | - Yuka Shibata
- Department of Dermatology, Kochi Medical School, Kochi University, Japan
| | - Kimiko Nakajima
- Department of Dermatology, Kochi Medical School, Kochi University, Japan
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Kochi University, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Japan
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Yu B, Xu G, Liu X, Yin W, Chen H, Sun B. Kimura's disease affecting multiple body parts in a 57-year-old female patient: a case report. Allergy Asthma Clin Immunol 2019; 15:84. [PMID: 31892932 PMCID: PMC6937823 DOI: 10.1186/s13223-019-0400-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022] Open
Abstract
Background Kimura’s disease (KD) is a rare chronic inflammatory disease with unknown etiology. It usually manifests as a painless soft tissue mass or subcutaneous nodule on one side of the patient’s head and/or neck and rarely affects multiple parts of the body. The disease is more common among young Asian males. Case presentation A 57-year-old Chinese woman complained of multiple masses on her body surface. Ultrasonography was used to examine the retroperitoneal, bilateral neck, bilateral supraclavicular, bilateral axillary, and bilateral inguinal superficial lymph nodes. Enlargement of multiple lymph nodes was found in all areas. Many solid nodules were also found in the right parotid gland and right posterior neck area, respectively. Numerous solid nodules were seen on the left chest wall. Laboratory tests showed that the percentage of eosinophils in the whole blood was 39.40%, total immunoglobulin E (IgE) level was > 5000 kU/L, and serum special IgE to Phadiatop (inhaled allergens) and fx5 (food allergens) were 1.01 and 1.04 kUA/L, respectively. After a complete examination, the masses located in the right neck, retroauricular and left axillary regions, and left chest wall were resected directly. Postoperative pathological findings revealed KD. Conclusions The case discussed in this study is extremely rare and did not meet the common affected areas and age characteristics of KD. This presentation can be used to improve disease awareness among physicians.
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Affiliation(s)
- Bo Yu
- 1Department of Emergency, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430014 Hubei province China
| | - Guoxing Xu
- 2Department of Allergy, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430010 Hubei Province China
| | - Xiaofan Liu
- 2Department of Allergy, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430010 Hubei Province China
| | - Wen Yin
- 2Department of Allergy, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430010 Hubei Province China
| | - Hao Chen
- 2Department of Allergy, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430010 Hubei Province China.,Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Medical University, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120 Guangdong Province China
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Medical University, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120 Guangdong Province China
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Ito T. Recurrent auricular inflammation caused by Kimura's disease: reminiscent of the early phase of relapsing polychondritis? Oxf Med Case Reports 2019; 2019:omz091. [PMID: 31772756 PMCID: PMC6765368 DOI: 10.1093/omcr/omz091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/28/2019] [Accepted: 07/27/2019] [Indexed: 11/13/2022] Open
Abstract
Recurrent auricular inflammation with pain and swelling is due to the composition and environmental exposures experienced by the constituent parts of the ear. A painful, swollen ear may suggest acute perichondritis, subperichondrial hematoma or relapsing polychondritis (RP). Here, we report a case of a 51-year-old Asian man who had an approximately 2-year history of recurrent auricular swelling and was referred for suspected RP. Biopsy of the lesion revealed the formation of lymphoid follicles with a dense infiltrate of lymphocytes, histiocytes and eosinophils. His serum IgE level was 12 040 U/mL (normal range 0-358). These findings suggest that the patient had Kimura's disease (KD). Physicians should be aware of KD as a potential cause of recurrent auricular inflammation.
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Affiliation(s)
- Toshiki Ito
- Division of Internal Medicine, Department of Internal Medicine, Chitose City Hospital, Hokkaido, Japan
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Al Shammari F, Nasiri A, Alkhathami M, Alawfi F, Alfifi M, Al Otaibi E. Mepolizumab as an effective treatment for Kimura's disease associated with ulcerative colitis: A case report. J Family Med Prim Care 2019; 8:3028-3031. [PMID: 31681687 PMCID: PMC6820387 DOI: 10.4103/jfmpc.jfmpc_373_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022] Open
Abstract
Kimura's disease was first described by Kimura and Sceto in China in 1937. Kimura disease is a chronic inflammatory disorder of idiopathic etiology. The clinical presentation of Kimura's disease is painless solitary or multiple subcutaneous nodules, asymmetric, mostly in the head and neck region with often association with lymphadenopathy. Typically, the nodules are found on preauricular, submandibular, and popliteal regions as well as oral cavity, larynx, and parotid glands. In the present report, we describe a case of a 27-year-old male presented to our hospital with history of right neck and lip swelling for 10 days. In the history, the patient mentioned that he had bloody diarrhea four to six times day and he lost 10 kg in 1 month. The specimen was sent for histopathological examination which showed the lymph node architecture is preserved with significant increase number of eosinophils which is consistent with Kimura's disease. There is no agreement on the management aspects in Kimura's disease so far. The primary treatment for Kimura's disease includes surgical resection. Additional medical therapy including regional or systemic steroid therapy, cytotoxic therapy, and radiation has also been utilized. Considered as an inflammatory process, the disease has an excellent prognosis, although it may recur locally and wax and wane over time.
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Affiliation(s)
- Faisal Al Shammari
- Department of Internal Medicine, Prince Mohammed Medical City Security, Aljouf, Riyadh, Saudi Arabia
| | - Abdulrahman Nasiri
- Department of Internal Medicine, Security Forces Hospital (SFH), Riyadh, Saudi Arabia
| | - Mohammed Alkhathami
- Department of Internal Medicine, Security Forces Hospital (SFH), Riyadh, Saudi Arabia
| | - Fahad Alawfi
- Department of Internal Medicine, Security Forces Hospital (SFH), Riyadh, Saudi Arabia
| | - Mohammed Alfifi
- Department of Internal Medicine, Security Forces Hospital (SFH), Riyadh, Saudi Arabia
| | - Eqab Al Otaibi
- Department of Internal Medicine, Security Forces Hospital (SFH), Riyadh, Saudi Arabia
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Zhang X, Jiao Y. The clinicopathological characteristics of Kimura disease in Chinese patients. Clin Rheumatol 2019; 38:3661-3667. [PMID: 31440918 DOI: 10.1007/s10067-019-04752-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/19/2019] [Accepted: 08/15/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Kimura disease (KD) is a rare idiopathic inflammatory disorder of unknown etiology. Unusual presentations of KD might cause diagnostic difficulty or be misdiagnosed as malignancy if clinical suspicion is insufficiently high. Here, we aimed to determine the clinicopathological features of Chinese KD patients to reveal further insights into the natural history and treatment of this disease. METHOD The clinical data of 46 cases of KD diagnosed at Peking Union Medical College Hospital from January 1980 to December 2018 were analyzed retrospectively through case record review. RESULTS Of 46 cases, 40 were male and six were female. The age at onset ranged from 2 to 56 years (median 27 years). All patients presented with either single (26.1%) or multi-focal (73.9%) subcutaneous masses. Twenty-nine (63.0%) cases presented with head and neck subcutaneous masses, and 9 cases (19.6%) involved different parts of the body. Parotid, submandibular, and lacrimal gland involvement occurred in 17 (37.0%), 3 (6.5%), and 2 cases (4.3%), respectively. Nephrotic syndrome was present in three cases (6.5%), and thromboembolism was present in five cases (10.9%). During follow-up, thirteen patients (13/28, 46.4%) relapsed over 1-13 years (median 8.5 years). The recurrence rate in patients receiving corticosteroids, surgery, and combined surgery and radiotherapy was 30.8%, 66.7%, and 50.0%, respectively. One patient was diagnosed with T cell lymphoma 1 year after diagnosis of KD. CONCLUSIONS KD is characterized by subcutaneous masses but it is also a systemic disease. Given the high rate of recurrence and reported association with lymphoma, patients require careful long-term follow-up.Key Points• Kimura disease (KD) is a rare inflammatory disorder of unknown etiology that is endemic in Asia.• Clinicians must regard and manage KD as a systemic disease.• There is no consensus on optimal treatments and further studies are necessary to improve outcomes.• Given the high rate of recurrence and reported association with lymphoma, patients require careful long-term follow-up.
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Affiliation(s)
- Xuehan Zhang
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Jiao
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing St., Beijing, 100730, China.
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Hashida Y, Higuchi T, Matsuzaki S, Nakajima K, Sano S, Daibata M. Prevalence and Genetic Variability of Human Polyomaviruses 6 and 7 in Healthy Skin Among Asymptomatic Individuals. J Infect Dis 2019; 217:483-493. [PMID: 29161422 DOI: 10.1093/infdis/jix516] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/27/2017] [Indexed: 12/21/2022] Open
Abstract
Background Despite the pathogenetic potential of human polyomavirus 6 (HPyV6) and human polyomavirus 7 (HPyV7), they have been found in the normal skin of healthy individuals. However, little is known about the prevalence, infection levels, and geographical variations of these polyomaviruses in the skin. Methods Using skin swabs from 470 participants aged 2-98 years, we estimated the prevalence of copy numbers of HPyV6 and HPyV7 with respect to age and ethnicity. Phylogenetic analyses were conducted based on viral sequences obtained from Asian and white populations. Results This study provides the first analyses of the age-specific prevalence and levels of HPyV6 and HPyV7 infections in normal skin. Comparisons of age groups revealed that the prevalence and viral loads were significantly higher in elderly persons. Phylogenetic analyses demonstrated the existence of Asian/Japanese-specific strains genetically distinct from strains prevalent in the skin of the white population studied. Conclusions This large study suggests that HPyV6 and HPyV7 infections in the skin are highly prevalent in elderly adults. Further research is warranted to understand whether persistent infection with high viral loads in the skin could be a risk factor for the development of HPyV6- and HPyV7-associated skin disorders.
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Affiliation(s)
- Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Japan
| | - Shigenobu Matsuzaki
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Japan
| | - Kimiko Nakajima
- Department of Dermatology, Kochi Medical School, Kochi University, Japan
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Kochi University, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Japan
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44
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Zhang W, Preeatum A, Liu C. Kimura's disease associated with IgA nephropathy: A case report. Exp Ther Med 2019; 17:1837-1840. [PMID: 30783457 DOI: 10.3892/etm.2018.7103] [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: 04/14/2018] [Accepted: 11/11/2018] [Indexed: 11/05/2022] Open
Abstract
Kimura's disease (KD) is a rare chronic inflammatory disorder of unknown etiology that manifests as painless subcutaneous lesions in the head and neck. It primarily affects young Asian males and is characterized by peripheral eosinophilia and elevated levels of serum Immunoglobulin (Ig)E. Histologically, a variety of renal lesions have been observed in patients with KD, although IgA nephropathy is rarely reported. In the current study, a case of KD with an atypical manifestation accompanied with IgA nephropathy was reported in a middle-aged Chinese man. The subcutaneous lesion was located on the elbow of the patient. Although the recurrence rate of KD-associated nephrotic syndrome is high, the patient has not experienced relapse following 6 months of pulse treatment with methylprednisone and cyclophosphamide. In conclusion, methylprednisone combined with cyclophosphamide is effective in the treatment of KD-associated IgA nephropathy, and long-term administration of methylprednisone may achieve the effect of preventing KD recurrence.
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Affiliation(s)
- Wei Zhang
- Department of Nephrology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Ancharaz Preeatum
- Nephrology Unit, Internal Medicine Department, Flacq Regional Hospital, Central Flacq 40606, Mauritius
| | - Chunyan Liu
- Department of Nephrology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
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46
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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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Aziz A, Mohamad I, Zawawi N. Kimura Disease: A differential diagnosis in a nephrotic child. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2018; 13:32-35. [PMID: 30302182 PMCID: PMC6173965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Kimura disease presents as benign lesion and is commonly present among the Asian population. It is a disease with a favourable prognosis and a peak age of onset in the third decade. It is a chronic inflammatory disorder of unknown etiology that involves the lymph nodes and subcutaneous tissues of the head and neck region. We report a case of a 15-year-old boy with multiple Kimura lymphadenopathies involving the left posterior auricular region as well as the anterior and posterior triangles of the neck.
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Affiliation(s)
- A Aziz
- MB Bch BAO, Department of Otorhinolaryngology Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu Kelantan, Malaysia.
| | - I Mohamad
- MMed ORL-HNS Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu Kelantan, Malaysia
| | - N Zawawi
- MPath, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kota Bharu Kelantan, Malaysia
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Kumar V, Mittal N, Huang Y, Balderracchi J, Zheng HX, Li Z, Xu Y. A case series of Kimura's disease: a diagnostic challenge. Ther Adv Hematol 2018; 9:207-211. [PMID: 30013767 DOI: 10.1177/2040620718780370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/16/2018] [Indexed: 11/17/2022] Open
Abstract
Kimura's disease (KD) is a rare, benign disorder characterized by subcutaneous masses with regional lymph-node enlargement. It is considered to be due to chronic inflammation of unclear etiology. Most cases have been reported in young, 20-30-year-old men of Asian descent. The diagnosis of KD is based on pathological features and elevated immunoglobulin E levels. Characteristic pathological features include intact lymph-node architecture, florid germinal center hyperplasia, extensive eosinophilic infiltrates, and proliferation of postcapillary venules. However, these features can also be seen in Hodgkin's disease or T-cell lymphoma, therefore, cases presenting as KD pose a diagnostic challenge. We report a case series of two cases with suspected KD at initial presentation, with one patient eventually diagnosed with Hodgkin's disease after clinical progression. The first case was a 45-year-old Asian man who presented with bilateral thigh masses and significantly enlarged inguinal lymph nodes. The histopathology was characteristic and the patient had stable disease on treatment with cetirizine for 20 months. The second case was a 29-year-old African-American man who had progressive enlargement of the right neck lymph nodes extending into the mediastinum, with the original biopsy suggestive of KD. An initial search for Reed-Sternberg cells using immunohistochemical staining for CD15 and CD30 was negative. However, the patient developed neurological symptoms corresponding to tumor extension to the cervical and thoracic neural foramina. A repeat biopsy showed a lack of nodal structure and atypical large cells that were positive for CD30 staining. The patient was treated with chemotherapy with good response. We emphasize the importance of following the clinical course to render an accurate diagnosis. Both cases showed extensive eosinophilic infiltration and other KD-like pathological features. However, KD is rare; not missing a malignant diagnosis lies in high clinical suspicion and repeated exhaustive work up.
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Affiliation(s)
- Vivek Kumar
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Navneet Mittal
- Oncology San Antonio, 12705 Toepperwein Road, San Antonio 78233, USA
| | - Yiwu Huang
- Department of Hematology-Oncology, Maimonides Medical Center, NY, USA
| | | | - Huo Xiang Zheng
- Family Medicine Resident, Southside Hospital, Bay Shore, NY, USA
| | - Zujin Li
- Pathology Private Practice, Staten Island, NY, USA
| | - Yiqing Xu
- Department of Hematology-Oncology, Maimonides Cancer Center, 6300 8th avenue, Brooklyn, NY 11220, USA
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49
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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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Bastos JTD, Rocha CRMD, Silva PMCE, Freitas BMPD, Cassia FDF, Avelleira JCR. Angiolymphoid hyperplasia with eosinophilia versus Kimura's disease: a case report and a clinical and histopathological comparison. An Bras Dermatol 2018; 92:392-394. [PMID: 29186256 PMCID: PMC5514584 DOI: 10.1590/abd1806-4841.20175318] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/15/2016] [Indexed: 11/22/2022] Open
Abstract
Angiolymphoid hyperplasia with eosinophilia is a rare and benign vascular tumor
whose etiology remains uncertain. It clinically presents itself by angiomatous
papules or nodules located on the head and neck. Many controversies in the
literature are found in relation to angiolymphoid hyperplasia with eosinophilia
and Kimura's disease - its main differential diagnosis - due to their clinical
and histopathological similarities. However, currently, most studies agree that
they are distinct diseases. The present case illustrates a characteristic
description of angiolymphoid hyperplasia with eosinophilia and also highlights
the main differences with Kimura's disease.
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