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Zhao F, Zhou M, Mao A, Zhang Y, Chen Y. Kimura Disease: A Detailed Analysis of Clinical and Radiological Manifestations in a Retrospective Case Series. J Inflamm Res 2024; 17:3371-3381. [PMID: 38803691 PMCID: PMC11129738 DOI: 10.2147/jir.s462098] [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: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
Background Kimura disease (KD) is a rare chronic inflammatory disease that affects mainly young Asian men and is characterized by painless subcutaneous masses, lymphadenopathy, and elevated serum IgE levels. Despite its benign nature, KD poses a diagnostic and therapeutic challenge due to its rarity and clinical variability. Objective This study aimed to provide a comprehensive analysis of the clinical and radiological features of KD in a retrospective case series, to assess treatment outcomes, and to discuss the implications for diagnosis and management. Methods We retrospectively analyzed four histologically confirmed cases of KD admitted to Zhejiang Provincial People's Hospital from January 2018 to October 2023. Clinical and radiological data were retrospectively analyzed, and imaging findings were analyzed by two neuroradiologists to determine lesion characteristics and contrast enhancement patterns. Results Our findings showed that the patients were predominantly male, with a mean age of 43 years and an age range of 13-71 years. All patients presented with painless subcutaneous masses and three of them had peripheral blood eosinophilia and elevated serum IgE levels. Radiographically, the lesions were predominantly ill-defined with heterogeneous enhancement, accompanied by subcutaneous fat atrophy. Complete surgical excision and oral corticosteroids were effective treatments, and no recurrence was noted during follow-up. Conclusion KD should be considered in the differential diagnosis of painless subcutaneous masses in the head and neck region, especially in the presence of eosinophilia and elevated IgE levels. Our findings contribute to the understanding of KD's clinical and radiological spectrum and highlight the need for long-term follow-up due to the risk of recurrence.
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Affiliation(s)
- Fanfan Zhao
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Min Zhou
- Department of Radiology, 903 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang Province, People’s Republic of China
| | - An Mao
- Department of Outpatient, 903 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Yingjiao Zhang
- Department of Gastroenterology, 903 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Yao Chen
- Department of Radiology, 903 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang Province, People’s Republic of China
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Rai P, Ankathi S, Panchal N, Janu A, Yadav S. Stubborn Swellings: A Rare Case of Kimura's Disease Presenting as Parotid Swellings. Cureus 2024; 16:e59570. [PMID: 38826922 PMCID: PMC11144294 DOI: 10.7759/cureus.59570] [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: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Kimura disease (KD) is a rare chronic inflammatory disorder characterized by the development of painless subcutaneous nodules, predominantly in the head and neck region. Diagnosis relies on a high index of clinical suspicion and clinicopathological correlation, with core biopsy serving as the gold standard for a definitive diagnosis. While the disease itself is benign, it can cause significant morbidity if left untreated. This case report describes a 48-year-old male who presented with bilateral infraauricular swellings, pruritus, and elevated serum IgE levels along with eosinophilia. Imaging and histopathological correlation confirmed the diagnosis of KD. Combination therapy of corticosteroids and cyclosporine resulted in significant clinical improvement, highlighting the efficacy of the approach while avoiding surgical resection. This case emphasizes the importance of radiologic-pathologic correlation along with the use of serology to effectively diagnose KD, even in atypical presentations.
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Affiliation(s)
- Pranjal Rai
- Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, IND
| | - Sumankumar Ankathi
- Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, IND
| | - Nitin Panchal
- Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, IND
| | - Amit Janu
- Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, IND
| | - Subhash Yadav
- Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, IND
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Liu L, Zhang W, Huang M, Li K, Zhu L, Ke L, Huang J, Wu Y. The clinical and pathological features of Kimura disease in pediatric patients. Front Med (Lausanne) 2024; 11:1352206. [PMID: 38725466 PMCID: PMC11079225 DOI: 10.3389/fmed.2024.1352206] [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: 12/09/2023] [Accepted: 04/03/2024] [Indexed: 05/12/2024] Open
Abstract
Background Kimura disease is characterized by inflammation, with its underlying causes remaining uncertain. There is a lack of comprehensive and systematic research on the pathology of this condition in pediatric patients. Our objective is to study the clinical and pathological attributes of Kimura disease in pediatric patients and investigate the potential diagnostic significance of immunoglobulin E (IgE) in this context. Methods Clinical and laboratory information, pathological characteristics, and follow-up data were correlated to examine the distinctive features. Immunohistochemistry, acid-fast staining, and molecular assay were used to identify the presence of IgE and pathogens. Results We conducted an analysis of five cases of Kimura disease in pediatric patients at our hospital. The patients' ages ranged from 5 years and 7 months to 14 years and 2 months, with 4 (80%) being male. The most common site was the head and neck region, particularly the postauricular subcutaneous area. Eosinophilia was observed in four patients (80%), and two patients (40%) had elevated serum immunoglobulin E (IgE) levels. Histopathological changes included eosinophilic infiltrates, follicular hyperplasia, and the proliferation of postcapillary venules. Immunohistochemical results supported the reactive nature of the lymphoid process and IgE deposition in the follicle, while no specific pathogens were discovered by special staining. All patients underwent surgical excision, and none experienced recurrence in their original location. Conclusion Children with Kimura disease show distinct eosinophilic and IgE alterations in both laboratory findings and pathological features. The application of immunohistochemical staining of IgE could serve as a promising marker for diagnosing Kimura disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Ying Wu
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Hemayati R, Binesh F, Pashmchi M, Mousavi Anary SMK, Mohammadi M. Challenging diagnosis of Kimura disease in a child with nephrotic syndrome: A case report. Clin Case Rep 2023; 11:e7031. [PMID: 36873072 PMCID: PMC9981570 DOI: 10.1002/ccr3.7031] [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: 12/05/2022] [Revised: 01/20/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Kimura disease (KD) is a rare condition with a challenging diagnosis because it may be misdiagnosed and not differentiated from other disorders. We reported a 13-year-old patient who presented with growing neck masses and was hospitalized due to the nephrotic syndrome relapse but was eventually diagnosed with KD.
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Affiliation(s)
- Roya Hemayati
- Department of Internal Medicine Shahid Sadoughi University of medical sciences Yazd Iran
| | - Fariba Binesh
- Department of Pathology Shahid Sadoughi University of medical sciences Yazd Iran
| | - Mohammad Pashmchi
- School of Medicine Shahid Sadoughi University of Medical Sciences Yazd Iran
| | | | - Mohammad Mohammadi
- School of Medicine Shahid Sadoughi University of Medical Sciences Yazd Iran
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Mai Y, Wang Y, Sun P, Jing Z, Dong P, Liu J. Kimura disease in children: A report of 11 cases and review of the literature. Front Pediatr 2023; 11:1131963. [PMID: 36873634 PMCID: PMC9982731 DOI: 10.3389/fped.2023.1131963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Kimura disease (KD), also known as eosinophilic hyperplastic lymphoid granuloma, is a rare benign chronic inflammatory condition, which is featured with the painless progressive mass located in the subcutaneous area of the head and neck region, elevated peripheral blood eosinophils, and raised serum immunoglobulin E (IgE) levels. KD is uncommon in clinical practice, especially with low incidence in children, so it often leads to misdiagnosis or missed diagnosis in pediatric patients. METHODS The clinical data of 11 pediatric patients with KD in the authors' institution were retrospectively analyzed. RESULTS There were 11 pediatric patients with KD enrolled in total, including 9 male patients and 2 female patients (sex ratio 4.5:1). The median age at diagnosis stood at 14 years (range 5-18 years), the initial symptoms in all patients included painless subcutaneous masses and focal swelling, the duration of symptoms ranged from 1 month to 10 years, and the average duration was 24.45 months. Six patients had single lesions, and 5 had multiple lesions. The highest proportion of lesion regions were parotid gland (n = 5, 31.3%) and retroauricular (n = 5, 31.3%), followed by cervical lymph nodes (n = 4, 25%), and others (n = 2,12.5; elbow n = 1; back n = 1). The eosinophil absolute count elevated in all patients, ranging from 0.71×109/L to 10.35 ×109/L (normal range 0.02-0.52×109/L). IgE levels were increased in all 7 patients who underwent serum immunoglobulin examination (normal range <100 IU/mL). Three patients received oral corticosteroid treatment while 2 relapsed. Three patients received surgical resection combined with oral corticosteroid treatment, and no patient relapsed. The other 3 patients received surgery and radiotherapy, surgery combined with corticosteroid and cyclosporin and corticosteroid combined with leflunomide respectively, and no patient relapsed. CONCLUSION Base on the study, it is found that Kimura disease is rare and may have the atypical symptoms in pediatric patients, combination therapy is recommended to reduce recurrence, and long-term follow-up should be performed.
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Affiliation(s)
- Yumiao Mai
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingjie Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pan Sun
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaohe Jing
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengpeng Dong
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian Liu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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A Rare Kimura's Disease in the Oral Cavity with Severe Sleep Apnea: Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121810. [PMID: 36557012 PMCID: PMC9783615 DOI: 10.3390/medicina58121810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Kimura's disease (KD) is a rare chronic inflammatory disorder that commonly occurs in Asian males. It mainly presents as painless subcutaneous masses or lymphadenopathy in the head and neck region. The incidence of KD in the oral cavity is quite rare. We reported a rare case of a 53-year-old male who had KD in his soft palate, hard palate and bilateral tonsils associated with severe sleep apnea. This patient underwent radiotherapy and exhibited a good response to the treatment. Throughout the 12-month follow-up period, the patient's condition remained satisfactory. Of the other 14 reviewed cases of KD in the oral cavity, the lesions can occur in the buccal mucosa, hard and soft palate, and mouth floor with specific clinical features. We further summarized their manifestations and treatments in order to guide the future identification and management of KD with lesions in the oral cavity.
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Chang SY, Lee CC, Chang ML, Teng WC, Hsiao CY, Yu HH, Hsieh MJ, Chan TM. Comparison of Clinical Manifestations and Pathology between Kimura Disease and IgG4-Related Disease: A Report of Two Cases and Literature Review. J Clin Med 2022; 11:jcm11236887. [PMID: 36498461 PMCID: PMC9740894 DOI: 10.3390/jcm11236887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/06/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Kimura disease (KD) is a rare, chronic proliferative condition presenting as a subcutaneous mass predominantly located in the head and neck region; it is characterized by eosinophilia and elevated serum IgE levels. IgG4-related disease (IgG4RD) is a fibroinflammatory condition characterized by swelling in single or multiple organs and the infiltration of IgG4 plasma cells. Herein, we presented two cases. Case 1 is a 38-year-old man with a painless mass in his right postauricular region, and Case 2 is a 36-year-old man with painless lymphadenopathy in his bilateral postauricular region. After surgical excision, they showed good recovery with no relapse. Although Cases 1 and 2 shared several overlapping pathological manifestations, there were a few differences that allowed the differentiation of KD and IgG4RD.
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Affiliation(s)
- Sing-Ya Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chih-Chun Lee
- Department of Medical Education, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan
| | - Ming-Ling Chang
- Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Wen-Chieh Teng
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chao-Yang Hsiao
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Han-Hua Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Meng-Ju Hsieh
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tien-Ming Chan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence:
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Tan WH, Wong M, Tay ZEA, Oh CC. Enlarged postauricular nodules in a young South Asian man. Clin Exp Dermatol 2022; 47:1406-1409. [PMID: 35484721 DOI: 10.1111/ced.15173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
We report a 19-year-old South Asian man with progressively enlarging postauricular nodules over a 5-year period, which were eventually treated by surgical resection.
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Affiliation(s)
- Wen Hao Tan
- Department of, Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Manzhi Wong
- Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Zhi En Amos Tay
- Department of, Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of, Dermatology, Singapore General Hospital, Singapore, Singapore
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