Misdiagnosed recurrent multiple Kimura's disease: A case report and review of the literature

Kimura Disease: A Detailed Analysis of Clinical and Radiological Manifestations in a Retrospective Case Series

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.

Case report: Kimura's disease with minimal degenerative glomerulopathy without eosinophil infiltration responds to mycophenolate mofetil treatment

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).

Kimura disease with Allergic Bronchopulmonary Aspergillosis: a case report

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.

Older-age onset of Kimura's disease

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.

Kimura's disease mimicking thoracic spine dumbbell neurogenic tumor: a case report and literature review

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.

Radiomics Based on CECT in Differentiating Kimura Disease From Lymph Node Metastases in Head and Neck: A Non-Invasive and Reliable Method

Background: Kimura disease may be easily misdiagnosed as malignant tumors such as lymph node metastases based on imaging and clinical symptoms. The aim of this article is to investigate whether the radiomic features and the model based on the features on venous-phase contrast-enhanced CT (CECT) images can distinguish Kimura disease from lymph node metastases in the head and neck.

Methods: A retrospective analysis of 14 patients of head and neck Kimura disease (a total of 38 enlarged lymph nodes) and 39 patients with head and neck lymph node metastases (a total of 39 enlarged lymph nodes), confirmed by biopsy or surgery resection, was conducted. All patients accepted CECT within 10 days before biopsy or surgery resection. Radiomic features based on venous-phase CECT were generated automatically from Artificial-Intelligence Kit (AK) software. All lymph nodes were randomly divided into the training set (n = 54) and testing set (n = 23) in a ratio of 7:3. ANOVA + Mann–Whitney, Spearman correlation, least absolute shrinkage and selection operator, and Gradient Descent were introduced for the reduction of the highly redundant features. Binary logistic regression model was constructed based on the selected features. Receiver operating characteristic was used to evaluate the diagnostic performance of the features and the model. Finally, a nomogram was established for model application.

Results: Seven features were screened out at the end. Significant difference was found between the two groups for all the features with area under the curves (AUCs) ranging from 0.759 to 0.915. The AUC of the model's identification performance was 0.970 in the training group and 0.977 in the testing group. The disease discrimination efficiency of the model was better than that of any single feature.

Conclusions: The radiomic features and the model based on these features on venous-phase CECT images had very good performance for the discrimination between Kimura disease and lymph node metastases in the head and neck.