An 8-year follow-up of IgG4-related skin disease presented with generalized ALHE-like eruptions: successful treatment of glucocorticoid and cyclophosphamide

Immunoglobulin gamma (IgG) type 4-related disease (IgG4-RD) is a chronic immunologic systemic disorder that could affect multiple organs, which may cause irreversible organ damage or even death. Skin involvement is rare and associated especially with systemic disease. The dermatologist must be equipped to recognize IgG4-RD to prevent delayed identification and treatment. This case reports a very rare case of IgG4-related skin disease (IgG4-RSD) presenting with a generalized angiolymphoid hyperplasia with eosinophilia (ALHE)-like lesions in a middle-aged male patient with no other organ involvement. He was treated with oral glucocorticoid and cyclophosphamide, which resulted in complete remission. No relapse and disease progression were seen with a follow-up for 8 years.

[Diagnostic challenges in Kimura's disease]

Ultra-rare diseases occur with a frequency of 2 in 100 000 people or less. Kimura's disease (KD) affects less than 1 in 1 000 000 people. It is a benign, chronic inflammatory soft tissue disorder, accompanied by eosinophilia, raised immunoglobulin E (IgE) titer and the presence of painless subcutaneous masses, usually in the head and neck region. The disease was first described in 1948 and occurs at higher rates in Asia than in America or Europe.

A CASE REPORT

A 35-year-old man without past medical history presented to his family doctor for bilateral cervical lymphadenopathy accompanied by eosinophilia. Despite subsequent in-depth diagnostics, including fine-needle aspiration biopsy (FNAB) of the lymph nodes, the definitive diagnosis was not initially established. After following 2 months, a selective lymphadenectomy was performed, putting Hodgkin's lymphoma under suspicion. The image of positron emission tomography coupled with computed tomography (PET-CT) corresponded to this diagnosis. Due to the lack of all the criteria necessary to make a diagnosis, another histopathological consultation was done. The image of the lymph nodes suggested reaction-inflammatory changes. Due to the presence of a triad of signs (reactive lymphadenopathy, several eosinophils in the paracortic zone, vascular proliferation), differential diagnosis was recommended, among others towards the Kimura's disease. A series of examinations allowed to exclude lymphadenopathy of parasitic, allergic and hyperplastic hematopoietic system aetiology. The patient started steroid therapy with a good effect at first. However, after the recurrence of the disease, the patient was qualified to intensify the immunosuppressive treatment.

CONCLUSIONS

In the described case, the intensive diagnostic process and the thorough analysis of the test results relatively quickly led to the correct diagnosis. This enabled the implementation of appropriate treatment and prevented the initiation of empirical therapy for the originally diagnosed Hodgkin's lymphoma.

An Unusual Cause of Papules on the Face

Dear Editor, Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, locally proliferating disorder that affects predominantly the head and neck region (1,2). There seems to be a higher incidence in middle-aged Caucasian women (2,3). A 28-year-old female patient with no relevant personal or family medical history and only taking an oral contraceptive, presented to our department with multiple, well delimited, infracentimetric erythematous papules with a smooth surface on the left frontal, temporal, and preauricular regions (Figure 1). The lesions had appeared 7 months earlier, with progressive growth in number and dimensions since. The patient reported pruritus and denied previous trauma, topical application of any sort, insect bite at these locations, and any other accompanying symptoms. A thorough physical examination revealed no additional abnormalities. An excisional biopsy of one of the left temporal papules revealed a prominent lymphoid component, with a dense multinodular infiltrate in the superficial and deep dermis, with reactive germinative centers of considerable dimensions (Figure 2). Large and atypical lymphocytes were confined to the germinative centers, with reactive characteristics. Lymphocytes surrounding the germinative centers were predominantly small, accompanied by a significant number of scattered eosinophils. CD3 and CD20 immunohistochemical staining revealed B-cells predominantly in the nodular areas corresponding to the germinative centers, while T-cells displayed a diffuse peripheral distribution. There was severe neovascularization, with thick-walled vascular channels lined by enlarged plump endothelial cells with an "epithelioid" appearance. These findings supported the diagnosis of angiolymphoid hyperplasia with eosinophilia (ALHE). Laboratory workup did not show any abnormalities, including eosinophilia or elevation of immunoglobulin E levels. Due to pruritus and aesthetic concerns, surgical excision of the larger and most symptomatic papules was performed. The patient was assured of the benign nature of the disease and informed about the possible development of new lesions. Kept under clinical surveillance, the patient remained free of new lesions at 6-month follow-up. ALHE generally presents as solitary or multiple erythematous or hyperpigmented dome-shaped papulonodules. Lesions can be pruritic or painful and do not tend to resolve spontaneously (4). The pathogenesis of ALHE remains controversial, although some theories have been suggested. The most widely accepted hypothesis is that it is an angioproliferative process, accompanied by an inflammatory infiltrate, reactive to several stimuli (3). Some authors believe it is an allergic reaction, but no specific sole agent has been identified (5). Others claim ALHE may represent a T-cell lymphoproliferative disorder of benign or low-grade malignant nature (6). Some recent studies suggest that ALHE pathogenesis may be related to a vascular malformation secondary to a subcutaneous arteriovenous shunt (1-3). Histologically there are both vascular and inflammatory components, with an abnormal vascular proliferation and diffuse lymphocytic infiltrates with eosinophils. The vascular component is formed by capillaries clustered around arterial or venous vessels, dilated and atypical, with a protruded endothelium (3). The main differential diagnosis of ALHE is Kimura's disease, and there has been some discussion regarding the relationship between these two entities due to their clinical and histopathological similarities. However, most studies currently agree that they are distinct diseases. The differential diagnosis also includes angiosarcoma, particularly the epithelioid variant, epithelioid hemangioendothelioma, Kaposi sarcoma, pyogenic granuloma, and cutaneous metastasis (3). ALHE usually requires treatment as spontaneous regression, although reported in the literature, is rare (1,3). Many options have been suggested, with variable levels of success, but there is no definitive treatment for this condition (2). Surgical excision is the preferred choice, but recurrence may happen if the excision is incomplete (1). Mohs micrographic surgery with excision of abnormal vessels at the base of the lesion may be more effective in reducing recurrences (4). Other treatments reported include laser therapy (pulsed dye, CO2, copper vapor), systemic or intralesional corticosteroid injection, cryotherapy, imiquimod, tacrolimus, isotretinoin, radiotherapy, interferon alfa 2a, anti-interleukin-5 antibody, photodynamic therapy, and methotrexate (1). In the present case the diagnosis of ALHE was established through the conjunction of clinical and histological findings. Although a rare entity, its predominantly facial involvement in young adults and the absence of a satisfactory treatment can produce a significant impact that can include the quality of life of the patients.

Multiple Grouped Scalp Nodules in a Middle-Aged Man: A Rare Case of Angiolymphoid Hyperplasia with Eosinophilia

An otherwise healthy man in his 50s presented complaining of pruritic lesions on the left side of his scalp. The lesions had slowly been growing in size over the preceding 30 years. They would occasionally bleed, and this is what ultimately prompted him to seek medical advice. Physical examination revealed multiple aggregated and soft, flesh-colored nodules on the left posterior auricular area of the scalp (Figure 1). No appreciable clinical lymphadenopathy was identified on examination. A shave biopsy of one of the nodules was performed for diagnostic clarification.

[Report of one case Kimura's disease]

A 48-year-old middle aged male presented swelling lymph nodes and mass in neck for 5 years. Physical examination shows swollen mass in head and neck regions. The masses could be touched in bilateral parotids and neck with a little movement and moderate tenderness. The level of IgG was normal, but Eosinophi count was high. The function of heart liver and kidney was normal. The result of B-mode ultrasonography reveals bilateral parotids and subcutaneous near parotids were widely swollen and several swollen lymph nodes in neck. pathological examination displays features of a large number of lymph follicles hyperplasia, acidophilic granulocyte infiltration, capillary hyperplasia and fibrosis of different level. The disease were eventually diagnosed by pathological examination. Method of treatment includes glucocorticoid drug therapy, surgical resection and local radiotherapy. The last treatment of patients with Kimura's disease should be combined with the clinical manifestation of them to determine the individualized treatment, so as to improve the quality of life of patients.

A CASE OF EOSINOPHILIC LYMPHFOLLICULOSIS OF THE SKIN (KIMURA'S DISEASE)

Eosinophilic lymphfolliculosis of the skin (Kimura's disease) in a 31-year-old male is reported. He had two subcutaneous tumors, 10 x 9 x 3 cm and 9 x 7 x 2 cm in size, in the right retroauricular and submaxillary areas respectively. Histopathologic examination of the tumors showed marked infiltration of eosinophils, mast cells and lymphocytes, and angiomatous proliferation of blood vessels from the dermis to the skeletal muscular tissue. In subcutaneous adipose tissue, there were numerous lymphfollicles with germinal centers in which IgE deposition with reticular appearance was observed by immunofluorescent technique. Study of the peripheral blood showed marked eosinophilia and an increase of serum IgE level. These findings suggest the possibility that Type 1 allergic reaction may be involved in the histogenesis of eosinophilic lymphfolliculosis of the skin, although there is no direct evidence for the existence of antigens which react to IgE antibody in the skin lesion.

Notch-1 and Ki-67 receptor as predictors for the recurrence and prognosis of Kimura's disease

Kimura's disease (KD) is a rare chronic disease with unknown origin. It remains controversial in KD's diagnosis, treatment, transformation and need further research. The aim of this study is to investigate the clinicopathologic features of KD and the relationship between the expression of Notch-1, Ki-67 receptor and the recurrence of KD. The hematoxylin and eosin sections and clinical data of 40 patients diagnosed with KD were examined retrospectively. Specimens were available in these 40 cases. Notch-1 and Ki-67 expression were examined using IHC (immunohistochemistry staining) analysis. Of 40 cases of KD (average age, 38.4 years; median age, 36.0 years), 34 cases (85.0%) were clinically seen to involve swelling of the head and neck region. Notch-1 and Ki-67 have a high expression in recurrent patients. High expression of Notch-1 receptor and Ki-67 tended to be found in patients who relapsed. This is the first study to discuss the correlation among Notch-1, Ki-67 and recurrent KD. These results suggest both of the markers may act as promising predictors for the recurrence and prognosis of KD. However, Notch-1 immunoexpression had no statistically significant association with the Ki-67 proliferation index.

Angiolymphoid hyperplasia with eosinophilia of the infra-axillary region: report of a case

Angiolymphoid hyperplasia with eosinophilia is an uncommon, benign hyperproliferative disorder. Papules and nodules occur predominantly in the head and neck region. Involvement of other sites such as the trunk and mucosae has been rarely reported. We herein report a case of angiolymphoid hyperplasia with eosinophilia involving the right infra-axillary region.

Profound proliferating angiolymphoid hyperplasia with eosinophilia of pregnancy mimicking angiosarcoma

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular proliferation that clinically manifests as nodules and papules of the head and neck region. We report a profound, rapidly proliferating case of ALHE in a 3-week postpartum woman that clinically mimicked angiosarcoma. The clinical and histologic features of ALHE, Kitamura disease, and cutaneous angiosarcoma are reviewed, and the relationship between ALHE and pregnancy is discussed.

[A clinical analysis of 33 cases of Kimura's disease]

OBJECTIVE

To improve the diagnosis and treatment of Kimura's disease (KD) by investigating its clinical characteristics, pathological features and complications.

METHOD

The clinical data of 33 cases of KD were analyzed retrospectively.

RESULT

Of 33 cases, 22 showed the mass on head and neck, while in the other cases, the mass distributed in the region of groin, axillary fossa, hilum of lung and mesentery. Regional lymph nodes were involved in 21 cases and major salivary glands were invaded in 8 cases. Twenty-three cases had typical peripheral eosinophilia, although only in 2 patients the quantity of serum total IgE increased markedly. Urine abnormalities happened to 7 cases, such as massive proteinuria (3 cases) and hematuria (2 cases). Among 6 cases which underwent bone marrow aspiration, 2 showed eosinophilia. Two cases were complicated with nephritic syndrome. Six cases were combined with local inflammation on head and neck and 2 cases were combined with malignant tumor.

CONCLUSION

Mass on the head and neck is the typical clinical manifestation in KD, with regional lymph nodes and major salivary glands involved most. Serum total IgE and histopathologic examination should always be done to confirm KD, especially in the cases with unknown eosinophilia increasing.

Angiolymphoid hyperplasia with eosinophilia: a study of 7 cases

INTRODUCTION

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vasoproliferative disease of undetermined origin. It is characterized by the presence of nodular pseudo-tumors corresponding microscopically to a vascular proliferation within an inflammatory infiltrate made up of lymphocytes, macrophages, and eosinophils. The authors describe 7 cases of ALHE.

METHODS

The 7 cases were diagnosed over a period of 19 years (1990-2008). Clinical data and histological slides were brought from the departments of dermatology and pathology of the Rabta Hospital.

RESULTS

The 7 patients were 4 women and 3 men with an average age of 34.5 years. The cephalic localization was the most frequent. Lesions were solitary or multiple and formed papules or plaques of variable color. The diagnosis was based in all cases on histological findings.

DISCUSSION

The main disease in the differential diagnosis of ALHE is Kimura disease, but the 2 entities have several clinical and histological differences. The pathogenesis remains unclear and there is no consensus on the best treatment.

Angiolymphoid hyperplasia with eosinophilia: Successful treatment with the Nd:YAG laser

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon idiopathic proliferation of blood vessels that manifests in adults as isolated or grouped papules, plaques, or nodules in the skin of the head and neck. We describe the case of a 31-year-old woman with a 3-year history of persistent ALHE, located on the tragus of her right ear, with no sign of spontaneous regression over a period of 3-6 months and refractory to intralesional corticosteroids. We report the successful use of the Nd:YAG laser for this condition, which offered excellent symptomatic and cosmetic results and suggests the consideration of this modality in the treatment of ALHE.

Kimura's disease in Malay patients

Kimura's Disease (KD) is an uncommon, chronic inflammatory disorder of unknown etiology which is endemic in Orientals. It is characterized by painless, large solitary or multiple nodules in subcutis of head and neck region or the major salivary glands, associated with regional lymphadenopathy, blood eosinophilia and elevated IgE levels. Its treatment ranging from conservative observation in asymptomatic patient to surgical resection of the mass, corticotherapy and irradiation therapy for the symptomatic ones.

Kimura disease

Kimura disease is a benign rare chronic inflammatory disorder of unknown etiology that involves the lymph nodes and subcutaneous tissue of the head and neck regions. Elevated serum immunoglobulin E levels and peripheral blood eosinophilia are also common. This disease is most common in middle-aged Asian men. Although the etiology is unknown, it most probably represents an aberrant chronic immune response. Treatment for Kimura disease includes surgical resection and regional or systemic steroid therapy. Cytotoxic therapy and radiation have also been utilized. The disease has an excellent prognosis, although it may recur locally.

Recurrent Kimura's disease: report of one case

Kimura's disease (KD) is a rare, chronic inflammatory disease, and the etiology is not yet to be determined. The disease is usually found in young Asian men but rarely in Western population. Here, we report an 8-year-old boy with the initial presentation of right upper eyelid swelling. Laboratory tests disclosed peripheral eosinophilia and elevated IgE level. KD with lacrimal gland involvement was diagnosed. Surgical excision was performed several times and steroid was also used, however the disease recurred. Thereafter, steroid, cyclosporine-A and azathioprine were prescribed. The tumor mass resolved and the laboratory data returned to normal level.

Kimura's disease of the parapharyngeal space

Kimura's disease is a fairly uncommon inflammatory condition of unknown etiology. It classically presents in young Asian males as tumorlike subcutaneous nodules in the head and neck with associated lymphadenopathy, peripheral eosinophilia, and an elevated serum IgE level. Kimura's disease affects the subcutaneous tissues, salivary glands, and lymph nodes; less common sites in the head and neck include the eyelid and tympanic membrane. We report a case of Kimura's disease of the parapharyngeal space in a 42-year-old Chinese woman. To the best of our knowledge, this is the first report of Kimura's disease at this site.

Refractory hypertension and anemia in end-stage renal disease: an unusual manifestation of Kimura's disease

Hypertension and anemia are common in uremic patients. This article describes a 35-year-old uremic Taiwanese who was admitted to our hospital with refractory hypertension and refractory anemia following chronic hemodialysis for more than two years. He was diagnosed with Kimura's disease finally. Refractory hypertension and refractory anemia were noted over two years before an enlarged inguinal lymph node was observed. The symptoms lead to the diagnosis of Kimura's disease. Unlike most cases, refractory hypertension and refractory anemia were first noted before the inguinal mass and eosinophilia were presented. The inflammatory parameters increased when the disease was active. Steroid treatment was conducted, and the symptoms including hypertension and anemia promptly decreased. To the authors' knowledge, this case is for first one in which Kimura's disease has induced refractory hypertension and anemia in an ESRD patient and in which these symptoms rapidly subsided following steroid treatment. The activity of Kimura's disease is closely related refractory hypertension, suggesting that inflammation may be involved in refractory hypertension and anemia in a dialytic patient with Kimura's disease.

[Kimura's disease on the hard palate in a patient from Martinique]

INTRODUCTION

We report an observation of Kimura's disease (angiolymphoid hyperplasia with eosinophilia) in a Black patient from West Indies, in a rare localisation on hard palate.

EXEGESIS

A 46-year-old male patient from French West Indies (Martinique) presented with a tumor of hard palate evolving from 2 years with locoregional lymph nodes. He had a history of chronic urticaria, prurigo, rhinitis and alopecia areata. Pathological examination of the tumor was consistent with the diagnosis of Kimura's disease. Blood tests showed hypereosinophilia, elevation of IgG and IgE. The serology of Toxocara canis with Western blott was positive. Corticosteroid therapy (0.7 mg/kg/d) and albendazole (800 mg/d) allowed regression of the tumor, lymph nodes, and urticaria. The remaining tumor was surgically excised.

CONCLUSION

Kimura's disease was first described in Japanese young men, between 20 and 40 years old, with subcutaneous nodules on head and neck area. Involvement of oral mucosa is rare, and the occurence in West Indian patients has been rarely reported.

Recurrent angiolymphoid hyperplasia with eosinophilia mimicking temporal arteritis associated with nephrotic syndrome

We report on a middle-aged Caucasian male who presented with nephrotic syndrome that on 2 consecutive recurrences was accompanied by a pulsating tumor suggesting temporal arteritis. Renal biopsies showed features of a low-grade mesangial-proliferative glomerulonephritis. The resected tumor in the temporal region revealed a lesion consistent with angiolymphoid hyperplasia with eosinophilia (ALHE), with moderate inflammatory involvement of the temporal artery. The patient was successfully treated with oral prednisolone in addition to removal of the tumor, but has remained steroid-dependent. To our knowledge, only 2 cases of ALHE and nephrotic syndrome have been reported so far in non-Japanese individuals [Altman et al. 1995, Sonkodi et al. 1987], and we are not aware of any previous case combining these features while simultaneuosly mimicking temporal arteritis.

Cryotherapy in the treatment of angiolymphoid hyperplasia with eosinophilia

BACKGROUND

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign and very rare skin disorder of uncertain etiology. It occurs in both dermal and subcutaneous forms, which are regarded as variants of the same condition. Clinically, it is characterised by solitary or multiple, red to brown cutaneous papules or nodules, usually located on the head and neck. ALHE occurs mainly in young to middle-aged adults, and more frequently affects women.

CASE REPORT

A 36-year-old Caucasian woman with a one-year history of ALHE is presented. The diagnosis of this rare entity was based on the clinical and histological examination.

CONCLUSIONS

Although there are many methods of treatment, the final result is not always satisfactory for patient. We present our case as a reminder that cryotherapy can be regarded as an easy, safe and successful method of treatment in some patients.

Kimura disease: 2 case reports and a literature review

Kimura disease (KD) is a chronic inflammatory soft-tissue disorder often presenting as swollen soft tissue or enlarged lymph nodes. KD is rare, and most reported cases have involved Asians. The pathogenesis is poorly understood, and treatments are unsatisfactory. KD is associated with allergic conditions such as asthma, rhinitis, and eczema. We present the cases of 2 patients treated for chronic endogenous eczema and KD in our dermatology clinic.

Kimura's disease in a teenage male: report of one case

A 14-year-old boy gradually developed several subcutaneous masses over bilateral peri-auricular regions, neck, and both upper arms near the elbows over the past 2 years. The recent development of eyelid puffiness elicited his seeking medical attention. Hypereosinophilic syndrome was first considered due to the markedly elevated blood eosinophil count without other evidence of allergy or parasite infestation, but the absence of organ involvement made this diagnosis questionable. The histopathological investigation of the subcutaneous mass in the upper arm showed lymph node-like tissue with markedly reactive follicular hyperplasia and eosinophilic abscesses associated with granulomatous inflammation, thus leading to the final diagnosis of Kimura's disease. Oral prednisolone was prescribed successfully. This illness occurs mainly in young oriental males. We report this case to introduce it to pediatric clinicians as an important differential diagnostic entity in eosinophilia-associated diseases and reactive lymphadenopathy.

[Soft tissue eosinophilic granuloma or Kimura's disease: a case report]

Soft tissue eosinophilic granuloma or Kimura's disease is a chronic inflammatory disorder of unknown etiology. It is endemic in the Far East but can occur sporadically in other populations especially Middle Eastern peoples as illustrated by the present case involving a 55-year-old man. Examination 8 years after an initial episode revealed masses in the cheek and submaxillary regions with hypereosinophilia and characteristic histological findings. The usual clinical presentation of Kimura's disease includes subcutaneous nodules with lymph node involvement or presence of tumor in the salivary glands. These clinicopathological findings require differential diagnosis with Hodgkin's lymphoma, dermopathic lymphoma, or Castelman's disease. However, the most difficult distinction involves angiolymphoid hyperplasia with eosinophilia. Final diagnosis requires anatomopathological study. The most frequently encountered histological criteria are preservation of node structure, highly developed germinal centers, eosinophilic infiltration, and presence of numerous postcapillary veinlets. Prognosis is favorable but multiple relapses are possible. Corticosteroid therapy is usually effective but radiation treatment may be necessary in patients with recurrent disease.

[A case of Kimura disease treated with interferon and general corticoid therapy]

INTRODUCTION

A case of Kimura's disease that occurred in a 5-year-old Caucasian boy after a tick bite is reported. When the child was 16 years old, symptoms developed. They included voluminous bilateral neck and head lymph nodes associated with hypereosinophilia (1,640/mm3), and increased IgE levels (18,866 KU/L). Clinical and immunological effects of treatment by interferon-alpha and steroids are presented.

EXEGESIS

Pathological and histological examination showed typical features of dense lymphoid cell infiltrates containing many eosinophils, mast cells, and vascular hyperplasia. Percentages of CD4+, CD27-, CD7- cells were increased In the blood and lymph nodes, showing a profile typical of TH2. IL-5 production by these cells was markedly increased and was inhibited by IFN-alpha and IFN-beta in vitro. No etiology was found. The role of antigens of Ixodes ricinus is discussed. Three surgical excisions of adenopathies were not successful. Treatment by IFN-alpha (Introna, Schering-Plough, 5.10(6) U/week) and a bolus of methylprednisolone hemisuccinate (1 g/month) was started. Eight months later, the size of the lymph nodes had decreased; however, eosinophil counts and ECP and IgE levels were still high. The decrease in corticosteroid induced a subsequent, slight increase in the size of the lymph nodes and a marked increase in ECP.

CONCLUSION

This is the first description of treatment of Kimura's disease by interferon-alpha and steroids. The disease outcome does not suggest that interferon-alpha may predominate.

Kimura's disease of bilateral upper eyelids: a case report

We present a rare case of Kimura's disease of bilateral upper eyelids. A 41-year-old Chinese male had multiple masses over retroauricular, submandibular regions and bilateral upper eyelids since 13 years previously. Tumor recurred after each surgical excision, chemotherapy and Co 60 radiotherapy. Eosinophilia and elevation of blood immunoglobulin E (IgE) were noted in this admission. We operated on left upper eyelid to relieve the blocking of vision. A diffuse infiltration with numerous fibrotic bands was noted. Histological section showed a lymphoid hyperplasia, remarkable infiltration of eosinophils and proliferation of capillaries. Oral prednisolone 60 mg was given postoperatively. The patient had a satisfactory appearance and a relief of visual block.

[Aneurysm of superficial temporal artery in angiolymphoid hyperplasia lesions]

INTRODUCTION

Subcutaneous angiolymphoid hyperplasia with eosinophilia is a disease which usually affects small vessels of neck and facial area.

CASE REPORT

A 44 year-old with cutaneous lesions corresponding to angiolymphoid hyperplasia with eosinophilia is reported. The lesions were located near the temporal region. This case was particular because of the development of an anevrism of the superficial temporal artery.

DISCUSSION

Involvement of the superficial temporal artery by angiolymphoid hyperplasia with eosinophilia has been reported in only one case which simulated a Horton disease because of an occlusion of the temporal artery. The development of an anevrism of this artery in a patient with angiolymphoid hyperplasia with eosinophilia is a very unusual presentation of the disease which has not been previously reported.

Kimura's disease. A typical case of a rare disorder

Images

[Kimura's disease: a case report]

Kimura's disease is endemic in Orientals. The pathogenesis of Kimura's disease is currently unknown, and the methods of treatment are undefined. The patient was a 21-year-old male, suffering from neck mass left over the parotid region of which the mass gradually increased and which combined with lymphadenopathy and pruritus over both lower limbs more than two years. The patient was diagnosed with Kimura's disease by neck lymph node biopsy, then received simple excision of mass and oral prednisolone therapy. The symptoms of lymphadenopathy and pruritus were improved without recurrence of neck mass.

Angiolymphoid hyperplasia with eosinophilia (histiocytoid hemangioma): evaluation of treatment options

Angiolymphoid hyperplasia with eosinophilia is an uncommon benign vascular proliferative lesion of unknown cause. In this report, a case is presented of a patient who was confirmed to be positive for human immunodeficiency virus and in whom the lesion had shown rapid accelerated growth. The case is used to illustrate a variety of therapeutic techniques and to evaluate the effectiveness of the various alternatives in the treatment of this unusual clinical problem. Long-term follow-up after radical excision of the tumor mass is presented.

[Angiolymphoid hyperplasia, a successfully treated case]

Recurrent nodules on the face of a 37-year-old man, clinically and histologically diagnosed as angiolymphoid hyperplasia with eosinophilia, promptly disappeared on intralesional infiltration of hydroxypolyethoxydodecan, although his eosinophilia and elevated level of IgE continued.