Kimura’s Disease – An Unusual Presentation

Document Type: Case Report

Authors

1 Department of Otorhinolaryngology, JLN Hospital & RC, Sector-9, Bhilai-490009, Chattisgarh, India.

2 Department of Otorhinolaryngology, Karnataka Institute of Medical Sciences, Hubli-(karnataka), India.

Abstract

Introduction:
Kimura’s disease is a rare chronic inflammatory disease of unknown etiology, presenting as painless subcutaneous nodules with lymphadenopathy and peripheral eosinophilia, mainly disturbing the head and neck region. It mainly affects Asian males in their 2nd to 4th decade of life. One such case of Kimura’s disease, which is uncommon in Indian natives, is reported.
 
Case Report:
A male patient presented with an insidious onset of a progressive painless disfiguring swelling over his nose since four years, which was associated with nasal obstruction and postaural swelling with a history of an inconclusive incisional biopsy. Clinical examination showed a bilobed subcutaneous swelling present over the nose and a collapsed nasal valve area on anterior rhinoscopy. FNAC was non-diagnostic and CT scan showed a mildly enhancing mass lesion over the external nose. Complete surgical excision was performed. Diagnosis was confirmed upon postoperative histopathology. During his 2nd week follow up, the patient had a small nasal recurrence, which was treated medically with oral steroids, cetirizine, and pentoxyphylline for 4 weeks. The patient was disease free for 6 months.
 
Conclusion: 
Kimura’s disease, although difficult to diagnosis clinically, should be considered in the differential diagnosis of patients who have a primary lymphadenopathy with eosinophilia with or without subcutaneous nodules. It should be investigated accordingly as the disease has an indolent course and good prognosis

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1. Li TJ, Chen XM, Wang SZ, Fan MW, Semba I,  Kitano M. Kimura's disease. A clinicopathologic study of 54 Chinese patients. Oral Surgery, Oral Medicine, Oral Pathology 1996; 82(5):549–55.

2. Ranka SR, Rajput A, Kantharia CV. Kimura's disease.Indian Journal of Otolaryngology and Head and Neck Surgery 2004; 56(1): 43–5.

3. Kimura T, Yoshimura S, Ishikawa E. On the unusual granulation combined with hyperplastic changes of lymphatic tissue. Trans. Soc. Pathol Japan 1948; 37: 179-80

4. Atar S, Oberman AS, Ben-Izak O, Flatau E. Recurrent Nephrotic syndrome associated with Kimuras disease in a young non-oriental male. Nephron 1994;68(2):259-61

5. Rajpoot DK, Pahl M, Clark J. Nephrotic syndrome associated with Kimura disease. Pediatric Nephrology 2000; 14 (6): 486–8.

6. Armstrong WB, Allison G, Pena F, Kim JK. Kimura's disease: two case reports and a literature review. Annals of Otology, Rhinology and Laryngology 1998; 107(12):1066–71

7. Day TA, Abreo F, Hoajsoe DK, Aarstad RF, Stucker FJ. Treatment of Kimura's disease: a therapeutic enigma. Otolaryngology Head and Neck Surgery 1995; 112 (2): 333–7.

 

8. Aoki A, Shiiki K, Naito H, Ota Y. Cytokine levels and the effect of prednisolone on Kimura's disease: report of a case. Journal of Oral and Maxillofacial Surgery 2001; 59 (10):1238–41.

9.  Hareyama M, Oouchi A, Nagakura H,   Asakura K, Saito A,  Satoh M, et al. Radiotherapy for Kimura's disease: the optimum dosage. International Journal of Radiation Oncology Biology Physics 1998; 40 (3):647–51.

10. Hongcharu W, Baldassano M, TaylorCR. Kimura's disease with oral ulcers: response to pentoxifylline.Journal of the American Academy of Dermatology 2000; 43(5):905–7.