Kimura's Disease - An Unusual Presentation

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 2(nd) to 4(th) 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 post aural 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.

Keywords: Candida; Eosinophilia; IgE; Kimura’s; Lymphadenopathy; Subcutaneous mass.

Fig 1

Pre op. Picture of patient with nasal mass

Fig 2

CT scan showing mild enhancing mass over nasal bones with no erosion of bones

Fig 3

HPE showing plumb like endothelial cells, eosinophils and interstitial fibrosis