Recurrent nephrotic syndrome associated with Kimura's disease in a young non-Oriental male

A case of minimal change nephrotic syndrome complicated by Kimura disease treated with rituximab

Kimura disease (eosinophilic granuloma of the soft tissue) is a benign granulomatous disease complicated by nephrotic syndrome. Herein, we report a case of recurrent minimal change nephrotic syndrome (MCNS) complicated by Kimura disease that was successfully treated with rituximab. A 57-year-old man presented to our hospital with relapsed nephrotic syndrome with worsening swelling of the right anterior ear and elevated serum IgE. MCNS was diagnosed on renal biopsy. Treatment with 50 mg of prednisolone rapidly placed the patient in remission. Therefore, RTX 375 mg/m2 was added to the treatment regimen, and steroid therapy was tapered. Early steroid tapering was successful, and the patient is currently in remission. In this case, the nephrotic syndrome flare-up was accompanied by worsening Kimura disease. Rituximab reduced the worsening of symptoms related to Kimura disease, including head and neck lymphadenopathy and elevated IgE levels. Kimura disease and MCNS may share a common IgE-mediated type I allergic condition. Rituximab effectively treats these conditions. In addition, rituximab suppresses Kimura disease activity in patients with MCNS, enables early tapering of steroids, and reduces the total dose of steroids.

Kimura's Disease—A Rare Cause of Postauricular Swelling: A Case Report from the Hilly Region

Kimura's disease (KD) is a chronic inflammatory disorder of the lymph node which is very rare in the Indian population. A 34-year-old female presented with left postauricular region swelling for the past 3 years at an outpatient department. On histopathological examination, it was diagnosed as KD. It should be kept in mind when treating a patient with lymphadenopathy and eosinophilia or a high immunoglobulin E level. This unique case report highlights this impressive clinical entity.

Kimura's disease involving bilateral lacrimal glands and extraocular muscles along with ipsilateral face: A unique case report

A 23 year female presented with bilateral recurrent swelling of eyelids along with ptosis and proptosis for last 3 years. She also had swellings over the right cheek, parotid gland, and retro auricular area along with regional lymphadenopathy. Systemic laboratory workup revealed raised serum IgE and a high peripheral eosinophil count. Computed tomography and magnetic resonance imaging showed bilateral enlargement of extraocular muscles, lacrimal glands, and ipsilateral parotid gland. Excision biopsy of the retro-auricular lymph node was suggestive of Kimura's disease (KD). The patient responded well to systemic corticosteroid. KD rarely affects orbit, but it should be included in the differential diagnosis of inflammatory diseases of the orbit. To our knowledge, this is the first reported case of KD from India involving the orbit, lacrimal gland, extraocular muscles, parotid gland and buccal area.

Kimura's disease: effects of age on clinical presentation

BACKGROUND

Kimura's disease (KD) is known to be dominant among young Asian men, but it can also occur in middle- and advanced-aged people. The clinical characteristics of KD, especially by age, are not well known.

AIM

This study was performed to investigate the effects of age on the clinical characteristics of KD.

DESIGN

We conducted a case series study.

METHODS

All case studies of patients diagnosed with KD were collected via a PubMed search of studies published until August 2018. The data were analyzed by age group.

RESULTS

In total, 215 studies were reviewed (238 patients; mean age of 36 years). The male:female ratio was 4:1 overall, 17:1 in patients aged <20 years, 4:1 in patients aged 20-39 years and 2:1 in patients aged ≥40 years (P = 0.01). The percentage of patients with pruritus was 15.4% overall, 3.8% in patients aged <20 years, 15.5% in patients aged 20-39 years and 21.7% in patients aged ≥40 years (P = 0.02). The time to diagnosis was 5.3 years overall, 3.2 years in patients aged <20 years, 4.7 years in patients aged 20-39 years and 7.1 years in patients aged ≥40 years (P < 0.01).

CONCLUSIONS

The proportion of female patients affected the incidence of pruritus, and the time to diagnosis increased as the patients' age increased. There were no significant age-related differences in region/race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, immunoglobulin E level, initial treatment, recurrence or outcomes. This may be useful information for the diagnosis of KD.

Increased CD45RO+ CD62L+ CD4+ T-cell subpopulation responsible for Th2 response in Kimura's disease

Kimura's disease is characterized by subcutaneous masses, eosinophilia, and markedly elevated serum immunoglobulin E, suggesting that T helper (Th)2 cells may play a role in the pathogenesis. We investigated Th2 cytokine synthesis by mononuclear cells and possible Th1/Th2 subpopulations in Kimura's disease. Peripheral blood samples were obtained from seven patients with Kimura's disease and CD4(+) T-cell subpopulations separated by CD45RO and CD62L were isolated. Purified cells were stimulated with PHA or anti-CD3 mAb, and the cytokine levels were measured by Cytometric Bead Array kit. Peripheral blood mononuclear cells in the majority of the patients produced Th2 cytokines such as interleukin (IL)-3, IL-4, IL-5, IL-13 or GM-CSF higher than those of controls. The ratio of CD45RO(+) CD62L(+) cells in CD4(+) T cells was increased in six out of seven patients compared to age-matched controls. Especially, patient 1 had remarkably increased levels of CD45RO(+) CD62L(+) population in CD4(+) T cells. In addition, IL-4 production levels by CD45RO(+) CD62L(+) CD4(+) T cells of patients 1 and 2 were higher than those of their CD45RO(+) CD62L(-) CD4(+) T cells, in the same manner as those by a normal control. Taken together, the synthesis of Th2 cytokines and CD62L-positive subpopulation in CD45RO(+) CD4(+) T cells, which may represent characteristics of Th2, are increased in patients with Kimura's disease, suggesting that deviation to Th2 may involve in pathogenesis of the disease.

Kimura's disease

A 12 year old child developed primary unilateral cervical mass. Routine investigations were inconclusive except cosinophibilia. Excision biopsy revealed the diagonisis as Kimura's Disease. Retrospective investigations confirmed it. This disease should be suspected when a patient presents with tetrad of painless unilateral cervical lymphodenopathy. Eosinophilia, Hyperimmunoglobulimemia (††/gE) & Positive Candida Specific Antibodies. A flow chart has been drawn to treat this condition after review of literature.

Kimura's Disease: Report of a Case & Review of Literature

Kimura's disease is an uncommon allergic disorder of unknown etiology affecting sporadic populations. A male patient in his third decade presented with a swelling in his left facial region. His investigations showed a raised eosinophil count. The lesion was excised surgically. He was put on a short term steroid therapy. Biopsy revealed it as Kimura's disease. Subsequent follow-ups have been satisfactory with no recurrences.

Kimura's disease mimicking an earlobe keloid

Kimura's disease (KD) is a rare chronic inflammatory disorder of unknown aetiology. It usually presents as soft-tissue masses predominantly in the head or neck region. We report a case of an asymptomatic tumour on the left earlobe mimicking a keloid. The tumour was histopathologically diagnosed as KD. This case suggests the importance of conducting skin biopsies of keloidal lesions on head and neck regions, particularly in patients who have peripheral eosinophilia and increased IgE levels.

Bilateral asymmetric superficial soft tissue masses with extensive involvement of both upper extremities: demonstration of Kimura's disease by US and MRI (2008: 12b)

Kimura's disease is known as a rare chronic inflammatory disease occurring mainly in the head and neck regions of Asian male patients. We present a case of Kimura's disease with extensive involvement of the bilateral upper extremities in a 20-year-old Korean man. Ultrasonography (US) and magnetic resonance imaging (MRI) demonstrated the presence of partially ill-defined, conglomerated soft tissue masses centered in the subcutaneous layer of both upper arms, with cranial extension along the cutaneous nerve in the right lesion. Medial epitrochlear, axillary and lower cervical lymphadenopathy accompanied the masses.

Kimura's disease--an unusual cause of lymphadenopathy in children

Kimura's disease is a rare inflammatory disorder of unknown cause primarily seen in young Asian males. The disease is characterized by a triad of painless subcutaneous masses in the head or neck region, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E levels. We describe a 3-year-old Indian boy with Kimura's disease who presented with generalized lymphadenopathy. The diagnosis was based on the characteristic histopathologic findings after surgical excision in conjunction with peripheral eosinophilia and elevated serum immunoglobulin E levels.

Kimura Disease

We have encountered 11 cases of Kimura disease, comprising 10 males and 1 female. The ages at presentation ranged from 16 to 48 years, with a mean of 31.5 years. The sites of the subcutaneous masses were bilateral posterior auricular regions in two cases, frontal region in two cases, temporal region in two cases, head region in one case, parotid region in two cases, parotid and temporal regions in one case, and left earlobe in one case. The interval from onset to surgery ranged from 1 to 10 years, with a mean of 4.7 years. For diagnostic imaging, a combination of magnetic resonance imaging (MRI) and ultrasonography had a high diagnostic value. MRI depicted abnormalities at sites in contact with bone, such as posterior auricular regions, and sites with abundant soft tissue, such as parotid and cheek regions. Diffuse atrophy of subcutaneous fat was observed at the sites of the masses. On ultrasonography, the interior of lymph nodes was homogeneous and hyperechoic, whereas the periphery was hyperechoic, and blood vessels entering lymph nodes were clearly depicted. Surgery was performed in all cases. Postoperative adjuvant radiotherapy was conducted in one patient and radiotherapy and steroid therapy in one other patient. There were two relapses, and both were excised by repeated surgery. Surgical excision of the subcutaneous mass in Kimura disease has the advantages that the treatment period is short and precise histopathologic diagnosis can be obtained.

Kimura disease with advanced renal damage with anti-tubular basement membrane antibody

Kimura disease (KD) is an autoimmune eosinophilic granulomatous disorder with generalized lymphadenopathy. A handful of pediatric patients with renal disease have been described, none of whom have been African-American (AA). We present an AA boy with KD and nephrotic syndrome (NS). Two months after stopping steroids, fever, asthma, eczema, and proteinuria recurred. His NS did not relapse but his platelet count decreased to 51,000/microl (x10(6)/l). On restarting prednisone, his platelet count normalized. A kidney biopsy revealed 23 of 37 glomeruli obsolescent and advanced damage with over 50% of cortical tissue replaced by interstitial fibrosis and chronic inflammation. Glomerular immunofluorescence was largely negative; very intense linear anti-tubular basement membrane (TBM) deposits of IgA, IgG, C3, and C4 were noted. At present, 36 months from onset, serum creatinine is 1.2 mg/dl (106 micromol/l). We present a 4-year-old AA boy with KD, NS, relapsing thrombocytopenia, and renal damage with anti-TBM antibody.

Magnetic resonance imaging findings in Kimura?s disease

Although early diagnosis of Kimura's disease, a rare chronic inflammatory disorder most commonly presenting with asymmetric swelling in the head and neck region, is helpful in avoiding unnecessary diagnostic tests and starting prompt treatment, only a few reports emphasized radiological findings in detail. Magnetic resonance imaging findings showing the infiltrative nature of the disease and diffuse loss of fat tissue even in nonpalpable normally appearing regions of the head and neck in a young man with Kimura's disease are presented in this report.

Kimura's disease: a diagnostic challenge

Kimura's disease is a rare inflammatory disorder of unknown cause, primarily seen in young Asian males. The disease is characterized by a triad of painless subcutaneous masses in the head or neck region, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E levels. We describe an 11-year-old Asian boy with Kimura's disease who presented with a chronic left neck mass. The diagnosis was based on the characteristic histopathologic findings after surgical excision in conjunction with peripheral eosinophilia and elevated serum immunoglobulin E levels. Pediatricians in western countries should be aware of the clinical presentation of Kimura's disease.

Kimura's disease with oral ulcers: response to pentoxifylline

We describe a man with Kimura's disease whose presentation included lymphadenopathy and cutaneous nodules, but was most distinctive for painful oral ulcerations. His lesions showed an initially moderate, but ultimately minimal response to monthly triamcinolone injections. With oral pentoxyifylline, he showed resolution of all of his lesions for 14 months. On cessation of his treatment, his disease flared for 3 months. When pentoxyifylline was restarted, his lesions regressed again within 4 weeks. We review the literature on Kimura's 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: an unusual cause of cervical tumour

An 11 year old Chinese boy developed a unilateral cervical mass associated with pronounced eosinophilia and a marked increase in IgE concentrations. A biopsy sample showed massive eosinophilic tissue infiltration consistent with Kimura's disease. This disorder should be suspected when the clinical triad of painless unilateral cervical adenopathy, hypereosinophilia, and hyper-IgE is present, particularly in male Asian patients.

Kimura's disease: a clinicopathologic study of 54 Chinese patients

Kimura's disease, a chronic inflammatory condition of unknown cause, is endemic in Orientals. The present study documented 54 cases of Kimura's disease in patients from mainland China. The main clinical features of this series included young and middle-aged male predominance (male:female = 3.5:1), predilection for the head and neck regions, and a long duration. The disease presented as either single (31 cases), or multiple lesions (23 cases), and mainly involved subcutaneous tissues (29 cases), major salivary glands (21 cases), and lymph nodes (17 cases) in isolation or in combination. Histopathologically, the lesion was characterized by hyperplasia of lymphoid tissue with well-developed lymphoid follicles, marked infiltration of eosinophils, proliferation of thin-walled capillary venules, and varying degrees of fibrosis. Distinctive features of salivary glands and nodal involvement were also described. Differences between Kimura's disease and angiolymphoid hyperplasia with eosinophilia, mostly reported in the West, were discussed to draw attention to their distinction.