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Fenech M, Ajanaku A, McCormick A, Coupland SE, Krishna Y, Sultan Z, Ghadiri N. Orbital Kimura disease: maintenance therapy using mycophenolate mofetil. Orbit 2024:1-8. [PMID: 38815210 DOI: 10.1080/01676830.2024.2358061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
Kimura disease (KD) is a rare, chronic, inflammatory condition, predominantly found in male patients of Asian ethnicity. It typically presents between 50-60 years of age and usually with bilateral disease. Angiolymphoid hyperplasia with eosinophilia (ALHE) remains the main differential diagnosis, although histological analysis is essential in differentiating from other similarly presenting pathologies. In this case, we present an atypical case of unilateral orbital KD in a middle-aged, Caucasian, male gentleman and no evidence of regional lymphadenopathy along with a literature review of orbital KD and the differential diagnoses, histological features and management modalities available, adding to the sparse literature on the topic. At present, no recognised diagnostic criteria for KD are available, with histopathological analysis through incisional or excisional biopsy being the primary diagnostic method. Complete surgical excision with or without corticosteroid management remains the most common treatment modality although management is shifting to steroid-sparing immunomodulatory therapy. To the best of our knowledge, this is the first case to describe maintenance therapy of KD using mycophenolate mofetil.
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Affiliation(s)
- Matthew Fenech
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ayodeji Ajanaku
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Austin McCormick
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sarah E Coupland
- Department of Histopathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Yamini Krishna
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ziyaad Sultan
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Nima Ghadiri
- Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Nagao N, Yabe H, Hirai K, Hiruta M, Ookawara S, Morishita Y, Nagashima T. Case report: Minimal change nephrotic syndrome in a patient with juvenile temporal arteritis and eosinophilia. Int J Rheum Dis 2024; 27:e15169. [PMID: 38706213 DOI: 10.1111/1756-185x.15169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Natsumi Nagao
- Division of Rheumatology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroki Yabe
- Division of Rheumatology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masahiro Hiruta
- Department of Pathology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takao Nagashima
- Division of Rheumatology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Brito MT, Baptista D, Pereira E, Fonseca E, Almeida JS. Kimura's Disease: A Literature Review Based on a Clinical Case. Cureus 2023; 15:e50463. [PMID: 38222219 PMCID: PMC10786330 DOI: 10.7759/cureus.50463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Kimura's disease (KD) was first described in 1937. It is a rare, benign, and chronic immune-mediated inflammatory disorder affecting the subcutaneous tissue, salivary glands, and lymph nodes. The disease is more common in the second to third decades of life in middle-aged Southeast Asian countries. The cause of Kimura's disease remains unknown; some authors believe it is related to an autoimmune or delayed-type hypersensitivity reaction. It commonly presents as a solitary painless lymph node in the head and neck or generalized lymphadenopathy (67%-100%) associated with peripheral eosinophilia and elevated IgE levels. Renal involvement may occur in some patients. Diagnosis is made by histology. A 21-year-old Caucasian man with no relevant medical history presented with a non-tender swelling of the left hemiface without other associated symptoms. Laboratory investigations revealed a leukocyte count with eosinophilia (2.29×10^9/L- 26.5%) and elevated total IgE and IgG4. He had no renal dysfunction. He underwent surgical resection of the lesion in the jugal, infraorbital, and left nasolabial regions, and the anatomopathological examination revealed the characteristics of Kimura's disease. Three months after surgery, an MRI showed an increase in the size of the mass, and he was started on corticosteroids. Six months after surgery, he presented with a slight increase in the size of the mass and was started on Ciclosporin, which allowed a progressive reduction in the dose of corticosteroid with evidence of a progressive reduction in swelling. Ciclosporin was stopped due to toxic serum levels, and he was started on mycophenolate mofetil. The dose was increased because of the increase in facial mass; on mycophenolate mofetil 2500mg/day, the patient remains stable. KD is a chronic disorder of unknown etiology that mainly affects young people in Southeast Asia and is rare in Western countries, as in the case of this young man. Studies have shown no significant differences in region or race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, or IgE levels between age groups. There is no consensus on the optimal treatment for KD; several treatments have been used, including surgery, systemic corticosteroids, immunosuppressants, and radiation. Due to the tendency to relapse and the rarity of the disease, there is no consensus on treatment options for relapse.
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Affiliation(s)
- Maria Teresa Brito
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Diana Baptista
- Pathologic Anatomy, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Edite Pereira
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Elsa Fonseca
- Pathologic Anatomy, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Jorge S Almeida
- Medicine, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, PRT
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
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Braun J, Mairinger T, Kaschke O, Behrendt K, Ramsbacher J, Karberg K. Bilateral swelling of the salivary glands and sicca symptoms: an unusual differential diagnosis-Kimura's disease, a rare allergic condition with a high IgE serum level-a case report and review of the literature. RMD Open 2023; 9:rmdopen-2023-003135. [PMID: 37164447 PMCID: PMC10173963 DOI: 10.1136/rmdopen-2023-003135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 05/12/2023] Open
Abstract
A 68-year-old woman presented with bilateral swelling of the salivary glands, sicca symptoms of eyes and mouth, itching, fatigue and weight gain of about 5 kg in the last 2-3 years. As part of a careful diagnostic work up including lab tests for antinuclear antibodies (ANA), antibodies to extractable nuclear antigens (ENA), anti-neutrophilic cytoplasmatic antiobodies (ANCA), immunoglobulin (Ig)G4, a whole body computed tomography (CT) and a parotid biopsy several rheumatic diseases such as Sjoegren's syndrome, IgG4-related disease and sarcoidosis were ruled out and, considering a very high titre of IgE, Kimura's disease was diagnosed. The case and a short review of the literature are presented.
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Affiliation(s)
- Jüergen Braun
- Rheumapraxis Berlin, Ruhr University Bochum, Berlin, Germany
| | - Thomas Mairinger
- Dept. of Pathology, Medizinisches Versorgungszentrum am Helios Klinikum Emil von Behring, Berlin, Germany
| | - Oliver Kaschke
- Dept of Otorhinolaryngology, St.Gertrauden Krankenhaus, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kai Behrendt
- Roentgenpraxis Radiologie Eins, Humboldt-Universitat zu Berlin, Berlin, Germany
| | - Josef Ramsbacher
- Praxis für Neurochirurgie, Humboldt-Universitat zu Berlin, Berlin, Germany
| | - Kirsten Karberg
- Rheumapraxis Berlin, Humboldt-Universitat zu Berlin, Berlin, Germany
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Lee CC, Chang SY, Teng WC, Wu CJ, Liu CH, Huang SW, Wu CE, Yu KH, Chan TM. Coexisting Nodular Sclerosis Hodgkin Lymphoma and Kimura's Disease: A Case Report and Literature Review. Int J Mol Sci 2023; 24:ijms24087666. [PMID: 37108825 PMCID: PMC10146151 DOI: 10.3390/ijms24087666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Kimura's disease (KD) is a rare lymphoproliferative fibroinflammatory disorder that commonly affects the subcutaneous tissue and lymph nodes of the head and neck. The condition is a reactive process involving T helper type 2 cytokines. Concurrent malignancies have not been described. Differential diagnosis with lymphoma can be challenging without tissue biopsy. Here, we present the first reported case of coexisting KD and eosinophilic nodular sclerosis Hodgkin lymphoma of the right cervical lymphatics in a 72-year-old Taiwanese man.
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Affiliation(s)
- Chih-Chun Lee
- Department of Medical Education, Chang Gung Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan
| | - Sing-Ya Chang
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Wen-Chieh Teng
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Chih-Ju Wu
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Chi-Hung Liu
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Szu-Wei Huang
- Division of Rheumatology, Allergy, and Immunology at Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Chiao-En Wu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology at Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Tien-Ming Chan
- Division of Rheumatology, Allergy, and Immunology at Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
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