Kimura Disease Manifesting as Synchronous Bilateral Parotid Swelling in a Young Middle-Eastern Patient

Abstract

Kimura disease is a rare, benign, chronic inflammatory swelling of the subcutaneous tissue, lymph nodes, and glandular tissue. Characteristic features of the disease include, but not limited to, painless subcutaneous head and neck swelling, blood and tissue eosinophilia, and markedly elevated immunoglobulin E (IgE) levels. Herein, we report a rare case of Kimura disease manifesting as synchronous bilateral parotid swelling of 12 years duration in a 33-year-old Middle-Eastern man. To our knowledge only few cases have been reported in the literature involving bilateral parotid glands, and this is the first case to be reported in the Middle East.

Kimura’s disease: a diagnostic and therapeutic enigma

“…1 It is a rare benign chronic inflammatory disease, presenting as a slowly growing soft tissue swelling associated with lymphoid and peripheral blood eosinophilia. Lymph nodes of head and neck are most commonly involved mimicking neoplastic lymphoproliferative disorder.…”

“…Axilla, popliteal region, orbit, groin and forearm are other less commonly involved sites. 1 Although it may mimic a neoplastic process but peripheral blood eosinophilia, increased serum IgE concentration andhistopathological findings suggest an immunological etiology to an unknown stimulus. Other postulated theories are allergic reaction, stimulation following arthropod bites, parasitic or candidal infection.…”

“…Asian population is more often affected with a male preponderance in a ratio of 3:1 in 2 nd and 3 rd decade. 1,2 Even though benign in nature its incidence of recurrence and devastating complications sometimes leading to disfigurement is a cause of much concern for the patient.…”

Synchronous Kimura lesions at two different sites–a diagnostic dilemma!

“…Histological diagnosis is often confirmatory, with the diagnosis established on lymph node or salivary gland specimen (1,3). Characteristic histological features of lymph nodes in KD include: follicular hyperplasia with reactive germinal centers and well-formed mantle zones, prominent eosinophilic microabscesses, eosinophilic folliculolysis along with proliferation of postcapillary venules.…”

“…Kimura disease (KD) is a rare chronic inflammatory disease of unknown etiology, which usually manifests with unilateral soft tissue swellings with no malignant potential in the head and neck region, including salivary glands and lymph nodes and is associated with peripheral blood eosinophilia and raised IgE levels (1). It most commonly occurs in young male adults in their second and third decades of life and is considered to be an endemic disease of Asia, which should be borne in mind in the differential diagnosis of head and neck swellings (2).…”