Eosinophilic peritonitis and nephrotic syndrome in Kimura’s disease: a case report and literature review

Abstract

Background: Eosinophilic peritonitis is a relatively rare entity. Kimura's disease is a rare chronic inflammatory disorder of unknown etiology, characterized by subcutaneous nodules mainly in the head and neck region, regional lymphadenopathy and occasional involvement of kidney. There is currently no report of eosinophilic peritonitis in Kimura's disease. Case presentation: A 44-year-old Chinese man presented with abdominal distention, nausea, vomiting and edema in lower limbs for 1 month. Laboratory data showed elevated eosinophils in peripheral blood and ascites, nephrotic syndrome with progressively renal dysfunction, and elevated IgE. Ultrasonography of lymph nodes showed multiple lymphadenopathy in bilateral inguinal regions. Surgical excision was performed for one of the enlarged lymph nodes and histopathology revealed diagnosis of Kimura's disease. Renal biopsy indicated focal segmental glomerulosclerosis (FSGS) and acute tubulointerstitial nephritis with infiltration of eosinophils in renal interstitium. The patient was prescribed with oral prednisolone therapy (30 mg/day), and underwent continuous ambulatory peritoneal dialysis (CAPD). The peripheral and peritoneal eosinophil count decreased rapidly and normalized within 2 days. Forty-five days after prednisolone therapy, partial remission of nephrotic syndrome and decrease of serum creatinine were achieved while peritoneal dialysis dosage had decreased. Inguinal lymph nodes gradually shrunk in size. The overall conditions remain stable afterwards. Conclusions: This rare case highlighted the clinical conundrum of a patient presenting with eosinophilic peritonitis, lymphadenopathy, nephrotic syndrome and renal failure associated with Kimura's disease. The remarkable eosinophilia, pathology of lymph node and kidney, as well as significant response to steroids should guide towards the diagnosis.

Gitelman syndrome combined with diabetes mellitus: A case report and literature review

“…Notably, certain individuals may remain asymptomatic, often leading to misdiagnoses as sporadic hypokalemia or hypomagnesemia. [3] Nonetheless, Severe adverse events have also been reported in the literature, encompassing growth retardation, [2,4] chondrocalcinosis, [5] generalized seizures, [6,7] non-periodic paralysis, [2] rhabdomyolysis, [8] and even cardiac arrest. [9] The course of GS typically follows a mild trajectory, characterized by predominantly modest clinical symptoms.…”

Disease characteristics of 70 patients with Kimura disease

“…Both glucocorticoids and immunosuppressive agents are effective in the treatment of KD and nephrotic syndrome, which may re ect a similarity in the immunopathogenesis of these diseases [12] . Glucocorticoids are known to regulate lymphopoiesis and T cell proliferation, suggesting that defects in T cell immune regulation play a role in the their pathogenesis [13] ; cytokines released by activated T cells may increase the permeability of the glomerular basement membrane, leading to proteinuria [14,15] . We compared clinical data of patients with vs. without renal impairment, and found that the former had lower albumin and total protein levels although there were no differences in their clinical manifestations, eosinophil ratio, creatinine, etc.…”

Eosinophilic interstitial nephritis and cardiac insufficiency in Kimura’s disease: a case report

“…An optimal therapy for KD is not defined due to the rarity of the disease, misdiagnosis and loss of follow-up. It is generally believed that KD-associated renal lesion is a benign course, only a few patients have been reported to progress to end-stage renal disease requiring dialysis [ 3 , 17 ]. Glucocorticoid is the first choice for medical treatment of KD with nephropathy [ 11 ], but it is easy to recur after glucocorticoids withdrawal or dose reduction [ 3 , 9 ].…”