Enfermedad de Kimura

Abstract

Introcuction: Kimura disease is a benign disease affecting the subcutaneous tissue and lymph nodes. It was first described in 1937 as eosinophilic hyperplastic lymphogranuloma, and its histological description was later reported by Kimura in 1948. This entity is endemic in parts of Asia (Japan, China and Indonesia), although cases have also been reported in Europe and America in the non-Asian population, with a similar clinicopathological presentation. It is a rare condition with about 300 cases in the world  and it occurs predominantly in men.Clinical case: We report a case of a 15-year-old boy with no history of interest, referred to our departmen due to the appearance of bilateral retroauricular mass, soft and painless. It does not present any other ENT or systemic accompanying clinic. Physical examination revealed only the retroauricular mass referred by the patient. CT scan of the neck, thorax and abdomen was performed, showing right retroauricular ganglion of 24x8mm and left of 6x20mm, with the remainder of the study being normal. The FNAC performed shows polymorph cellularity with abundant eosinophils; all the microbiological studies performed were negative. It was decided to perform exeresis of the tumors. Histopathological examination demonstrates reactive lesion with densed eosinophils compatible with Kimura disease.Discussion: Although the aetiology of this disease is unknown, it is considered the result of inflammation caused by immune dysfunction. It may be associated with autoimmunity, insect bites or infections and allergies caused by parasites. Clinical symptoms of Kimura disease include a painless soft tissue mass, with peripheral lymphadenopathy in the neck and submandibular region. Kimura disease may be misdiagnosed as malignant tumors, including T-cell lymphoma, Kaposi sarcoma, Hodgkin disease, or parotid tumor). Eosinophilia is the most important finding and it must identified to establish a positive diagnosis. Although Kimura disease shows a benign course, activated T cells may increase the permeability of the glomerular basement membrane and cause proteinuria and nephrotic síndrome. Treatment modalities reported in the literature are heterogeneous, but surgical removal and oral corticosteroids represent the most frequently used strategies.