Pulmonary Manifestations of Systemic Disease: Systemic Disease |

Kimura's Disease in Respiratory Department: Two Case Reports FREE TO VIEW

Zheng Wang, MD; Jun Wan, PhD; Juanni Gong, MD; Yuhui Zhang, MD
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Beijing Institute of Respiratory Medicine, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A470. doi:10.1016/j.chest.2016.02.489
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SESSION TITLE: Systemic Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Kimura’s disease is rare especially in respiratory department. But there are still chances to meet the case of Kimura's disease with respiratory situations.

CASE PRESENTATION: Patient 1 A 49-year-old man who had been admitted with intermittent cough for 16 years and recurrent enlargement of left submandibular mass for 6 years. He had undergone submandibular lymphatic nodes (SMLN) surgery for local excision in January 2008, and after short time intravenous drip of methylprednisolone the SMLN got shrinkage and eosinophil level was also dropped to normal. We re-evaluated the pathological section of excised specimens and confirm the diagnosis of Kimura's disease. To explore the reason of cough, bronchial provocation test was applied and the patient was diagnosed as airway hyper reactivity. The patient's cough symptoms and lung function is still on follow-up visit. Patient 2 An 68-year old woman complained with itchy erythematous papules for 3 years, edema of lower extremity for 2 years and pulmonary shadow for 1 year. She was diagnosed as eosinophilic dermitis and nephrotic and prescribed of oral steroid and ciclosporin for the several months. During that treatment, the patient got cough with little sputum and was found nodular shadow in the right upper lobe. Rifampicin and isoniazid could not improve the pulmonary shadow and enlarged lymph nodes. We carried out lymph node and lung biopsy and got the diagnosis of Kimura’s disease accompanied with pulmonary tuberculosis. Treatment of antituberculosis (HRSZ) and mycophenolate alleviated the patient's cough, albuminuria and yielded improved chest CT scan.

DISCUSSION: Kimura’s disease is characteristic of eosinophilia. It could induce lung or bronchial eosinophilia infiltration, which could be the reason of airway hyper reactivity. The key treatment of Kimura’s disease disease includes immunosuppression, which is one of the risk factors of opportunistic infections, such as pulmonary tuberculosis.

CONCLUSIONS: Herein, we have described 2 cases of Kimura’s disease associated with airway hyper reactivity and pulmonary tuberculosis. When patients with Kimura’s disease visited the respiratory department, pulmonologists should consider at high risk for airway hyper reactivity and accompanied opportunistic infections after immunosuppression.

Reference #1: Tsukagoshi H, Nagashima M, Horie T et al. Kimura's disease associated with bronchial asthma presenting eosinophilia and hyperimmunoglobulinemia E which were attenuated by suplatast tosilate (IPD-1151T). Intern Med 1998;37:1064-1067.

Reference #2: Kapoor NS, O'Neill JP, Katabi N et al. Kimura disease: diagnostic challenges and clinical management. Am J Otolaryngol 2012;33:259-262.

DISCLOSURE: The following authors have nothing to disclose: Zheng Wang, Jun Wan, Juanni Gong, Yuhui Zhang

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