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Orbital Kimura disease: maintenance therapy using mycophenolate mofetil.

Matthew Fenech1, Ayodeji Ajanaku1, Austin McCormick1

  • 1Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.

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Summary

Kimura disease (KD), a rare inflammatory condition, typically affects Asian males. This case highlights an unusual unilateral orbital presentation in a Caucasian male, exploring novel treatment with mycophenolate mofetil.

Keywords:
Kimura diseaseangiolymphoid hyperplasia with eosinophiliabiopsymycophenolate mofetilorbit

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Area of Science:

  • Ophthalmology
  • Dermatology
  • Pathology

Background:

  • Kimura disease (KD) is a rare, chronic inflammatory condition often affecting Asian males, typically presenting bilaterally in middle age.
  • Angiolymphoid hyperplasia with eosinophilia (ALHE) is a key differential diagnosis, necessitating histological analysis for accurate differentiation.
  • Current diagnostic criteria for KD are lacking, with histopathology via biopsy being the primary diagnostic method.

Purpose of the Study:

  • To report an atypical case of unilateral orbital Kimura disease in a middle-aged Caucasian male.
  • To review the literature on orbital KD, its differential diagnoses, histology, and management.
  • To present the first reported case of maintenance therapy for KD using mycophenolate mofetil.

Main Methods:

  • Case presentation of unilateral orbital Kimura disease.
  • Comprehensive literature review of orbital KD and related conditions.
  • Histopathological analysis for diagnosis.

Main Results:

  • An atypical case of unilateral orbital KD in a Caucasian male without lymphadenopathy was identified.
  • Literature review confirmed the rarity of orbital KD and highlighted diagnostic and management challenges.
  • Mycophenolate mofetil was successfully used as maintenance therapy, a novel approach for KD.

Conclusions:

  • Orbital Kimura disease can present atypically in non-Asian, Caucasian males.
  • Management strategies are evolving towards steroid-sparing immunomodulatory therapies.
  • Mycophenolate mofetil shows promise as a maintenance therapy for Kimura disease.