Kimura's disease: a mysterious orbital mass

Area of Science:

• Ophthalmology
• Immunology
• Pathology

Background:

• Kimura's disease is a rare, benign inflammatory condition characterized by lymphadenopathy and eosinophilia, often affecting the head and neck.
• Orbital involvement, though uncommon, can lead to significant ocular morbidity, including proptosis and visual impairment.

Purpose of the Study:

• To report a case of Kimura's disease presenting as an orbital mass in a young male.
• To highlight the diagnostic challenges and successful management of orbital Kimura's disease.

Main Methods:

• Clinical presentation, ocular examination, laboratory investigations (TLC, ESR, eosinophilia), and MRI findings were analyzed.
• Fine-needle aspiration cytology (FNAC) and histopathology were crucial for diagnosis.
• Treatment involved oral leflunomide and prednisolone.

Main Results:

• The patient presented with right lower eyelid swelling, proptosis, and restricted eye movement.
• Hematological tests showed elevated TLC, ESR, and eosinophilia.
• MRI revealed a lesion involving the inferior rectus muscle, confirmed as Kimura's disease by FNAC and histopathology.
• Treatment resulted in rapid symptom improvement and complete resolution of the mass within 2 months.

Conclusions:

• Kimura's disease should be considered in the differential diagnosis of orbital masses, especially in the presence of eosinophilia.
• Multimodality diagnostic approaches, including imaging and histopathology, are essential.
• Systemic immunosuppressive therapy, such as leflunomide and corticosteroids, can effectively manage orbital Kimura's disease.