Persistent Progressive Peri-Auricular Nodules with Lymphadenopathy

Kimura's disease (KD) is a rare, benign chronic inflammatory disorder of unknown etiology, predominantly affecting young Asian males. It typically presents with painless subcutaneous nodules in the head and neck region, often accompanied by lymphadenopathy, peripheral eosinophilia, and elevated serum IgE levels. We report a case of an 18-year-old male with multiple lobulated, non-tender swellings over the bilateral retroauricular regions and left cheek persisting for eight years. Histopathology from a peri-auricular lesion revealed hyperplastic lymphoid follicles with germinal centers, interfollicular eosinophilic infiltrates, and eosinophilic deposits. Laboratory tests showed marked eosinophilia and elevated IgE. Imaging demonstrated bilateral cervical lymphadenopathy and parotid gland involvement. A diagnosis of KD was made, and the patient responded well to oral corticosteroids. This case underscores the diagnostic challenges posed by KD, particularly in differentiating it from malignancies and angiolymphoid hyperplasia with eosinophilia. Recognition of this entity is crucial to avoid misdiagnosis and ensure appropriate treatment.