Kimura’s disease: a case report of recurrent bilateral post-auricular masses mimicking keloid and angiolymphoid hyperplasia with eosinophilia

Abstract

Kimura’s disease is a rare chronic inflammatory condition of poorly understood aetiology that presents as painless, slow-growing subcutaneous masses, associated with peripheral eosinophilia and markedly elevated serum immunoglobulin E (IgE) levels. This case highlights an unusual presentation and an important diagnostic pitfall of the disease. It adds to the literature by emphasising the need to consider Kimura’s disease in recurrent post-auricular masses, particularly when eosinophilia and elevated IgE are present. We describe a case of a 22-year-old male with a years-long history and multiple follow-ups for progressively enlarging bilateral post-auricular swellings, with a history of recurrence after an attempt at surgical excision during the course of the disease. The swellings were initially misdiagnosed as keloids, mainly due to their post-auricular location, recurrent course after prior excision, and gross appearance; however, the soft consistency, bilateral distribution, and absence of typical scar-related skin changes were atypical for keloid. They were later thought to be angiolymphoid hyperplasia with eosinophilia (ALHE) on core biopsy, largely because of vascular proliferation, although the subcutaneous nature of the lesions and the presence of lymphoid follicles with germinal centres were not typical for classic ALHE. In view of eosinophilia, markedly elevated serum IgE, and histopathology findings on bilateral excisional biopsy, an impression of Kimura’s disease was made. Three months postoperatively, the patient received intralesional methylprednisolone acetate 40 mg injection under dermatology as local corticosteroid therapy, while immediate radiotherapy was deferred in view of the patient’s young age. Kimura’s disease should be included in the differential diagnosis of recurrent post-auricular swellings, especially in young patients with unusual features of keloid or with eosinophilia.