Case 31A & B

Male 30. Infiltrated scalp nodules and neck

lymphadenopathy for 6 months. Biopsy of

skin (A) and lymph node (B).

The best diagnosis is:

A. Haemangioma

B. Kimura disease

C. Kaposi’s sarcoma

D. Hodgkin’s lymphoma

E. Rosai-Dorfman disease

Initial presentation in community

• 31 year old Jamaican man

• Arrived in UK Nov 2010

• Presented Oct 2011 to GP

• Pruritic nodular prurigo-like rash

• Treated with Ivermectin for ? Scabies

• Incisional biopsy from lesion R thigh

• WCC 31.6 x 109/L

• Eosinophils 24 x

109/L

• Syphilis

• HIV

• Hep B+C

• ANA

• ENA

• UE

• LFT

• Stool

• Parasitic screen

• Urine dip

Case 31

Male 30. Infiltrated scalp nodules and neck

lymphadenopathy for 6 months. Biopsy of

skin (A) and lymph node (B).

The best diagnosis is:

A. Haemangioma

B. Kimura disease

C. Kaposi’s sarcoma

D. Hodgkin’s lymphoma

E. Rosai-Dorfman disease

Kimuras disease • Chronic inflammatory disorder, aetiology unkn

• own

• Rare

• Painless nodules, usually head / neck area

• Associated lymphadenopathy

• M>F, late 20’s, oriental asians

• Histology

• Eosinophilia, Raised total IgE

• Prognosis good, prolonged course

- Nephrotic syndrome in 15-20%

• Management: Steroids, immunosuppressants, excision

• Important DDx: Angiolymphoid Hyperplasia with

eosinophilia- not related

ALHE Kimura’s disease

Presentation Superficial papules or nodules +/or subcutaneous nodules

Large subcutaneous nodules

Localisation Head and Neck Head and Neck

Population Third and fourth decades

Caucasian

Female > male

Younger age

Asian

Male

Regional Lymph nodes

Infrequent Possible

Skeletal involvement No Possible

Blood eosinophilia

Mild Marked

Elevated serum IgE Infrequent

Frequent

Origin of the disease ? Vascular origin (endothelial cell)

Chronic inflammatory process

Adapted from: Head and Face Medicine 2006, 2:32

Differential Diagnoses

• Inflammatory angiomatous nodules

• ALHE

• Pyogenic granuloma

• Histiocytoid haemangioma

• Kaposi’s sarcoma

• Pseudolymphoma (lymphoid hyperplasia)

• Cutaneous lymphoma

• Kimura disease – different entity!! Not

ALHE