Isolated Cervical Lymph Node Kimura Disease in a Child Mimicking Tuberculosis: A Diagnostic Challenge

ABSTRACT: Kimura disease (KD) is a rare, benign chronic inflammatory disease. It is characterized by a painless progressive mass, mainly located in the head-and-neck region, elevated eosinophil count, and increased serum immunoglobulin E (IgE) level. It is most commonly diagnosed in Asian males but rarely presents in childhood. A 16-year-old male child was admitted with a complaint of progressive round, nodular swelling in the left side of the neck lasting for 4 months. It was preceded by low-grade fever but not associated with excessive sweating and weight loss. In general examination, icterus and cervical and axillary lymphadenopathy were present. In abdominal examination, no visceromegaly was found. Complete blood count showed total leukocyte count - 22990/mm3, and high eosinophil - 42.9%. Serum IgE level was >4000 IU/Ml. In the excisional biopsy showed lymphoid tissue with hyperplastic lymphoid follicles showing prominent germinal centers comprising centrocytes, centroblasts, and follicular dendritic cells. Interfollicular areas reveal dense eosinophilic infiltrate. Few eosinophilic microabscesses along with multinucleated giant cells are noted. On the above evidence, KD of the lymph node was diagnosed. The child was treated with oral prednisolone 2 mg/kg/day for 2 weeks, and then it was tapered to 0.6 mg/kg/day and given for 2 months. KD rarely affects children and is easily missed and misdiagnosed as tuberculosis and other neoplastic diseases. Any child presented with painless soft tissue in the neck and cervical region which not respond to an antibiotic course, KD should be suspected if the eosinophil count and IgE level are high.