Indian Dermatology Online Journal

SKINDIA QUIZ
Year
: 2018  |  Volume : 9  |  Issue : 4  |  Page : 282--283

SkinIndia Quiz 46: Asymptomatic unilateral inguinal swelling with peripheral eosinophilia


Sidharth Tandon1, Jasmeet Singh2, Surabhi Sinha1, Preeti Sharma3,  
1 Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
2 Department of Dermatology, Venereology and Leprosy, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India
3 Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Correspondence Address:
Surabhi Sinha
Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, Baba Kharak Singh Marg, New Delhi - 110001
India




How to cite this article:
Tandon S, Singh J, Sinha S, Sharma P. SkinIndia Quiz 46: Asymptomatic unilateral inguinal swelling with peripheral eosinophilia.Indian Dermatol Online J 2018;9:282-283


How to cite this URL:
Tandon S, Singh J, Sinha S, Sharma P. SkinIndia Quiz 46: Asymptomatic unilateral inguinal swelling with peripheral eosinophilia. Indian Dermatol Online J [serial online] 2018 [cited 2021 Apr 10 ];9:282-283
Available from: https://www.idoj.in/text.asp?2018/9/4/282/231793


Full Text

Clinical History and Examination

A 50-year-old male presented with right-sided inguinal swelling [Figure 1] for the past 1 year. Previously, the patient was clinically diagnosed as a case of tubercular lymphadenopathy and had received 6 months of antitubercular therapy without any noticeable improvement. Cutaneous examination revealed a single, mobile, firm, nontender, matted, irregular mass of size 6 Χ 6 cm in the right inguinal regional with normal overlying skin. Blood investigations showed peripheral eosinophilia (52%) with an absolute eosinophil count of 4500/mm3 and normal erythrocyte sedimentation rate. A regional fine needle aspiration cytology showed features of reactive lymphoid hyperplasia. The results of renal function tests, liver function tests, and routine urine tests were within normal limits, and chest radiography was unremarkable. Mantoux test was 5 × 5 mm.{Figure 1}

Histopathology

A lesional biopsy revealed preserved architecture of lymphoid follicles with prominent germinal centers. Interfollicular areas showed prominence of eosinophils

and plasma cells along with the presence of an occasional multinucleate giant cell [Figure 2]. Eosinophils were also seen infiltrating into lymphoid follicles and the capsule, with proliferation of capillaries and venules [Figure 3]. Stains and cultures were negative for bacteria, fungi, and mycobacteria.{Figure 2}{Figure 3}

What is Your Diagnosis?

 View Answer

 Answer



Kimurafs Disease.

 Discussion



Kimurafs disease (KD) is a chronic inflammatory disease of unknown etiology. It presents as a single or multiple nontender subcutaneous nodules usually in the head and neck region. It has been mostly reported in the Asian population in the second or third decade of life with a male preponderance.[1] Hemogram characteristically reveals peripheral eosinophilia with raised serum IgE levels.[2] Our case presented with inguinal lymphadenopathy, which is a rare site of involvement. The histopathologic features seen with KD are preserved nodal architecture, follicular hyperplasia with florid germinal centers, eosinophilic infiltration of interfollicular areas, and proliferation of blood vessels.[3] Differential diagnoses include Hodgkinfs lymphoma, epithelioid hemangioma, plasma cell Castlemanfs disease, and tuberculosis. Hodgkinfs lymphoma may show eosinophilic infiltration of lymph nodes but Reed Sternberg cells are typically seen. Epithelioid hemangioma is difficult to differentiate from KD histopathologically, with the most prominent difference between the two being in their vasculature. Epithelioid hemangioma shows thick.walled blood vessels with concentric rings of fibrosis, and endothelial cells within the vessels appear eosinophilic with vacuolated cytoplasm having a characteristic hobnail appearance.[4]

Clinically, KD presents with lymphadenopathy, raised serum IgE levels, and is occasionally associated with nephrotic syndrome, ascites, and pleural effusion,[5] whereas epithelioid hemangioma presents with multiple, small dermal papular or nodular lesions which are seen in older patients and have a shorter duration.[4] Treatment options of KD include surgical excision or conservative management such as systemic or intralesional steroid, cytotoxic drugs, or radiotherapy.

The patient was started on oral prednisolone (40 mg), which was continued for 4 weeks till his eosinophil counts reverted back to normal levels and was gradually tapered off over 6 weeks. A single dose of injection triamcinolone 40 mg/ml was also given intralesionally.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

 Conflicts of interest



There are no conflicts of interest.

References

1Takagi K, Harada T, Ishikawa E. Kimura's disease eosinophilic: lymphfolliculoid granuloma. Nihon Rinsho 1993;51:785-8.
2Kuo T, Shih L, Chan H. Kimura's disease. Involvement of regional lymph nodes and distinction from angiolymphoid hyperplasia with eosinophilia. Am J Surg Pathol 1988;12:843-54.
3Chen H, Thompson LD, Aguilera NS, Abbondanzo SL. Kimura disease: A clinicopathologic study of 21 cases. Am J Surg Pathol 2004;28:505-13.
4Lenk N, Artüz F, Kulaçoğlu S, Alli N. Kimura's disease. Int J Dermatol 1997;36:437-9.
5Diwan AW, Godbole GP, Pophale HS, Kulkarni SR. Unusual presentation of Kimura's disease. Saudi J Med Sci 2014;2:52-6.