Eosinophilic granuloma (Kimura's disease) of the orbit: a case report

Background: Eosinophilic granuloma of the soft tissue, Kimura's disease, is a benign slow-growing tumor that is manifested clinically by one or more i nflammatory nodules involving mainly the face and scalp, but rarely the eye . Case report: The patient was a 32-year-old male with swelling of the left l ower eyelid, marked peripheral blood eosinophilia and increased serum immun ogloblin E. MRI revealed swelling of all rectus muscles of the left eye, bu t no tumor mass. Corticosteroid treatment reduced the swelling of the eyeli d, but it recurred after corticosteroid was discontinued. Eight years later the patient returned with a complaint of increased swelling of the left lo wer eyelid. An elastic, nontender, soft tumor mass was palpable subcutaneou sly in the left lower eyelid extending into the orbit. MRI revealed a tumor mass in the left orbital space. The parotid gland was also swollen and pal pable. Both tumors were resected surgically, and histopathological study re vealed prominent proliferation of lymphoid follicles with germinal centers showing interfollicular infiltration by eosinophils. The pathological findi ngs in the parotid gland were similar. The diagnosis was Kimura's disease. Conclusion: This patient is unique in that he had no tumor at the first exa mination, only swelling of the rectus muscles, and a tumor mass appeared ma ny years later. Unilateral swelling of the rectus muscles may be one of the first signs of Kimura's disease. Not only tumor but also swelling of the r ectus muscles limited ocular movement.