Treatment of Kimura's disease by interferon and corticosteroid

Introduction.- A case of Kimura's disease that occurred in a 5-year-old Cau casian boy after a tick bite is reported. When the child was 16 years old, symptoms developed. They included voluminous bilateral neck and head lymph nodes associated with hypereosinophilia (1,640/mm(3)), and increased IgE le vels (18,866 KU/L). Clinical and immunological effects of treatment by inte rferon-alpha and steroids are presented. Exegesis.- Pathological and histological examination showed typical feature s of dense lymphoid cell infiltrates containing many eosinophils, mast cell s, and vascular hyperplasia. Percentages of CD4+, CD27-, CD7- cells were in creased In the blood and lymph nodes, showing a profile typical of TH2. IL- 5 production by these cells was markedly increased and was inhibited by IFA -alpha and IFN-beta in vitro. No etiology was found. The role of antigens o f Ixodes ricinus is discussed. Three surgical excisions of adenopathies wer e not successful. Treatment of IFN-alpha (Introna(R), Schering-Plough, 5.10 6 U/week) and a bolus of methylprednisolone hemisuccinate (1 g/month) was s tarted. Eight months later, the size of the lymph nodes had decreased; howe ver, eosinophil counts and ECP and IgE levels were still high. The decrease in corticosteroid induced a subsequent, slight increase in the size of the lymph nodes and a marked increase in ECP. Conclusion.- This is the first description of treatment of Kimura's disease by interferon-alpha and steroids. The disease outcome does not suggest tha t interferon-alpha may predominant. (C) 1999 Elsevier, Paris.