Abstract

Title: Supraorbital arteritis associated with lymphoid follicles and eosinophilia.

Introduction: Kimura disease (KD) is an uncommon lymphoproliferative fibroinflammatory disorder, wherein patients present with subcutaneous nodules of the head and neck, with or without lymphadenopathy. KD has a predilection to younger Asian populations, occasionally with eosinophilia and elevated serum IgE levels. Juvenile temporal arteritis (JTA) with eosinophilia (Kimura disease in association with JTA), described by Fujimoto et al. in 1996, is a less well-documented disease. 

Case Description: We report a rare case of supraorbital arteritis in association with lymphoid follicles and eosinophils in a 62-year-old male. Our patient was referred to plastic surgery for a long-standing lesion to the left eyebrow, obscuring his visual field. He did not endorse additional symptoms. Upon physical exam, the mass was mobile and was not fixed to deep structures locoregionally. Mild eosinophilia was identified on blood work. Intraoperatively, the lesion was found to be closely associated with the supraorbital nerve down to the supraorbital foramen. Histological examination revealed multiple prominent secondary lymphoid follicles with abundant eosinophils, in tandem with eosinophilic arteritis of a large muscular artery (supra-orbital artery).

Discussion: The literature to date is limited in the documentation of KD associated with JTA, and less so in older individuals. Some authors believe that JTA is a manifestation of KD. We report a case of supraorbital arteritis associated with lymphoid follicles and eosinophilia, which may fall within the spectrum of the described cases of Kimura disease in association with juvenile temporal arteritis.