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Kimura disease: a case report of a rare illness presenting as a common complaint

  • Margaret L. Rush EMAIL logo , Alexandra Mauro and Priti Bhansali
Published/Copyright: February 22, 2019
Diagnosis
From the journal Diagnosis Volume 6 Issue 4

Abstract

Background

Kimura is an uncommon inflammatory cause of pediatric head and neck masses due to eosinophilic infiltration of unclear etiology. Kimura can present similarly to infectious lymphadenitis, a much more common pediatric complaint. This case explores the role of anchoring bias when faced with an illness that at first appears to fit a common illness script that led to a delayed diagnosis.

Case presentation

A 7-year-old boy presented with acute onset of pre-auricular lymphadenopathy and fevers initially thought to be most consistent with infectious cervical lymphadenopathy. Despite treatment with broad spectrum antibiotics and multiple evaluations for underlying abscess requiring surgical drainage, the patient did not improve and remained febrile. Eventually, excisional lymph node biopsy was obtained and a pathologic diagnosis of Kimura disease was made.

Conclusions

This case illustrates an uncommon pediatric diagnosis which presented similarly to infectious cervical lymphadenitis without additional laboratory features consistent with Kimura. We highlight the role of anchoring bias and care fragmentation leading to repeat imaging and delayed biopsy in the eventual diagnosis of a rare illness.

Keywords: anchoring bias; care fragmentation; cervical lymphadenopathy; Kimura disease; parotiditis; pediatric
Corresponding author: Margaret L. Rush, MD, Department of Hospital Medicine, Children’s National Medical Center, 111 Michigan Drive, NW, Washington, DC 20001, USA, Phone: +(202) 476-5044

  1. Author contributions: Dr. Rush conceptualized the manuscript, drafted the initial article and reviewed the relevant literature. Dr. Mauro provided input on the clinical course of the patient and edited the manuscript. Dr. Bhansali conceptualized the case report and critically reviewed the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

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Received: 2018-10-24
Accepted: 2019-01-28
Published Online: 2019-02-22
Published in Print: 2019-11-26

©2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Competencies for improving diagnosis: an important developmental step forward
  4. Guidelines and Recommendations
  5. Recommendations for using the Revised Safer Dx Instrument to help measure and improve diagnostic safety
  6. Review
  7. What interventions could reduce diagnostic error in emergency departments? A review of evidence, practice and consumer perspectives
  8. Original Articles
  9. Competencies for improving diagnosis: an interprofessional framework for education and training in health care
  10. Primary adrenal insufficiency in the United States: diagnostic error and patient satisfaction with treatment
  11. Follow-up of incidental pulmonary nodules and association with mortality in a safety-net cohort
  12. Assessing diagnostic error in cerebral venous thrombosis via detailed chart review
  13. Can citrate plasma be used in exceptional circumstances for some clinical chemistry and immunochemistry tests?
  14. Clinical impact of citrate-containing tubes on the detection of glucose abnormalities by the oral glucose tolerance test
  15. Letter to the Editor
  16. Public perception of diagnostic and laboratory errors among Internet users
  17. Case Report – Lessons in Clinical Reasoning
  18. Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of chest pain and shortness of breath
  19. Case Report
  20. Kimura disease: a case report of a rare illness presenting as a common complaint
  21. Acknowledgment
  22. Congress Abstracts
  23. The Diagnostic Error in Medicine 12th Annual International Conference
https://doi.org/10.1515/dx-2018-0096
Keywords for this article
anchoring bias; care fragmentation; cervical lymphadenopathy; Kimura disease; parotiditis; pediatric

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Competencies for improving diagnosis: an important developmental step forward
  4. Guidelines and Recommendations
  5. Recommendations for using the Revised Safer Dx Instrument to help measure and improve diagnostic safety
  6. Review
  7. What interventions could reduce diagnostic error in emergency departments? A review of evidence, practice and consumer perspectives
  8. Original Articles
  9. Competencies for improving diagnosis: an interprofessional framework for education and training in health care
  10. Primary adrenal insufficiency in the United States: diagnostic error and patient satisfaction with treatment
  11. Follow-up of incidental pulmonary nodules and association with mortality in a safety-net cohort
  12. Assessing diagnostic error in cerebral venous thrombosis via detailed chart review
  13. Can citrate plasma be used in exceptional circumstances for some clinical chemistry and immunochemistry tests?
  14. Clinical impact of citrate-containing tubes on the detection of glucose abnormalities by the oral glucose tolerance test
  15. Letter to the Editor
  16. Public perception of diagnostic and laboratory errors among Internet users
  17. Case Report – Lessons in Clinical Reasoning
  18. Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of chest pain and shortness of breath
  19. Case Report
  20. Kimura disease: a case report of a rare illness presenting as a common complaint
  21. Acknowledgment
  22. Congress Abstracts
  23. The Diagnostic Error in Medicine 12th Annual International Conference
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