Kimura disease in a patient with renal allograft failure secondary to chronic rejection.
Recent studies suggest that CD4(+ )T helper 2 (Th2) cell proliferation and overexpression of Th2 cytokines may play an important role in the development of Kimura disease. Chronic rejection of a renal allograft by the indirect allo recognition pathway is also induced by Th2 cytokines. We report a 12-year-old boy who had presented with nephrotic syndrome 10 years previously. He was found to have focal segmental glomerulosclerosis, which was attributed to vesicoureteral reflux, and he underwent renal transplantation at the age of 5 years. Allograft dysfunction secondary to chronic rejection was noted by 2 years post transplant, after which continuous ambulatory peritoneal dialysis was instituted. After discontinuation of immunosuppressive therapy, he progressively developed peripheral eosinophilia and eczema, followed by cervical lymphadenopathy and then epitrochlear lymphadenopathy. Kimura disease was diagnosed on lymph node biopsy. Our patient demonstrated that Kimura disease can occur after renal allograft failure secondary to chronic rejection. Both disorders involve the Th2-dominant immune response, according to previous observations.
Lu
Hsiang-Ju
HJ
Department of Pediatrics, Mackay Memorial Hospital, 92, Section 2, Chung San North Road, Taipei 104, Taiwan.
Tsai
Jeng-Daw
JD
Sheu
Jin-Cherng
JC
Tzen
Chin-Yuan
CY
Tsai
Tsuen-Chiuan
TC
Lin
Chun-Chen
CC
Huang
Fu-Yuan
FY
D000796:Angiolymphoid Hyperplasia with Eosinophilia / Q000150:complications* / Q000473:pathology; D001706:Biopsy; D002648:Child; D002908:Chronic Disease; D006084:Graft Rejection / Q000150:complications* / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D018418:Th2 Cells / Q000276:immunology; D014184:Transplantation, Homologous