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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

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

Margaret L. Rush / Alexandra Mauro
  • Children’s National Medical Center, Washington, DC, USA
  • Walter Reed National Military Medical Center and George Washington University, Washington, DC, USA
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/ Priti Bhansali
Published Online: 2019-02-22 | DOI: https://doi.org/10.1515/dx-2018-0096



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.


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


  • 1.

    Barton LL, Feigin RD. Childhood cervical lymphadenitis: a reappraisal. J Pediatr 1974;84:846–52.PubMedCrossrefGoogle Scholar

  • 2.

    Dajani AS, Garcia RE, Wolinsky E. Etiology of cervical lymphadenitis in children. N Engl J Med 1963;268:1329–33.CrossrefPubMedGoogle Scholar

  • 3.

    Rosenberg TL, Nolder AR. Pediatric cervical lymphadenopathy. Otolaryngol Clin North Am 2014;47:721–31.CrossrefPubMedGoogle Scholar

  • 4.

    Weinstock MS, Patel NA, Smith LP. Pediatric cervical lymphadenopathy. Pediatr Rev 2018;39:433–43.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 5.

    Mrówka-Kata K, Kata D, Kyrcz-Krzemień S, Helbig G. Kikuchi-Fujimoto and Kimura diseases: the selected, rare causes of neck lymphadenopathy. Eur Arch Otorhinolaryngol 2010;267:5–11.PubMedCrossrefGoogle Scholar

  • 6.

    Thomas J, Jayachandran NV, Chandrasekhara PK, Rajasekhar L, Narsimulu G. Kimura’s disease – an unusual cause of lymphadenopathy in children. Clin Rheumatol 2008;27:675–7.CrossrefWeb of SciencePubMedGoogle Scholar

  • 7.

    Dixit MP, Scott KM, Bracamonte E, Dixit NM, Schumacher MJ, Hutter J, et al. Kimura disease with advanced renal damage with anti-tubular basement membrane antibody. Pediatr Nephrol 2004;19:1404–7.CrossrefPubMedGoogle Scholar

  • 8.

    Chen H, Thompson LD, Aguilera NS, Abbondanzo SL. Kimura disease: a clinicopathologic study of 21 cases. Am J Surg Pathol 2004;28:505–13.PubMedCrossrefGoogle Scholar

  • 9.

    Viswanatha B. Kimura’s disease in children: a 9 years prospective study. Int J Pediatr Otorhinolaryngol 2007;71:1521–5.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 10.

    Miki H, Tsuboi H, Kaneko S, Takahashi H, Yokosawa M, Asashima H, et al. A case of refractory Kimura disease with a buccal bulky mass successfully treated with low-dose cyclosporine A: report and review of the literature. Allergol Int 2016;65:212–4.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 11.

    Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med 2002;9:1184–204.CrossrefPubMedGoogle Scholar

  • 12.

    Schmidt HG, Rikers RM. How expertise develops in medicine: knowledge encapsulation and illness script formation. Med Educ 2007;41:1133–9.PubMedWeb of ScienceGoogle Scholar

  • 13.

    Singh H, Thomas EJ, Wilson L, Kelly PA, Pietz K, Elkeeb D, et al. Errors of diagnosis in pediatric practice: a multisite survey. Pediatrics 2010;126:70–9.CrossrefWeb of ScienceGoogle Scholar

About the article

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

Received: 2018-10-24

Accepted: 2019-01-28

Published Online: 2019-02-22

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.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

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.

Citation Information: Diagnosis, 20180096, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2018-0096.

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