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Diagnosis

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

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

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / Singhal, Geeta / McDonald, Kathryn / Singh, Hardeep / Newman-Toker, David

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura

Online
ISSN
2194-802X
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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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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Priti Bhansali
Published Online: 2019-02-22 | DOI: https://doi.org/10.1515/dx-2018-0096

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

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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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