Painless lymphadenopathy, eosinophilia and nephrotic syndrom
A 32-year-old male presented with edema in the lower limbs and scrotum. Lymphadenopathy and progressive œdemas were noticed 2–3 months before admission. A physical examination revealed œdema at the lower limbs and scrotum and the presence of retroauricular masses. On admission, biochemical findings indicated severe hypoalbuminemia, moderate renal failure, the modification of diet in renal disease formula (MDRD), acute kidney injury stage 2 and severe eosinophilia with a normal white blood cell count. Total- and low-density cholesterol (LDL) levels were increased. Immunoglobulin E (IgE) levels were increased. Initially, the patient was treated with water and salt restriction as well as a daily intravenous infusion of human albumin 20% and furosemide 40 mg for five days inducing only a mild reduction of the edema and a small increase in serum albumin.

The patient was discharged after 11 days of hospitalization with improved biochemical findings consisting of a normal eosinophil count, decreased 24-h proteinuria levels, normal renal function and a mild improvement in serum albumin levels. He was dismissed with a recommended therapy of high oral methylprednisolone dose to be tapered slowly while waiting for the histological result.The combination of the clinical presentation, the histological result and the geographic origin of the patient indicated Kimura’s disease.

Kimura’s disease has only rarely been reported in Europe. However, in an era of globalization and increased migration, practitioners should always take ‘imported diseases’ into consideration if clinically suspected.

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