Recurrent eyelid swelling in an adolescent female: An atypical presentation of Kimura disease

Kimura disease is a rare, chronic inflammatory disorder of unknown etiology, presenting as subcutaneous nodules in the head and neck region with peripheral eosinophilia and elevated serum immunoglobulin E (IgE) levels. Initially identified as eosinophilic hyperplastic lymphogranuloma in East Asia in the 1930s, it frequently involves regional lymphadenopathy.[1,2] While isolated ocular involvement is rare,[2] especially in adolescent females, it is usually observed in young Asian males.[1,2] An 18-year-old female presented with a recurrent, painless swelling in the right lower eyelid for 1 year. The swelling was insidious, gradually progressive, and not associated with redness, discharge, or visual symptoms. She had undergone two previous excisions for similar lesions, followed by three recurrences, the latest 6 weeks before presentation. There was no history of trauma, insect bite, fever, or systemic illness. Examination revealed a firm, nontender 25 mm × 7 mm swelling over the lateral two-thirds of the right lower eyelid, with an overlying surgical scar [Figures 1 and 2]. Ocular findings were normal, and there was no regional lymphadenopathy.Figure 1: Clinical photograph of the right eye showing swelling at the lateral aspect of the lower lid. The black arrow indicates the site of the swelling, with overlying skin displaying a scar from previous surgeryFigure 2: Clinical photograph showing swelling at the lateral aspect of right lower lid. The black arrow indicates the site of the swellingA provisional diagnosis of lymphoma was made. Peripheral blood analysis showed an elevated absolute eosinophil count (450/μL; normal 40–400/μL), eosinophils 7.6%, and markedly increased serum IgE (1552 IU/mL; normal