Kimura disease presenting with isolated axillary lymphadenopathy and eosinophilia in a young female: A case report and review of diagnostic and management considerations

Kimura disease (KD) is a rare, benign, chronic inflammatory disorder that predominantly affects young Asian men in the head and neck region. Presentation as solitary axillary lymphadenopathy in a female patient is highly uncommon, and diagnostically challenging. Our case follows a 32-year-old Asian woman with a six-month history of erythematous forearm rash, nocturnal pruritus, and progressively enlarging, painless left axillary swelling. Initial assessment revealed peripheral eosinophilia and markedly elevated serum IgE levels. Contrast-enhanced imaging demonstrated isolated left axillary lymphadenopathy without evidence of organomegaly, systemic nodal involvement, or mediastinal extension. Histopathological analysis identified microabscesses, extensive eosinophilic infiltration, and florid germinal center hyperplasia. Molecular and immunohistochemical (IHC) studies confirmed a polyclonal lymphoid pattern, excluding viral etiologies, IgG4-related disease, and lymphoma. 
Management with complete surgical excision was performed following multidisciplinary tumor board review, resulting in symptom resolution and normalization of laboratory findings. Sequential multifocal recurrences, initially in the right cervical region at fourteen months and contralateral axilla, required a gradual transition from systemic corticosteroids to low-dose cyclosporine. Sustained remission was maintained after 18 months of follow-up, with stable renal function throughout the disease course. 
This case contributes to the limited literature on atypical presentations of Kimura disease, underscores the importance of considering this diagnosis in cases of unexplained eosinophilic lymphadenopathy irrespective of anatomical location or sex, and highlights the chronic, relapsing-remitting nature of the disease, which necessitates individualized, multidisciplinary long-term management.