LAUSR

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A 75yearold man was initially admitted for elective inguinal hernia repair but was noted by the anaesthetist to have a ‘uvulalike’ mass in the oropharynx arising inferiorly, either from the base of the tongue or supraglottis, as seen in figure 1. He denied difficulties in swallowing, throat pain or voice changes. The anaesthetist cancelled the routine procedure and referred the patient to Ear, Nose, and Throat (ENT) department. His medical history was unremarkable. His full blood count was essentially normal apart from slight eosinophilia. On fibreoptic examination, the mass was noted to be smooth surfaced lying on the anterior surface of the epiglottis and extending to the left supraglottis. Neck palpation was normal. Neck CT scan showed 3 cm×1.5 cm lobulated soft tissue mass over the left side of the epiglottis extending to the pharyngoepiglottic fold, as seen in figure 2. Intraoperatively, the 3cm pedunculated mass was noted arising from the left arytenoid and was completely excised. The surrounding structures of the larynx and the hypopharynx were all normal. His postoperative events were unremarkable and he was discharged the following day. The initial histopathology showed features compatible with either Kimura disease (KD) or angiolymphoid hyperplasia with eosinophilia (ALHE), as seen in figure 3. Review of the specimen in a specialist pathology centre confirmed the diagnosis of KD. The patient had been followed up yearly for the past 8 years. Recurrence was noted after 6 years from initial presentation and once again, he denied any symptoms from his throat. The lesion which arose from the previous surgical site was successfully reexcised. KD is seen in young male adults (M:F=5:1; mean age 32.8 years old), endemic in Oriental Asia, but has been described in Caucasians, Blacks, Hispanics and Arabs. 2 Hashim et al noted that KD, also known as eosinophilic lymphogranuloma, is a clinical dilemma as specific diagnostic guidelines do not exist. It is a chronic inflammatory disorder with unknown cause and presents as large painless solitary mass in the head and neck region, noted in deepseated tissues or subcutaneous area with intact overlying skin and commonly with regional lymph node and salivary gland involvement. It is also found in the limbs, groin and trunk and intriguingly associated with nephropathy in 12%–16% of cases. Serum eosinophilia and raised IgE, mast cells, interleukin (IL)-4, IL-5 and IL-13 are common suggestive of underlying autoimmune pathology or potential parasitic infestation. Differential diagnoses would include necrotising lymphadenitis such as Kikuchi