Bilateral orbital involvement with angiolymphoid hyperplasia with eosinophilia (Kimura's disease)

A 54-year-old woman with a history of nonspecific granulomatous disease of the skin, breast, and lung presented with eyelid edema and proptosis of the right eye. Computed tomography demonstrated a diffuse mass involving the right orbit and both maxillary sinuses. Incisional biopsy of the orbital mass revealed angiolymphoid hyperplasia with eosinophilia, or Kimura's disease. In spite of treatment, the disease clinically subsequently extended to involve the left orbit. Kimura's disease is an uncommon dermatologic disease that is rarely seen in the ocular area. When involving the orbit, the lesion is usually well circumscribed, but in the case reported here, the mass was diffuse, progressive, and difficult to control. Kimura's disease has been associated with trauma, infection, pregnancy, immune suppression and acquired immunodeficiency syndrome (AIDS) and this is the first reported case with clinically evident bilateral orbital involvement.