Rare disorders of the immune system: Kimura’s disease and Evans syndrome – anaesthetic implications

• Author Details:   
• Pradnya Milind Bhalerao
• Shital Mahendra Kuttarmare ^*
• Amartya Chaudhuri

---

Background: Kimura’s disease is a rare, chronic eosinophilic inflammatory disorder that typically affects the salivary glands, skin, lymph nodes and kidneys. Evans syndrome is an autoimmune condition characterised by the simultaneous or sequential occurrence of idiopathic thrombocytopenic purpura and autoimmune haemolytic anaemia.

Case Presentations: We present two distinct cases highlighting the anaesthetic considerations in patients with rare immune disorders. The first case involves a 35-year-old male with Kimura’s disease, presenting with a post-auricular mass scheduled for surgical excision. The second case features an 18-year-old female diagnosed with Evans syndrome, who was scheduled for pan-retinal photocoagulation under topical anaesthesia due to visual disturbances.

Conclusions: Anaesthetic management of Kimura’s disease (KD) requires vigilance due to potential complications such as increased intraoperative bleeding, difficult airway management from mass effect and renal impairment associated with nephrotic syndrome. In patients with Evans syndrome, key concerns include thrombocytopenia, risk of airway bleeding, systemic involvement, and the need for perioperative corticosteroid supplementation.

Keywords: Kimura’s disease, Evans syndrome, Anaesthesia, Immune disorders, Airway management, Perioperative care.