150 specimens from suspected herpes simplex genital and skin lesions were received in virus transport medium. They were inoculated into Hep-2 cell monolayers, examined for the presence of virus by cytopathic effect (CPE), direct immunoperoxidase (DIP) and direct immunofluorescence (DIF). Of 39 (26.0%) virus-positive specimens by CPE, 37 (24.7%) were HSV-positive by DIP and 36 (24.0%) by DIF staining. DIP staining had a sensitivity of 100%, specificity of 99.1%, positive predictive value of 97.3% and negative predictive value of 100% in relation to DIF as a standard test. Of 39 specimens positive by CPE, only 25.6% were HSV-positive within 24 h post-inoculation compared to 94% HSV-positive by DIP and DIF staining at the same time.
Kimura's disease is a rare condition and typically presents as non-tender subcutaneous swellings in the head and neck region, usually in the pre-auricular and submandibular areas. It is associated with lymphadenopathy (both local and distal), marked peripheral eosinophilia, and an elevated IgE level. It can easily be mistaken for a malignant disorder. Fine needle aspiration can be misleading, and a diagnosis is established only by histopathological examination. Renal involvement, which may affect up to 60% of patients, is the only systemic manifestation. We report a case of Kimura's disease in a Malay patient who was associated with steroid-responsive nephrotic syndrome.