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Misra D, Kiran AS, Dora A, Srivani N, Reddy LS. Kimura's Disease in Temporal Bone: A Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:2793-2797. [PMID: 38883553 PMCID: PMC11169285 DOI: 10.1007/s12070-023-04454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/19/2023] [Indexed: 06/18/2024] Open
Abstract
To publish a rare case of Kimura's Disease in Temporal Bone. A 27 year-old male presenting with history of right ear pain and discharge for 2 months was thoroughly evaluated by clinical evaluation, hematological, radiological and histopathological study. Clinical examination revealed a bulge in posterior-inferior quadrant right side of tympanic membrane. HRCT temporal bone revealed a heterogeneous attenuating focal lesion is noted in the region of right middle ear cavity, mastoid antrum mastoid air cells in continuation with the superior aspect of right jugular foramen with erosions and bone destructions, involving the mastoid air cells and sinus plate. Patient was managed surgically with right side canal wall down mastoidectomy and Type 1 Tympanoplasty. Histopathological examination showed focal ulcerated stratified epithelium, dilated elongated congested blood vessels and hemorrhage. Diagnosis was made as Kimura's disease.
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Affiliation(s)
- Deeptabha Misra
- Department of ENT, Government ENT Hospital, Hyderabad, Telengana India
| | | | - Aseesh Dora
- Department of ENT, Government ENT Hospital, Hyderabad, Telengana India
| | - N Srivani
- Department of Pathology, Osmania Medical College, Hyderabad, Telengana India
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Battesti G, Jachiet M, Lepelletier C, Petit A, Vignon-Pennamen MD, Cassius C, de Masson A, Battistella M, Bagot M, Bouaziz JD, Mahévas T. Two cases of dupilumab-responsive Kimura disease. Clin Exp Dermatol 2024; 49:502-506. [PMID: 38149974 DOI: 10.1093/ced/llad455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
Kimura disease (KD) is a rare, chronic angiolymphoproliferative inflammatory disease appearing to be mostly restricted to the skin and soft tissue. Cutaneous involvement of KD includes head and/or neck nodules showing suggestive histological features, frequently associated with an atopic dermatitis-like or prurigo-like presentation. KD is challenging to treat, with high rate of recurrence using current therapeutic strategies. Evidence for involvement of a T-helper type 2 (Th2) immune response in KD pathogenesis has been found in previous studies. Consequently, this study aimed to determine the efficacy and safety of dupilumab, a human monoclonal antibody that inhibits signalling of key Th2 cytokines, interleukin (IL)-4 and IL-13, within a single-centre cohort of patients with cutaneous KD. Two adults with a diagnosis of refractory (failure of at least one treatment line) cutaneous-restricted KD based on clinical, biological, histological, molecular and imaging findings received dupilumab for KD, and showed dramatic response with a good safety profile.
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Affiliation(s)
- Gilles Battesti
- Departments of Dermatology
- Université Paris Cité, Paris, France
| | | | | | | | | | - Charles Cassius
- Departments of Dermatology
- Université Paris Cité, Paris, France
| | - Adèle de Masson
- Departments of Dermatology
- Université Paris Cité, Paris, France
| | - Maxime Battistella
- Université Paris Cité, Paris, France
- Pathology, Saint-Louis Hospital, Paris, France
| | - Martine Bagot
- Departments of Dermatology
- Université Paris Cité, Paris, France
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Luo SY, Zhou KY, Wang QX, Deng LJ, Fang S. Kimura's disease treated with dupilumab: A case report and literature review. Int Immunopharmacol 2024; 131:111895. [PMID: 38508096 DOI: 10.1016/j.intimp.2024.111895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Kimura's disease (KD) is a rare chronic inflammatory disorder characterised by painless, deep subcutaneous nodules that most commonly affect the head and neck region of Asian men. Due to high relapse rates and side effects of current therapies, the treatment of KD is challenging. OBJECTIVES To present a case of KD that was successfully treated with dupilumab and to review the literature with a focus on the evaluation of the efficacy and safety of dupilumab in KD. METHODS A review of the available literature on the treatment of KD with dupilumab was performed and a new case was analyzed. To gain further insight into this promising therapy, literature review of 8 articles published between January 2016 and January 2024 were included in this study using the PubMed database. RESULTS Our patient with KD was successfully treated with dupilumab 300 mg every 2 weeks, at an initial dose of 600 mg. The treatment was well tolerated. In the past, only nine patients with KD treated with dupilumab have been reported and reviewed, half of whom had failed prior treatment. All patients achieved significant efficacy after treatment with dupilumab, with no relapses during an average follow-up of 10.4 months (ranged from 4 to 16 months). CONCLUSION Dupilumab may be an emerging alternative treatment option for KD patients. Larger randomized controlled studies are needed to confirm these findings.
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Affiliation(s)
- Si-Yu Luo
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai-Yi Zhou
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin-Xiao Wang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Jia Deng
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sheng Fang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Ao S, Huang G, Tang X, Zhu Z, Han J, Wang F, Zhai W. Anti-immunoglobulin E provides an additional therapy to conventional steroids for Kimura's disease. J Dermatol 2024; 51:602-606. [PMID: 37950550 DOI: 10.1111/1346-8138.17021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
Kimura's disease (KD) is a chronic inflammatory disease characterized by painless subcutaneous head and neck swelling, eosinophilia, and elevated serum immunoglobulin (Ig) E levels. There are various therapies, including surgery, radiation, systemic steroids, and immune suppressants, but their efficacy remains moderate due to the high recurrence rate. Biologics, like monoclonal antibodies, have shown tremendous effectiveness for chronic inflammatory diseases. Omalizumab is a monoclonal antibody against IgE and has not been approved for KD so far. We describe two refractory KD cases that responded to a small dose of steroids plus omalizumab. Additionally, we reviewed another 13 KD cases that were treated with biologics, including omalizumab, rituximab, dupilumab, and mepolizumab. The results indicate that biologics provide an alternative treatment strategy for KD.
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Affiliation(s)
- Suiting Ao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Gege Huang
- Department of Dermatology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xuhua Tang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhe Zhu
- Department of Pathology and Cell Biology, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Jiande Han
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fang Wang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wanying Zhai
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Heo J, Choi HY, Park J. Successful Management of Refractory Kimura Disease with CVP Chemotherapy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942753. [PMID: 38282341 PMCID: PMC10838562 DOI: 10.12659/ajcr.942753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/21/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Kimura disease is a rare, chronic inflammatory disorder typically presenting as a painless mass in the head or neck and associated with elevated serum immunoglobulin E and blood and tissue eosinophilia. Generally benign, its management is not well-defined, but corticosteroids are a common initial treatment. We detail a case of refractory Kimura disease successfully managed with CVP (Cyclophosphamide, Vincristine, Prednisone) chemotherapy and no recurrence during 6 rounds of treatment. CASE REPORT A 64-year-old woman, previously diagnosed with Kimura disease, returned to the hospital with upper eyelid ptosis. Upon examination, a solid mass was palpable in her left upper eyelid. Peripheral blood tests confirmed elevated IgE levels at 356.0 IU/ml. An excisional biopsy showed infiltration of lymphocytes and eosinophils, consistent with Kimura disease. Despite undergoing corticosteroid treatment, surgical debulking, radiation, and immunosuppressant therapy, her condition worsened. Concerns were raised due to imaging features suggestive of lymphoma, although no malignancy was evident in subsequent biopsies. It was decided to manage the disease using CVP chemotherapy, leading to significant symptom improvement. There have been no recurrences during the 12-month follow-up period. CONCLUSIONS Kimura disease is typically benign and responsive to treatment, but it often recurs and can progress. When symptoms are not controlled with conventional treatments, including corticosteroids, immunosuppressants, radiation, and surgical debulking, chemotherapy may be a reasonable option even when no definite signs of malignancy is identified. Further research is needed to explore the utility of CHOP and CVP in managing uncontrolled Kimura disease.
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Affiliation(s)
- Jun Heo
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
| | - Hee-young Choi
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jungyul Park
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Brito MT, Baptista D, Pereira E, Fonseca E, Almeida JS. Kimura's Disease: A Literature Review Based on a Clinical Case. Cureus 2023; 15:e50463. [PMID: 38222219 PMCID: PMC10786330 DOI: 10.7759/cureus.50463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Kimura's disease (KD) was first described in 1937. It is a rare, benign, and chronic immune-mediated inflammatory disorder affecting the subcutaneous tissue, salivary glands, and lymph nodes. The disease is more common in the second to third decades of life in middle-aged Southeast Asian countries. The cause of Kimura's disease remains unknown; some authors believe it is related to an autoimmune or delayed-type hypersensitivity reaction. It commonly presents as a solitary painless lymph node in the head and neck or generalized lymphadenopathy (67%-100%) associated with peripheral eosinophilia and elevated IgE levels. Renal involvement may occur in some patients. Diagnosis is made by histology. A 21-year-old Caucasian man with no relevant medical history presented with a non-tender swelling of the left hemiface without other associated symptoms. Laboratory investigations revealed a leukocyte count with eosinophilia (2.29×10^9/L- 26.5%) and elevated total IgE and IgG4. He had no renal dysfunction. He underwent surgical resection of the lesion in the jugal, infraorbital, and left nasolabial regions, and the anatomopathological examination revealed the characteristics of Kimura's disease. Three months after surgery, an MRI showed an increase in the size of the mass, and he was started on corticosteroids. Six months after surgery, he presented with a slight increase in the size of the mass and was started on Ciclosporin, which allowed a progressive reduction in the dose of corticosteroid with evidence of a progressive reduction in swelling. Ciclosporin was stopped due to toxic serum levels, and he was started on mycophenolate mofetil. The dose was increased because of the increase in facial mass; on mycophenolate mofetil 2500mg/day, the patient remains stable. KD is a chronic disorder of unknown etiology that mainly affects young people in Southeast Asia and is rare in Western countries, as in the case of this young man. Studies have shown no significant differences in region or race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, or IgE levels between age groups. There is no consensus on the optimal treatment for KD; several treatments have been used, including surgery, systemic corticosteroids, immunosuppressants, and radiation. Due to the tendency to relapse and the rarity of the disease, there is no consensus on treatment options for relapse.
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Affiliation(s)
- Maria Teresa Brito
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Diana Baptista
- Pathologic Anatomy, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Edite Pereira
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Elsa Fonseca
- Pathologic Anatomy, Centro Hospitalar Univeristário de São João, Porto, PRT
| | - Jorge S Almeida
- Medicine, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, PRT
- Internal Medicine, Centro Hospitalar Univeristário de São João, Porto, PRT
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Shang B, Hsiao C, Tsao T, Liao Y, Lin W, Lee W, Lue K. Clinical effects of dupilumab: A novel treatment for Kimura disease. Immun Inflamm Dis 2023; 11:e1084. [PMID: 38018601 PMCID: PMC10632088 DOI: 10.1002/iid3.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Kimura disease (KD) is a rare chronic inflammatory disorder involving the Th2 pathway. Although medical treatment with steroids or other immunosuppressants is available, they may cause developmental issues in the pediatric population. Surgical intervention has also been suggested; however, it is associated with high recurrence rates. CASE PRESENTATION A 14-year-old boy presented with left retroauricular lymph node enlargement at the age of 5 years. At the age of 7 years, he was diagnosed with nephrotic syndrome which subsided after steroid treatment for approximately 6 years. The retroauricular lymph node was surgically excised, and KD was confirmed. However, recurrent enlargement of the left retroauricular and neck lymph nodes occurred after 2 years. Persistently high IgE levels and fluctuating eosinophil counts were observed following steroid treatment. Dupilumab was prescribed because of the difficulty in tapering the steroid dosage. A loading dose of 600 mg was administered, followed by a maintenance dose of 300 mg every 2 weeks. The IgE level decreased after 3 months, and a low eosinophil count was maintained after steroid discontinuation. Follow-up computed tomography revealed a decrease in the size of the lymph nodes with no side effects such as conjunctivitis. CONCLUSION Traditional treatments have raised developmental concerns in the pediatric population and are associated with high recurrence rates. Dupilumab targets the Th2 pathway and provides effective results, with few adverse effects. Dupilumab may be a therapeutic option for KD and other diseases involving the Th2 pathway.
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Affiliation(s)
- Bing‐Shiau Shang
- Department of PediatricsChung Shan Medical University HospitalTaichung CityTaiwan
- Department of MedicineChung Shan Medical UniversityTaichung CityTaiwan
- Institute of MedicineChung Shan Medical University HospitalTaichung CityTaiwan
| | | | - Teng‐Fu Tsao
- Department of MedicineChung Shan Medical UniversityTaichung CityTaiwan
- Department of Medical ImagingChung Shan Medical University HospitalTaichung CityTaiwan
| | - Yuan‐Ya Liao
- Department of MedicineChung Shan Medical UniversityTaichung CityTaiwan
- Department of SurgeryChung Shan Medical University HospitalTaichung CityTaiwan
| | - Wea‐Lung Lin
- Department of PathologyChung Shan Medical University HospitalTaichung CityTaiwan
- Department of PathologyChung Shan Medical UniversityTaichung CityTaiwan
| | - Wen‐I Lee
- Department of Pediatrics, Division of Allergy, Asthma, Immunology and RheumatologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
- Primary Immunodeficiency Care and Research InstituteChang Gung University College of Medicine and Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Ko‐Huang Lue
- Department of PediatricsChung Shan Medical University HospitalTaichung CityTaiwan
- Department of MedicineChung Shan Medical UniversityTaichung CityTaiwan
- Department of Biological Science & TechnologyNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
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Braun J, Karberg K. [Swelling of the salivary glands and sicca symptoms in Kimura's disease, a rare rheumatological differential diagnosis with an indicatively high IgE serum level-A current overview after literature search]. Z Rheumatol 2023:10.1007/s00393-023-01411-9. [PMID: 37707569 DOI: 10.1007/s00393-023-01411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 09/15/2023]
Abstract
Rheumatic and musculoskeletal diseases (RMD) include various diseases with sometimes rather different symptoms, some of which are locally confined and others show systemic features. Autoimmune phenomena, such as those occurring in Sjögren's syndrome, often cause symptoms such as xerostomia and xerophthalmia in association with inflammation of the salivary glands. The pathogenesis of these diseases is only partly clarified. This is similar to allergic diseases, which are otherwise clearly different with respect to the symptoms and pathomechanisms but swelling of the salivary glands can also rarely occur here. As this is a possible differential diagnosis of Sjögren's syndrome or also IgG4-associated diseases, and such a case was recently described, a literature search was carried out in PubMed, the results of which are presented here and summarized in this article in a brief overview.
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Affiliation(s)
- Jürgen Braun
- Rheumapraxis Berlin, Schlossstr. 110, 12163, Berlin, Deutschland.
- Ruhr Universität Bochum, Bochum, Deutschland.
| | - Kirsten Karberg
- Rheumapraxis Berlin, Schlossstr. 110, 12163, Berlin, Deutschland
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Braun J, Mairinger T, Kaschke O, Behrendt K, Ramsbacher J, Karberg K. Bilateral swelling of the salivary glands and sicca symptoms: an unusual differential diagnosis-Kimura's disease, a rare allergic condition with a high IgE serum level-a case report and review of the literature. RMD Open 2023; 9:rmdopen-2023-003135. [PMID: 37164447 PMCID: PMC10173963 DOI: 10.1136/rmdopen-2023-003135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 05/12/2023] Open
Abstract
A 68-year-old woman presented with bilateral swelling of the salivary glands, sicca symptoms of eyes and mouth, itching, fatigue and weight gain of about 5 kg in the last 2-3 years. As part of a careful diagnostic work up including lab tests for antinuclear antibodies (ANA), antibodies to extractable nuclear antigens (ENA), anti-neutrophilic cytoplasmatic antiobodies (ANCA), immunoglobulin (Ig)G4, a whole body computed tomography (CT) and a parotid biopsy several rheumatic diseases such as Sjoegren's syndrome, IgG4-related disease and sarcoidosis were ruled out and, considering a very high titre of IgE, Kimura's disease was diagnosed. The case and a short review of the literature are presented.
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Affiliation(s)
- Jüergen Braun
- Rheumapraxis Berlin, Ruhr University Bochum, Berlin, Germany
| | - Thomas Mairinger
- Dept. of Pathology, Medizinisches Versorgungszentrum am Helios Klinikum Emil von Behring, Berlin, Germany
| | - Oliver Kaschke
- Dept of Otorhinolaryngology, St.Gertrauden Krankenhaus, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kai Behrendt
- Roentgenpraxis Radiologie Eins, Humboldt-Universitat zu Berlin, Berlin, Germany
| | - Josef Ramsbacher
- Praxis für Neurochirurgie, Humboldt-Universitat zu Berlin, Berlin, Germany
| | - Kirsten Karberg
- Rheumapraxis Berlin, Humboldt-Universitat zu Berlin, Berlin, Germany
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Olbrich H, Sadik CD, Ludwig RJ, Thaçi D, Boch K. Dupilumab in Inflammatory Skin Diseases: A Systematic Review. Biomolecules 2023; 13:biom13040634. [PMID: 37189381 DOI: 10.3390/biom13040634] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Dupilumab was first approved for the treatment of atopic dermatitis (AD) and blocks the signaling of interleukin (IL)-4 and -13. Several other chronic skin conditions share mechanistic overlaps with AD in their pathophysiology, i.e., are linked to type 2 inflammation. Most recently, dupilumab was approved by the U.S. Food and Drug Administration for prurigo nodularis (PN). Given its relatively good safety profile, effective off-label use of dupilumab has been reported for a multitude of dermatologic diseases and several clinical trials for dermatologic skin conditions are currently ongoing. We conducted a systematic review of applications of dupilumab in dermatology other than AD and PN by searching the databases PubMed/Medline, Scopus, Web of Science and Cochrane Library as well as the clinical trial registry ClinicalTrials.gov. We found several reports for effective treatment of bullous autoimmune diseases, eczema, prurigo, alopecia areata, chronic spontaneous urticaria, Netherton syndrome and a variety of other chronic inflammatory skin diseases.
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Affiliation(s)
- Henning Olbrich
- Department of Dermatology, University of Lübeck, 23566 Lübeck, Germany
| | | | - Ralf J. Ludwig
- Department of Dermatology, University of Lübeck, 23566 Lübeck, Germany
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23566 Lübeck, Germany
| | - Diamant Thaçi
- Department of Dermatology, University of Lübeck, 23566 Lübeck, Germany
- Institute and Comprehensive Center for Inflammation Medicine, University-Hospital Schleswig-Holstein, 23566 Lübeck, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, 23566 Lübeck, Germany
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