Clinical heterogeneity and prognostic markers in head and neck Kimura disease: A retrospective study

Kimura disease (KD) is a rare, chronic inflammatory disorder that is typically located in the head and neck region. It is characterized by subcutaneous nodules, eosinophilia, and elevated IgE levels. Its unclear etiology and similarities to malignancies create diagnostic and therapeutic challenges. The purpose of this study is to share our treatment experience and explore prognostic factors associated with KD.

We collected data on KD patients treated at our hospital between June 2013 and May 2024. The data included the patients' demographics, clinical and laboratory profiles, radiological and pathological findings, treatments, and outcomes. Non-normal variables are presented as medians with ranges, and categorical variables are shown as frequencies. We performed statistical comparisons using Mann-Whitney U tests.

This study analyzed 13 KD patients (median age 44 years, male-to-female ratio 9:4). All patients present with had head and neck lesions. 75.0% showed elevated peripheral eosinophilia, 77.8% had increased blood eosinophilia percentages, and all tested patients had elevated IgE levels. Treatments included surgical excision, glucocorticoids, methotrexate, low-dose radiotherapy, and observation. Remission was achieved in 76.9% of patients. Patients with poor outcomes had significantly higher absolute eosinophil counts (median: 1.77 vs. 0.90 × 10⁹/L, p = 0.04) and percentages (median: 21.4% vs. 12.2%, p = 0.03) than those with favorable outcomes. Imaging misdiagnosis occurred in 38.5% of patients, highlighting the superiority of histopathology for diagnosis. Urine abnormalities, mild renal dysfunction, and uncommon lesion sites were also observed.

The clinical heterogeneity of KD requires multidisciplinary management. Pre-treatment eosinophilia is emerging as a prognostic marker. Future studies should prioritize the identification of biomarkers, kinetic surveillance, and targeted biologics in order to reduce recurrence and systemic complications.