Treatment of Kimura disease with photodynamic therapy: a case report

Background

Kimura disease (KD) is a chronic inflammatory disorder with a secondary vascular component. The aetiology is unknown. It is mostly reported in Asian populations and has a 6:1 male/female ratio. Clinical manifestation is often as a painless unilateral cervical lymphadenopathy or as subcutaneous masses in the head and neck region. KD is generally limited to the skin, lymph nodes and salivary glands.

Conventional management includes conservative, intra-lesional steroids, chemotherapeutic drugs, radiotherapy and surgical excision. Unfortunately none of which are curative as the lesion inevitably recurs.

Photodynamic therapy has previously been shown to reduce the bulk of vascular malformations.

Case report

A 58-year-old Asian man, diagnosed with Kimura disease at 40 years of age, was referred for further management of facial disfigurement after recurrence.

Initially, he presented with an asymptomatic, slowly enlarging, right-sided facial swelling. Biopsy and imaging confirmed the diagnosis. He subsequently underwent surgical debulking of the lesion and superficial parotidectomy, which left him with a mild facial weakness. Following recurrence, it was felt that further surgery or medical management was not the optimal choice.

Interstitial PDT was performed using a baseline MRI scan as a guide. Clinical and radiological assessments at follow-up showed a promising reduction in lesional size.

Conclusion

The authors propose PDT as a repeatable treatment option in shrinkage of this lesion.