Recurrent Kimura Disease of the Submandibular Region After Prolonged Remission to Radiotherapy and Its Challenges

Kimura disease is a rare, chronic inflammatory condition predominantly affecting young adults, particularly those of Asian descent. It presents with subcutaneous nodules and regional lymphadenopathy, and while benign, it can cause significant disfigurement and recurrent issues. A 56-year-old male of Chinese descent with a history of Kimura disease presented with a recurrent mass in the right infraauricular area, initially diagnosed in 1987. Despite surgical resections and extended steroid therapy, disease recurrence persisted. The patient then underwent radiotherapy targeting the right cheek and mandible. He experienced excellent disease control for 12 years. However, in 2022, the patient experienced a relapse. Given the recurrence and prior response to radiotherapy, re-irradiation was considered but reserved as a last option due to potential risks. Instead, triamcinolone acetonide injections were administered, resulting in significant symptom improvement and control of the lesion. Management of Kimura disease remains challenging due to high recurrence rates. This case highlights the difficulties in managing recurrent Kimura disease after radiation and demonstrates the effectiveness of intralesional steroid therapy as an alternative treatment option.