IntroductionKimura disease (KD), also known as eosinophilic hyperplastic lymphoid granuloma, is a rare benign chronic inflammatory condition, which is featured with the painless progressive mass located in the subcutaneous area of the head and neck region, elevated peripheral blood eosinophils, and raised serum immunoglobulin E (IgE) levels. KD is uncommon in clinical practice, especially with low incidence in children, so it often leads to misdiagnosis or missed diagnosis in pediatric patients.MethodsThe clinical data of 11 pediatric patients with KD in the authors' institution were retrospectively analyzed.ResultsThere were 11 pediatric patients with KD enrolled in total, including 9 male patients and 2 female patients (sex ratio 4.5:1). The median age at diagnosis stood at 14 years (range 5-18 years), the initial symptoms in all patients included painless subcutaneous masses and focal swelling, the duration of symptoms ranged from 1 month to 10 years, and the average duration was 24.45 months. Six patients had single lesions, and 5 had multiple lesions. The highest proportion of lesion regions were parotid gland (n = 5, 31.3%) and retroauricular (n = 5, 31.3%), followed by cervical lymph nodes (n = 4, 25%), and others (n = 2,12.5; elbow n = 1; back n = 1). The eosinophil absolute count elevated in all patients, ranging from 0.71×109/L to 10.35 ×109/L (normal range 0.02-0.52×109/L). IgE levels were increased in all 7 patients who underwent serum immunoglobulin examination (normal range <100 IU/mL). Three patients received oral corticosteroid treatment while 2 relapsed. Three patients received surgical resection combined with oral corticosteroid treatment, and no patient relapsed. The other 3 patients received surgery and radiotherapy, surgery combined with corticosteroid and cyclosporin and corticosteroid combined with leflunomide respectively, and no patient relapsed.ConclusionBase on the study, it is found that Kimura disease is rare and may have the atypical symptoms in pediatric patients, combination therapy is recommended to reduce recurrence, and long-term follow-up should be performed.
Purpose Limited data are available on the characteristics, risk factors, and antimicrobial treatment of critically ill pediatric patients with carbapenem-resistant Enterobacteriaceae (CRE) infections. This study was to identify the risk factors for 30-day mortality in pediatric intensive care unit (PICU) patients with CRE infections and compare the clinical outcomes of different antimicrobial regimens. Methods A retrospective, observational cohort study was performed on patients admitted to the PICU with positive CRE cultures between January 2016 and December 2021. Results For the 56 patients, the overall 30-day mortality was 50% (n=28). Multivariable logistic regression analysis revealed that pediatric critical illness score (PCIS; HR = 0.879; 95% CI, 0.827–0.935; P < 0.001) and serum albumin levels (HR = 0.921; 95% CI, 0.860–0.987; P = 0.019) were independently associated with 30-day mortality. At the same time, there was no significant difference in 30-day mortality (42.9% versus 45.5%, P = 0.854) or clinical efficiency rate (53.4% versus 40.9%, P = 0.374) between with and without polymyxin B therapy. Conclusion The study revealed PCIS and serum albumin levels were the independent mortality-related risk factors of CRE infections in critically ill pediatric patients. Treatment with polymyxin B could not reduce 30-day mortality. Future prospective cohort studies are needed to investigate the optimal antimicrobial regimens for CRE infection in PICU patients.
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