Kimura disease (KD) is a rare, chronic inflammatory disorder presenting with solitary or multiple masses. Treatment options include surgical excision, corticosteroids, and radiotherapy; however, optimal therapy remains to be established. Moreover, efficacy of a humanized monoclonal antibody, dupilumab (Dupixent), requires to be demonstrated. Here, we present a 36-year-old male patient with an enlarging mass in the left medial thigh and chronic eczema over the abdomen and lower legs. Kimura disease was diagnosed after surgical excision. Postoperative treatment with dupilumab was applied with an initial dose of 600 mg followed by 300 mg every 2 weeks for 8 months. No recurrence of KD was observed in the 1-year follow-up. The eczematous lesions improved greatly. To our knowledge, this is the first report of using dupilumab for treating KD.

s u m m a r y Background: Necrotizing fasciitis is a surgical emergency and old age is one of the predictors to mortality. Nonetheless, no specific report has addressed necrotizing fasciitis concerning aged patients. The aim of this study was to determine risk factors of mortality in elderly patients with necrotizing fasciitis. Methods: A retrospective review of 65 patients with surgically confirmed necrotizing fasciitis in a tertiary medical center from January 2004 to December 2008 was conducted. Comparison between patients who survived and died was based on clinical findings, laboratory data, complications, and surgical timing. Results: The mortality rate for the 65 patients was 32%. The average hospitalization was 33.7 days. Significant differences between the two groups were observed in surgical time, wound closure method, and admission levels of hemoglobin and albumin. Significant risk factors from binary logistic regression were liver cirrhosis, acute renal failure, and respiratory failure. Patients with more complications had a lower survival rate. Conclusion: Early diagnosis of necrotizing fasciitis is difficult in aged patients, but in-hospital complications are the main determinants of mortality. Patients with liver cirrhosis are the high-risk group to mortality. Prevention of complications, such as acute renal failure and acute respiratory failure may be helpful in survival.

Background Reuse of cardiac implantable electronic devices (CIEDs) can reduce the cost of using these expensive devices. However, whether resterilized CIEDs will increase the risk of reinfection in patients with previous device infection remains unknown. The aim of the present study is to compare the reinfection rates in patients who had initial CIED infection and underwent reimplantation of resterilized CIEDs or new devices. Methods Data from patients with initial CIED infection who received debridement of the infected pocket and underwent reimplantation of new or resterilized CIEDs at MacKay Memorial Hospital, Taipei, Taiwan, between January 2014 and June 2019 were retrospectively analyzed. Patient characteristics, relapse rates of infection, and potential contributing factors to the infection risk were examined. Results Twenty-seven patients with initial CIED infection and reimplanted new CIEDs (n = 11) or resterilized CIEDs (n = 16) were included. During the 2-year follow-up, there were 1 (9.1%) and 2 (12.5%) infection relapses in the new and resterilized CIED groups, respectively. No relapse occurred for either group if the lead was completely removed or cut short. The median duration between debridement and device reimplantation in patients with infection relapse vs patients without relapse was 97 vs 4.5 days for all included patients, and 97 vs 2 days and 50.5 vs 5.5 days for the new and resterilized CIED groups, respectively. Conclusions Subpectoral reimplanting of resterilized CIEDs in patients with previous device infection is safe and efficacious. With delicate debridement and complete extraction of the leads, the CIED pocket infection relapse risk can be greatly decreased.

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