1
|
Chen X, An L, Jiang Z, Jia Y. A case report of multicentric reticulohistiocytosis with atypical cutaneous presentation. Front Immunol 2024; 15:1344313. [PMID: 38426104 PMCID: PMC10903083 DOI: 10.3389/fimmu.2024.1344313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare systemic disorder characterized by histiocytic hyperplasia that mainly involves the skin, mucous membranes, and joints. The typical clinical features include papules, nodules, and arthritis. MRH lesions are relatively extensive but small and scattered. Joint inflammation is characterized by diffuse symmetric polyarthritis as the first symptom, which can be severe and disabling due to destructive joint changes. MRH is easily misdiagnosed in clinical practice. Here, we report the case of an elderly male patient who presented with polyarticular pain in the hip and interphalangeal joints as the first manifestation, followed by the development of large, isolated, bulging skin nodules, which are atypical MRH lesions. This is rare in all MRH case reports, and we made the correct diagnosis by combining skin histopathology, immunohistochemistry, and other clinical examinations. We performed surgical treatment on the local skin lesions of this patient. This case suggests that clinicians should actively correlate the condition and accurately diagnose MRH when encountering atypical skin changes or other diseases as the first symptom and explore the mechanisms of MRH and other clinical manifestations.
Collapse
Affiliation(s)
| | | | | | - Yuxi Jia
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
2
|
Li Y, Yin H, Zhang L, Lu L. Janus kinase inhibitor for multicentric reticulohistiocytosis, a new potential treatment. Int J Rheum Dis 2023; 26:1656-1659. [PMID: 37664958 DOI: 10.1111/1756-185x.14793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Yuan Li
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanlin Yin
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Le Zhang
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Pharmacy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangjing Lu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Ashaolu O, Ng S, Smale S, Hughes J. Multicentric Reticulohistiocytosis-A rare and disabling disease. Clin Case Rep 2023; 11:e7846. [PMID: 37645054 PMCID: PMC10460929 DOI: 10.1002/ccr3.7846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
Multicentric reticulohistiocytosis is a rare multisystemic condition associated with papulonodular skin lesions, severe arthritis and malignancy. Histopathology shows histiocytes containing abundant eosinophilic ground glass cytoplasm and multinucleated giant cells. Early recognition, age-appropriate malignancy work-up and treatment is important to prevent impairment of daily life activity.
Collapse
Affiliation(s)
| | - Selwyn Ng
- Department of HistopathologyMorriston HospitalSwanseaUK
| | - Shaun Smale
- Department of RheumatologyPrincess of Wales HospitalBridgendUK
| | - Jenny Hughes
- Department of DermatologyPrincess of Wales HospitalBridgendUK
| |
Collapse
|
4
|
Kincaid CM, Sharma AN, Arnold JD, Horton L, Lee BA, Mesinkovska NA. Multicentric reticulohistiocytosis after severe COVID-19 infection. JAAD Case Rep 2023; 33:73-76. [PMID: 36742148 PMCID: PMC9883206 DOI: 10.1016/j.jdcr.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023] Open
Affiliation(s)
| | | | | | | | | | - Natasha A. Mesinkovska
- Correspondence to: Natasha A. Mesinkovska, MD, PhD, Department of Dermatology, Hewitt Hall Building, 843 Health Sciences Rd, Room 1001, Irvine, CA 92697
| |
Collapse
|
5
|
Zou XJ, Qiao L, Li F, Chen H, Yang YJ, Xu D, Zheng WJ, Jiang ZY, Wang L, Wu QJ, Zhang FC. Clinical characteristics of multicentric reticulohistiocytosis and distinguished features from rheumatoid arthritis: a single-center experience in China. Orphanet J Rare Dis 2022; 17:164. [PMID: 35413870 PMCID: PMC9004099 DOI: 10.1186/s13023-022-02311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the clinical features of multicentric reticulohistiocytosis (MRH). METHODS The clinical manifestations, laboratory examination results and histologic characteristics of eleven patients with MRH were collected and compared with those of 33 patients with rheumatoid arthritis. RESULTS In total, 72.7% of the MRH patients were women. The median age was 46 years (range 33-84 years). Diagnosed by specific pathologic features, all MRH patients exhibited cutaneous involvement. The dorsa of the hands, arms, face and auricle were the most commonly affected areas. Nodules were also located on the legs, scalp, trunk, neck, and even the hypoglossis and buccal mucosa. Ten MRH patients (90.9%) had symmetric polyarthritis. Compared with rheumatoid arthritis (RA) patients, MRH patients were more likely to have distal interphalangeal joint (DIP) involvement (63.6% vs 24.2%, P = 0.017) and less likely to have elbow (36.4% vs 72.7%, P = 0.003), ankle (45.5% vs 93.9%, P < 0.001) and metacarpophalangeal joint (MCP) (36.4% vs 78.8%, P = 0.009) involvement. Positivity for rheumatoid factor (RF) (36.4% vs 84.6%, P = 0.001) and anti-CCP antibody (9.1% vs 81.8%, P = 0.000), as well as the median RF titer [43.8 (31.7-61.0) vs 175.4 (21.3-940.3), P = 0.021], in MRH patients was lower than in RA patients. Elevation of the erythrocyte sedimentation rate (ESR) was also less common in MRH patients than in RA patients (36.4% vs 72.7%, P = 0.030). After treatment with median- to large-dose corticosteroids and disease-modifying antirheumatic drugs, 8 patients achieved complete remission and 2 patients partial remission (skin lesions ameliorated, joint lesions not ameliorated). CONCLUSION Always pathologically diagnosed, MRH is a systemic disease involving RA-like erosive polyarthritis and a specific distribution of skin nodules characterized by "coral beads". More DIP involvement and less elbow, ankle and MCP involvement are seen in MRH than in RA. In addition, less positivity and lower-titer RF, uncommon presence of anti-CCP antibodies and ESR elevation may be helpful to distinguish MRH from RA.
Collapse
Affiliation(s)
- Xiao-Juan Zou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.,Department of Rheumatology, First Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Lin Qiao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Feng Li
- Department of Dermatology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hua Chen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Yun-Jiao Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Wen-Jie Zheng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Zhen-Yu Jiang
- Department of Rheumatology, First Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Li Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.
| | - Qing-Jun Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China.
| | - Feng-Chun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| |
Collapse
|
6
|
Abstract
ABSTRACT Multicentric reticulohistiocytosis (MRH) is a rare multisystem disorder, primarily affecting the skin and joints. As severe joint damage is a possible symptom, early diagnosis and therapeutic intervention are required. Cutaneous lesions present with characteristic features such as discrete reddish nodules, especially on acral locations. Additionally, the face, scalp, trunk and extremities are also affected. Xanthomatous plaques are also seen on the face. The cutaneous manifestations of MRH are various, which therefore should be differentiated from several diseases. In particular, MRH has been reported to assume clinical appearances resembling Gottron papules, periungual erythema, V-neck erythema, shawl sign, and poikiloderma associated with dermatomyositis. Histopathologic features show proliferation of multinucleated giant cells with abundant eosinophilic granular ground glass-like cytoplasm in the dermis. Multicentric reticulohistiocytosis is occasionally paraneoplastic and is associated with internal malignancies. The appropriate therapies are still challenging, and oral prednisolone, immunosuppressants, and recent biologics are used. In this article, cutaneous lesions, histopathology, and pathogenesis of MRH are mainly discussed from a dermatological perspective. It is important, not only for dermatologists but also for rheumatologists and orthopedists, to be able to distinguish between the various types of skin lesions brought on by MRH. Cutaneous signs are important diagnostic clues and assessment tools for therapeutic efficacy.
Collapse
Affiliation(s)
- Toshiyuki Yamamoto
- From the Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
7
|
翟 莉, 邱 楠, 宋 惠. [Multicentric reticulohistiocytosis: A case report]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:1183-1187. [PMID: 34916702 PMCID: PMC8695165 DOI: 10.19723/j.issn.1671-167x.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Indexed: 06/14/2023]
Abstract
A 65-year-old woman developed erythema, papules and nodules over the body. Some nodules of her auricles and hands like string beads. Besides, she suffered from symmetrical swelling and pain of multiple joints, morning stiffness with deformity of joints; She had elevated erythrocyte sedimentation rate and C reactive protein levels; Her rheumatoid factor and antinuclear antibody were positive; Joints destruction was found with X-ray imaging; Skin pathology showed Dermal infiltrate of abundant histiocytes, part of them with a ground-glass appearance; A CD68 immunohistochemical stain was positive and the cells were negative for S100, CD1a. These findings were diagnostic evidences of multicentric reticulohistiocytosis (MRH). The patient received high-dose of glucocorticoids combinated with immunosuppressive agents, and achieved a satisfactory effect. MRH was a rare multisystem disease characterized by papulonodular mucocutaneous and destructive arthritis, and its pathogeny was not yet completely understood. The typical lesions of MRH were hard papules or nodules that usually occured on the hands, face and arms. Classic coral bead appearance from periungual cutaneous nodules that were characteristic of MRH. MRH was an inflammatory joint disease, affecting almost all the appendicular joints and characterized by joint multiple, symmetrical, destructive, progressive disability. Joints destruction of the distal interphalangeal joints was a unique feature of MRH. In addition to skin and joints, it could also involve other systems. There were no diagnostic laboratory markers for MRH. Laboratory examinations had often been found to be non-specific. Imageological examination mainly showed bone and joint destruction. Skin biopsy was the best test to diagnose MRH, the typical histopathological findings included an infiltrate with histiocytes and multinucleated giant cells with a ground-glass appearing in eosinophilic cytoplasm, and the immunohistochemical stain was positive for CD68. The diagnosis was typically made based on the clinical presentation, supportive radiographic findings and skin biopsy. MRH was easily possible to mistake for other more common autoimmune conditions, such as rheumatoid arthritis, psoriatic arthritis, osteoarthritis, and dermatomyositis, but the distinctive clinical, radiographic, and histologic features could aid in differentiating these diseases. MRH could mimic other rheumatic diseases, besides, it could also coexist with cancer or other autoimmune disorders. There was no standardized treatment for MRH. However, Nonsteroidal anti-inflammatory drugs, glucocorticoid, Immunosuppressant, biologic medications, and bisphosphonates had been used with varying degrees of curative effect. Treatment with glucocorticoid combined with immunosuppressants were effective for rash and arthritis, early use of them should be strongly considered, and refractory cases could be treated with biological agents. By reporting a MRH case and reviewing literature, this paper aims to help the clinicians improve the understanding of this rare disease, and suggests that when one diagnosis cannot explain the whole picture of the disease, and further evidence should be sought to confirm the diagnosis.
Collapse
Affiliation(s)
- 莉 翟
- 中国人民解放军联勤保障部队第960医院,山东泰安 271000Department of Rheumatology and Immunology, The 960th Hospital of the PLA Joint Logistics Support Force, Tai'an 271000, Shandong, China
| | - 楠 邱
- 中国人民解放军联勤保障部队第960医院,山东泰安 271000Department of Rheumatology and Immunology, The 960th Hospital of the PLA Joint Logistics Support Force, Tai'an 271000, Shandong, China
| | - 惠 宋
- 泰安市中心医院中医科,山东泰安 271000Department of Traditional Chinese Medicine, Taian City Central Hospital, Tai'an 271000, Shandong, China
| |
Collapse
|
8
|
Li Y, Desai K, Milikowski C, Galimberti F. Disseminated Pruritic Papules in an Adult Male: Answer. Am J Dermatopathol 2021; 43:752. [PMID: 34546989 DOI: 10.1097/dad.0000000000001861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yumeng Li
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
- Department of Dermatology, Jackson Memorial Hospital, Miami, FL; and
| | - Karishma Desai
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Clara Milikowski
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
| | - Fabrizio Galimberti
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
- Department of Dermatology, Jackson Memorial Hospital, Miami, FL; and
| |
Collapse
|
9
|
Behera A, Devi S, Guru S, Sethy M. A Rare Case of Multicentric Reticulohistiocytosis with Concurrent Rheumatoid Arthritis. Cureus 2019; 11:e5476. [PMID: 31646135 PMCID: PMC6805039 DOI: 10.7759/cureus.5476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare multisystem macrophage disorder of unknown etiology characterized by papulonodular skin and mucosal lesions, rapidly progressive erosive symmetric polyarthritis, and inflammation of internal organs. Most often, it is misdiagnosed as rheumatoid arthritis (RA). Here, we report the case of a 60-year-old woman found to have features of both MRH and RA with positive rheumatoid factor and high titer of anti-cyclic citrullinated peptide antibody in serum. It was confirmed by a histopathology of skin lesions, which showed diffuse histiocytic infiltrate with multinucleated giant cells. She was treated with methotrexate, hydroxychloroquine, corticosteroids, and nonsteroidal anti-inflammatory drugs and bisphosphonate.
Collapse
Affiliation(s)
- Anupama Behera
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Sujata Devi
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Satyabrata Guru
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Madhusmita Sethy
- Pathology, All India Institute of Medical Sciences, Bhubaneswar, IND
| |
Collapse
|
10
|
Manzo A, Bugatti S, Rossi S. Clinical Applications of Synovial Biopsy. Front Med (Lausanne) 2019; 6:102. [PMID: 31134204 PMCID: PMC6524205 DOI: 10.3389/fmed.2019.00102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
The synovial tissue is a primary target of multiple diseases characterized by different pathogenic mechanisms, including infective, deposition, neoplastic, and chronic immune-inflammatory pathologies. Synovial biopsy can have a relevant role in differential diagnosis of specific conditions in clinical practice, although its exploitation remains relatively limited. In particular, no validated synovial-tissue-derived biomarkers are currently available in the clinic to aid in the diagnosis and management in most frequent forms of chronic inflammatory arthropathies, namely rheumatoid arthritis (RA) and the spondyloarthritides (SpA). In this brief review, we will discuss the current spectrum of clinical applications of synovial biopsy in routine rheumatologic care and will provide an analysis of the perspectives for its potential exploitation in patients with chronic inflammatory arthritides.
Collapse
Affiliation(s)
- Antonio Manzo
- Rheumatology and Translational Immunology Research Laboratories, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Serena Bugatti
- Rheumatology and Translational Immunology Research Laboratories, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Silvia Rossi
- Rheumatology and Translational Immunology Research Laboratories, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| |
Collapse
|
11
|
Zinn DJ, Eckstein O, Olsen ML, Allen CE, McClain KL. Thalidomide, A Rational Agent for Treatment of Multicentric Reticulohistiocytosis. DERMATOLOGY CASE REPORTS 2019; 4. [PMID: 32529194 PMCID: PMC7289025 DOI: 10.35248/2684-124x.19.4.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A patient with Multifocal Reticulohistiocytosis (MRH) of skin and joints failed treatment with etanercept, methotrexate, hydroxychloroquine, prednisone, bisphosphonates and hydroxyzine. Long term treatment with thalidomide led to marked improvement in joint and cutaneous manifestations.
Collapse
Affiliation(s)
- Daniel J Zinn
- Department of Pediatrics, Lehigh Valley Reilley Children's Hospital, Allentown, Pennsylvania, USA
| | - Olive Eckstein
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
| | - Mary L Olsen
- Baptist Physicians Network, Rheumatology Center, Beaumont, Texas, USA
| | - Carl E Allen
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth L McClain
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
12
|
Papulonodular Eruption on the Hands in a Patient With Arthritis: Answer. Am J Dermatopathol 2018; 40:784-785. [PMID: 30234563 DOI: 10.1097/dad.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Asano T, Suzutani K, Watanabe A, Honda A, Mori N, Yashiro M, Sato S, Kobayashi H, Watanabe H, Hazama M, Kanno T, Suzuki E, Ishii S, Migita K. The utility of FDG-PET/CT imaging in the evaluation of multicentric reticulohistiocytosis: A case report. Medicine (Baltimore) 2018; 97:e11449. [PMID: 30113451 PMCID: PMC6112898 DOI: 10.1097/md.0000000000011449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Multicentric reticulohistiocytosis (MRH) is a rare histiocytic disorder that involves the skin, joints, and visceral organs. CASE PRESENTATION We report a 67-year-old woman with MRH who presented with a 2-years history of polyarthralgia and skin nodules. Her symptoms were an inflammatory polyarthropathy with punched-out lesions of the distal interphalangeal (DIP) joints of both hands. Doppler ultrasonography of the hands showed large bone erosions with power Doppler signals in the DIP joints. F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) demonstrated increased FDG uptake in cutaneous papules surrounding the affected joints, suggesting an inflammatory process. There was no evidence of malignancy. Biopsy samples of skin nodules exhibited dermal infiltration with CD68-positive histiocytes and multinucleated giant cells. The patient was diagnosed with MRH and treated with combination therapy comprising a steroid (prednisolone), tacrolimus, methotrexate, and infliximab, which resulted in clinical improvement. Following infliximab treatment, there was a significant decrease in a bone resorption marker (tartrate-resistant acid phosphatase 5b: TRACP-5b), suggesting that tumor necrosis factor-α targeting therapy may inhibit osteoclast formation and resorption activity in patients with MRH. CONCLUSION MRH is a progressive destructive arthritic condition, and early diagnostic and therapeutic strategies are necessary to improve the outcome. FDG-PET/CT and joint ultrasonography might be noninvasive imaging modalities that could help diagnose MRH.
Collapse
Affiliation(s)
| | | | | | - Aki Honda
- Department of Dermatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima
| | | | | | | | | | | | - Momoko Hazama
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation, Nishinouchi, Koriyama
| | - Takashi Kanno
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation, Nishinouchi, Koriyama
| | - Eiji Suzuki
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation, Nishinouchi, Koriyama
| | - Shiro Ishii
- Department of Radiology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | | |
Collapse
|
14
|
Luder C, Nordmann T, Ramelyte E, Mühleisen B, Kerl K, Guenova E, Dummer R. Histiocytosis - cutaneous manifestations of hematopoietic neoplasm and non-neoplastic histiocytic proliferations. J Eur Acad Dermatol Venereol 2018; 32:926-934. [DOI: 10.1111/jdv.14794] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 12/11/2017] [Indexed: 01/18/2023]
Affiliation(s)
- C.M. Luder
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - T.M. Nordmann
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - E. Ramelyte
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - B. Mühleisen
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - K. Kerl
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - E. Guenova
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - R. Dummer
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| |
Collapse
|
15
|
Singer SB, Thomas C, Lezcano C, Robbins M, Gordian A, Nori S, Granter SR, Merola JF, O'Malley JT. Polyarthralgias and Papulonodules in a 56-Year-Old Woman. Arthritis Care Res (Hoboken) 2018; 70:925-930. [PMID: 29342504 DOI: 10.1002/acr.23516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/09/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Sean B Singer
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cristina Thomas
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cecilia Lezcano
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark Robbins
- Harvard Vanguard Medical Associates/Atrius Health, Boston, Massachusetts
| | - Amparo Gordian
- Harvard Vanguard Medical Associates/Atrius Health, Boston, Massachusetts
| | - Sarita Nori
- Harvard Vanguard Medical Associates/Atrius Health, Boston, Massachusetts
| | - Scott R Granter
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John T O'Malley
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
16
|
Varilla V, Taxel P, Tannenbaum S. Metastatic Inflammatory Breast Cancer Associated With Multicentric Reticulohistiocytosis Successfully Treated With Zoledronic Acid. Clin Breast Cancer 2016; 16:e203-e207. [PMID: 27435627 DOI: 10.1016/j.clbc.2016.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/27/2016] [Accepted: 06/17/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - Pamela Taxel
- Division of Endocrinology and Metabolism, UConn Health, Farmington, CT
| | | |
Collapse
|
17
|
Zhao H, Wu C, Wu M, Zhou Y, Zhu H, Li Y, You Y, Luo H, Wang L, Zuo X. Tumor necrosis factor antagonists in the treatment of multicentric reticulohistiocytosis: Current clinical evidence. Mol Med Rep 2016; 14:209-17. [PMID: 27175854 PMCID: PMC4918541 DOI: 10.3892/mmr.2016.5253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 04/04/2016] [Indexed: 12/22/2022] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare and debilitating systemic disorder characterized by cutaneous nodules and destructive polyarthritis. Due to its unknown etiology, the treatment of MRH varies with different rates of success, which causes treatment options to be rather independent and empirical. In the present study, a case of a 48‑year‑old woman with a 12‑month history of polyarthralgia and skin nodules was reported. Biopsy samples, which were obtained from her skin eruption exhibited dermal infiltration with histiocytes and multinucleated giant cells. Immunohistochemical staining indicated positivity for CD68. The patient was diagnosed with MRH and treated with a combination therapy of infliximab, prednisolone and methotrexate. Her symptoms improved markedly within 2 weeks. Following the results of this case study, a systematic review of 17 cases of MRH treated with tumor necrosis factor (TNF) antagonists was performed, and the efficacy of anti‑TNF treatment in MRH was analyzed.
Collapse
Affiliation(s)
- Hongjun Zhao
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Chunmei Wu
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Mengyun Wu
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yaou Zhou
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Honglin Zhu
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yisha Li
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yunhui You
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Hui Luo
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Lijing Wang
- Department of Gerontology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiaoxia Zuo
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| |
Collapse
|
18
|
Toz B, Büyükbabani N, İnanç M. Multicentric reticulohistiocytosis: Rheumatology perspective. Best Pract Res Clin Rheumatol 2016; 30:250-260. [DOI: 10.1016/j.berh.2016.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/13/2016] [Indexed: 12/22/2022]
|
19
|
Tariq S, Hugenberg ST, Hirano-Ali SA, Tariq H. Multicentric reticulohistiocytosis (MRH): case report with review of literature between 1991 and 2014 with in depth analysis of various treatment regimens and outcomes. SPRINGERPLUS 2016; 5:180. [PMID: 27026876 PMCID: PMC4766148 DOI: 10.1186/s40064-016-1874-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
Multicentric reticulohistiocytosis is a rare disease affecting skin and joints primarily and rarely other organs. We present a case report of this disease and an extensive review of the literature. We reviewed the data between 1991 and 2014 and extracted 52 individual cases. Only articles in English were chosen after checking for relevance. The articles were studies and data was extracted into excel spread sheets and later used to compute such variables like frequency, mean and percentage of distribution of various clinical manifestations. The treatments used in these articles were critically analyzed and graded for their relative efficacy for skin and joint manifestations. The grades were 0 = worse, 1 = no benefit/condition remained same, 2 = improvement without resolution, and 3 = resolution. This article also reports the demographic, clinical, laboratory and pathological data from the reviewed articles. Authors attempted to discuss the findings of this review in depth to help manage this condition and proposed a treatment algorithm to help clinicians approach this rare and challenging disease.
Collapse
Affiliation(s)
- Saad Tariq
- Division of Rheumatology, Department of Medicine, Indiana University School of Medicine, 1120 West Michigan Street, Room CL 370, Indianapolis, IN 46202 USA
| | - Steven T Hugenberg
- Division of Rheumatology, Department of Medicine, Indiana University School of Medicine, 1120 West Michigan Street, Room CL 370, Indianapolis, IN 46202 USA
| | - Stefanie A Hirano-Ali
- Dermatopathology Division, Department of Pathology, Indiana School of Medicine, Indianapolis, IN USA
| | - Hassan Tariq
- Department of Histopathology, AFIP (Armed Forces Institute of Pathology) , Rawalpindi, Pakistan
| |
Collapse
|
20
|
Mokuda S, Oiwa H. Successful treatment of FKBP51-expressed multicentric reticulohistiocytosis using combination therapy with low-dose denosumab and tacrolimus. Scand J Rheumatol 2015; 45:247-9. [PMID: 26652057 DOI: 10.3109/03009742.2015.1110199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- S Mokuda
- a Department of Rheumatology , Hiroshima City Hiroshima Citizens Hospital , Hiroshima , Japan
| | - H Oiwa
- a Department of Rheumatology , Hiroshima City Hiroshima Citizens Hospital , Hiroshima , Japan
| |
Collapse
|
21
|
Saibaba B, Sen RK, Das A, Sharma A. Bilateral Total Hip Arthroplasty in a Rare Case of Multicentric Reticulohistiocytosis. Clin Orthop Surg 2015; 7:509-14. [PMID: 26640636 PMCID: PMC4667121 DOI: 10.4055/cios.2015.7.4.509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 06/26/2014] [Indexed: 12/26/2022] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, which commonly manifests as muco-cutaneous papulonodules and inflammatory erosive polyarthropathy. In this research, we report the clinical manifestations and management of a rare case of MRH with destructive arthropathy of bilateral hip joints and arthritis mutilans presenting with characteristic deformities. Disabling hip arthropathy that occurs secondary to MRH can be successfully managed with bilateral total hip arthroplasty (THA). Osteopenia and acetabular bone defects must be anticipated during THA. This case is reported due to its rare occurrence and because little literature has been published regarding THA in such patients.
Collapse
Affiliation(s)
- Balaji Saibaba
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramesh Kumar Sen
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
22
|
Olson J, Mann JA, White K, Cartwright VW, Bauer J, Nolt D. Multicentric reticulohistiocytosis: a case report of an atypical presentation in a 2-year-old. Pediatr Dermatol 2015; 32:e70-3. [PMID: 25727569 DOI: 10.1111/pde.12531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare systemic inflammatory granulomatous disease marked by severe and often rapidly progressive polyarticular arthritis and cutaneous papulonodules. Initial clinical diagnosis may be difficult. We describe a 2-year-old girl presenting with pink dermal papules on the forehead, thighs, elbows, knees, and palms of the hands. Based on clinical findings and skin biopsy results, she was initially diagnosed with granuloma annulare. At 5 years of age, she developed arthritis, fatigue, and more widespread skin papules leading to the diagnosis of MRH. To our knowledge, this is the youngest individual with MRH yet described. We outline the timeline and unique features of her case and review the literature pertaining to MRH in children. Although rare, MRH can be permanently debilitating, making prompt diagnosis critical. A standardized approach to investigation and management needs to be developed.
Collapse
Affiliation(s)
- Jaleh Olson
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Julianne A Mann
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.,Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Kevin White
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.,Department of Dermatology, Oregon Health and Science University, Portland, Oregon.,Department of Dermatopathology, Oregon Health and Science University, Portland, Oregon
| | - Victoria W Cartwright
- Division of Rheumatology, Department of Pediatrics, Randall Children's Hospital, Portland, Oregon
| | - Jeremy Bauer
- Shriners Hospital for Children, Portland, Oregon
| | - Dawn Nolt
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.,Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
23
|
Miscellaneous arthropathies. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
24
|
Baek IW, Yoo SH, Yang H, Park J, Kim KJ, Cho CS. A case of multicentric reticulohistiocytosis. Mod Rheumatol 2014; 27:165-168. [PMID: 25211404 DOI: 10.3109/14397595.2014.952702] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare non-Langerhans histiocytosis of unknown etiology with a predilection for joint and skin. The characteristic clinical features are papulonodular skin eruptions and inflammatory polyarthritis, sometimes progressive to arthritis mutilans, a severe destructive arthropathy. Although these manifestations can present at the same time, it is more common that one feature precedes the others. Notably, these features are similar to those found in some rheumatic diseases, such as rheumatoid arthritis or dermatomyositis, and this can lead to a misdiagnosis, especially during periods where only one feature is present. Herein, we report a female patient with polyarthralgia and subsequent skin eruptions, who was eventually diagnosed with MRH. Her symptoms seemed to resemble those of some rheumatic diseases, but several features such as affected joints and the characteristic shape of the skin lesions did not correspond to that. The histological result of infiltration of histiocytes and multinucleated giant cells in the skin ultimately facilitated the correct diagnosis. In this paper, we review MRH briefly and highlight several differential points which enable us to increase the likelihood of correctly diagnosing MRH.
Collapse
Affiliation(s)
- In-Woon Baek
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Sang Hoon Yoo
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Hyun Yang
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Jeongmi Park
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Ki-Jo Kim
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Chul-Soo Cho
- a Division of Rheumatology, Department of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| |
Collapse
|
25
|
Keum DI, Yoon NY, Lee WS. Multicentric reticulohistiocytosis misdiagnosed as rheumatoid arthritis. Int J Dermatol 2014; 54:e222-5. [DOI: 10.1111/ijd.12333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 02/19/2013] [Accepted: 05/04/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Dong In Keum
- Department of Dermatology and Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - Na-Young Yoon
- Department of Dermatology and Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - Won-Soo Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| |
Collapse
|
26
|
Macía-Villa CC, Zea-Mendoza A. Multicentric reticulohistiocytosis: case report with response to infliximab and review of treatment options. Clin Rheumatol 2014; 35:527-34. [DOI: 10.1007/s10067-014-2611-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 12/01/2022]
|
27
|
KRAUSE MEGANL, LEHMAN JULIAS, WARRINGTON KENNETHJ. Multicentric Reticulohistiocytosis Can Mimic Rheumatoid Arthritis. J Rheumatol 2014; 41:780-1. [DOI: 10.3899/jrheum.131062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
28
|
Abstract
Monoclonal antibodies (mAbs) are antibodies of a single antigen specificity produced by identical immune cells, i.e., clones of a common germ cell. They offer unprecedented opportunities to drug development because of their ability to target almost any cell surface or secreted molecule with remarkable efficacy and safety. In this chapter, the application of human mAbs in the treatment of inflammatory diseases is reviewed. We discuss in detail several mAb-based drugs such as anti-tumor necrosis factor (anti-TNF), anti-interleukin-1 (anti-IL-1) receptor, anti-IL-6 receptor, anti-α4 integrin subunit, and anti-CD20 agents, all of which have been documented by clinical trials to be efficacious and have been approved for the therapy of several inflammatory and immune diseases, including rheumatoid arthritis, Crohn's disease, ulcerative colitis, spondyloarthropathies, juvenile arthritis, psoriasis, psoriatic arthritis, and others. These novel drugs can be used either as a monotherapy or in combination with other conventional therapeutic modalities, particularly if the disease under treatment is refractory to therapy using solely conventional techniques. As a large variety of mAb-based agents targeting a plethora of cytokines, chemokines, adhesion and co-stimulatory molecules, receptors, as well as diverse cell types, are presently under investigation, the therapeutic armamentarium of the clinician is expected to greatly broaden in the near future, providing improved patient care for a wide range of devastating diseases of our times.
Collapse
|
29
|
Andrew R, Nuara A, McCollough M, Kelly E. Papular xanthomas with destructive arthritis. J Am Acad Dermatol 2013; 69:e309-10. [PMID: 24238192 DOI: 10.1016/j.jaad.2013.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/05/2013] [Accepted: 08/08/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Rachel Andrew
- The University of Texas Southwestern Medical Center, Hummelstown, Pennsylvania.
| | | | | | | |
Collapse
|
30
|
Huang X, Zhang L, Zhang S. Multicentric reticulohistiocytosis with extra-mammillary Paget's disease: a case report. Eur J Med Res 2013; 18:38. [PMID: 24168966 PMCID: PMC3874611 DOI: 10.1186/2047-783x-18-38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 10/14/2013] [Indexed: 11/30/2022] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is a very rare systemic disease with variable phenotypic presentation and a high rate of misdiagnosis. Here we describe a patient with MRH and extra-mammillary Paget’s disease (EMPD), a diagnosis that has not previously been described in the literature.
Collapse
Affiliation(s)
| | | | - Songzhao Zhang
- The Department of Clinical Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.
| |
Collapse
|
31
|
|
32
|
Wade RG, Daivajna S, Chapman P, Murphy JG, Makkuni D. Hand surgery for Multicentric Reticulohistiocytosis: A new avenue of treatment and review of the literature. Int J Surg Case Rep 2013; 4:744-7. [PMID: 23796955 DOI: 10.1016/j.ijscr.2013.04.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/09/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Multicentric Reticulohistiocytosis (MRH) is a rare non-Langerhans cell histiocytosis characterised by destructive polyarthritis and violaceous skin papules. PRESENTATION OF CASE In 2010, a 70-year-old woman with Palindromic Rheumatism was diagnosed with MRH. Within a few months, she developed ankylosis of the small joints of both hands which resulted in severe fixed flexion deformities of the fingers and thumbs. The joint disease failed to respond to medical therapies and the palmar skin of her left hand was becoming increasingly macerated. Therefore, she elected to undergo arthrodesis of the metacarpophalangeal joints to allow hand hygiene. DISCUSSION To-date, this is the first report of a surgical intervention for this rare condition and represents a novel avenue of potential therapy. Medical therapies for MRH are usually ineffective in preventing the debilitating small joint disease which often develops and there is on-going research into newer agents and alternative surgical techniques. CONCLUSION Once medical therapies are exhausted, clinicians should consider the input of Hand Surgeons in managing the inevitable and mutilating joint disease of this rare condition.
Collapse
Affiliation(s)
- Ryckie G Wade
- Norfolk and Norwich University Hospital NHS Foundation Trust, NR4 7UY, UK
| | | | | | | | | |
Collapse
|
33
|
Multicentric reticulohistiocytosis presenting with papulonodular skin lesions and arthritis mutilans. Case Rep Rheumatol 2013; 2013:201563. [PMID: 23555066 PMCID: PMC3608314 DOI: 10.1155/2013/201563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/21/2013] [Indexed: 01/25/2023] Open
Abstract
Multicentric reticulohistiocytosis is a rare multisystem disorder of unknown etiology that is characterized by erosive polyarthritis and papulonodular lesions on the skin, mucous membranes, and internal organs. We report the case of a 54-year-old female who was misdiagnosed as having rheumatoid arthritis and underwent numerous joint replacement surgeries for progressively destructive arthritis in her hands, shoulders, hips, and knees. The patient finally received a diagnosis of multicentric reticulohistiocytosis after histopathological examination of the patient's left knee arthroplasty which revealed a diffuse histiocytic infiltrate, multinucleated giant cells, and finely granulated eosinophilic cytoplasm with a ground-glass appearance.
Collapse
|
34
|
Trotta F, Colina M. Multicentric reticulohistiocytosis and fibroblastic rheumatism. Best Pract Res Clin Rheumatol 2013; 26:543-57. [PMID: 23040366 DOI: 10.1016/j.berh.2012.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2012] [Indexed: 12/22/2022]
Abstract
Multicentric reticulohistiocytosis (MRH) and fibroblastic rheumatism (FR) are uncommon disorders with similar joint and skin manifestations. They are usually included among the non-Langerhans histiocytoses, but recent insights drive some criticism. The diagnosis is often challenging and must be confirmed by the histological typical features. If the skin manifestations are missing, the arthritic complaints may be confused with those of other rheumatic disorders. In these cases, only a careful clinical and radiological evaluation leads to the correct diagnosis. The natural course of the diseases may rapidly develop into disabling manifestations, making an aggressive treatment strongly recommendable. There is emerging evidence that anti-tumour necrosis factor-α agents and bisphosphonates are promising drugs for MRH, while a course of methotrexate and steroids seems to be the best option for FR. Finally, the clinician should be aware that in many cases MRH, but not FR, is associated with a large number of systemic manifestations and with malignancy. This eventuality must be accurately ruled out.
Collapse
Affiliation(s)
- Francesco Trotta
- Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | | |
Collapse
|
35
|
Yeter KC, Arkfeld DG. Treatment of multicentric reticulohistiocytosis with adalimumab, minocycline, methotrexate. Int J Rheum Dis 2012; 16:105-6. [DOI: 10.1111/j.1756-185x.2012.01762.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Karen C. Yeter
- Department of Medicine - Rheumatology; Keck School of Medicine; University of Southern California; CA; USA
| | - Daniel G. Arkfeld
- Department of Medicine - Rheumatology; Keck School of Medicine; University of Southern California; CA; USA
| |
Collapse
|
36
|
Allen CP, Clayton R, Burge SM. Papular rash with arthritis. Clin Exp Dermatol 2012; 37:453-4. [PMID: 22582917 DOI: 10.1111/j.1365-2230.2011.04180.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C P Allen
- Department of Dermatology, Churchill Hospital, Oxford, UK
| | | | | |
Collapse
|
37
|
Iwata H, Okumura Y, Seishima M, Aoyama Y. Overexpression of monocyte chemoattractant protein-1 in the overlying epidermis of multicentric reticulohistiocytosis lesions: a case report. Int J Dermatol 2012; 51:492-4. [DOI: 10.1111/j.1365-4632.2010.04573.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
38
|
Shah A, Jack A, Liu H, Hopkins RS. Neoplastic/paraneoplastic dermatitis, fasciitis, and panniculitis. Rheum Dis Clin North Am 2012; 37:573-92. [PMID: 22075198 DOI: 10.1016/j.rdc.2011.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The skin changes outlined in this article can be important clues to an underlying malignancy. Paraneoplastic dermatoses are skin disorders associated with an underlying neoplasm and whose course parallels that of the neoplasm. Recognizing these skin presentations leads to early diagnosis and management of the underlying malignancy. Effective treatment of the associated neoplasm often leads to improvement of the cutaneous manifestations and should be the primary focus of each patient's management.
Collapse
Affiliation(s)
- Anjali Shah
- Division of Dermatology, Department of Medicine, Loyola University Medical Center, Room 101, Building 54, 2160 South First Avenue, Maywood, IL 60153, USA
| | | | | | | |
Collapse
|
39
|
Synovial xanthomatosis: are there clues to mechanisms for this rare disease? Mod Rheumatol 2012; 22:907-11. [PMID: 22322588 DOI: 10.1007/s10165-012-0592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 01/06/2012] [Indexed: 10/14/2022]
Abstract
We report a 64-year-old man with arthritis and nodules to describe that this picture can be caused by normo-lipidemic xanthomas. Light and electron microscopy (EM) plus polymerase chain reaction (PCR) studies were performed for diagnosis and investigation. These showed features typical of xanthomas plus PCR and EM evidence of possible infection with Chlamydia pneumoniae as a pathogenetic mechanism deserving consideration. With such rare diseases, any clues to possible mechanisms seem important to record and thus to encourage future investigations. This uncommon cause of arthritis and nodules had been confused with rheumatoid arthritis by others in this case.
Collapse
|
40
|
Bennàssar A, Mas A, Guilabert A, Julià M, Mascaró-Galy JM, Herrero C. Multicentric reticulohistiocytosis with elevated cytokine serum levels. J Dermatol 2011; 38:905-10. [PMID: 21658110 DOI: 10.1111/j.1346-8138.2010.01146.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multicentric reticulohistiocytosis (MRH) is an uncommon non-Langerhans cell histiocytosis of unknown etiology. It is a multisystem disorder characterised by a papulonodular skin eruption, mainly in the extensor surfaces, and destructive polyarthritis. Histologically, either cutaneous lesions or the synovium show a dense dermal infiltrate of histiocytes and multinucleated giant cells with an eosinophilic granular material in the cytoplasm. In the immunohistochemical analysis these cells stain positively with monocyte/macrophage markers (CD68 and CD45), as well as with certain cytokines (tumor necrosis factor-α, interleukin 1β and interleukin 6). Moreover, recent reports suggest an osteoclastic nature of the infiltrating cells, as they stain strongly with osteoclast tissue lytic markers including tartrate-resistant acid phosphatase and cathepsin K. We report a case of MRH presenting with clinical features of dermatomyositis. Furthermore, the patient showed elevated cytokine serum levels that lowered after therapy.
Collapse
|
41
|
Miscellaneous arthropathies including synovial tumors and foreign body synovitis and nephrogenic systemic fibrosis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
42
|
Tan BH, Barry CI, Wick MR, White KP, Brown JG, Lee A, Litchfield AH, Lener EV, Shitabata PK. Multicentric reticulohistiocytosis and urologic carcinomas: a possible paraneoplastic association. J Cutan Pathol 2010; 38:43-8. [DOI: 10.1111/j.1600-0560.2010.01608.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
43
|
BROADWELL AARONW, CALAMIA KENNETHT, KRANSDORF MARKJ, GINSBURG WILLIAMW. Healing of Erosive Disease in Multicentric Reticulohistiocytosis: Figure 1. J Rheumatol 2010; 37:1366-7. [DOI: 10.3899/jrheum.091329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
44
|
Multicentric reticulohistiocytosis: An autoimmune systemic disease? Case report of an association with erosive rheumatoid arthritis and systemic Sjogren syndrome. Joint Bone Spine 2010; 77:274-6. [DOI: 10.1016/j.jbspin.2010.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2010] [Indexed: 11/19/2022]
|
45
|
Malignancy-associated multicentric reticulohistiocytosis. Rheumatol Int 2009; 31:1235-8. [DOI: 10.1007/s00296-009-1287-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/29/2009] [Indexed: 10/20/2022]
|
46
|
Lauwers A, Guichard I, Charmion S, Koenig M, Cathébras P. [Polyarthritis and nodules on the hands of a 45-year-old man]. Presse Med 2009; 39:281-3. [PMID: 19850441 DOI: 10.1016/j.lpm.2009.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/26/2009] [Accepted: 09/02/2009] [Indexed: 10/20/2022] Open
Affiliation(s)
- Anne Lauwers
- Service de médecine interne, Hôpital Nord, F-42055 Saint-Etienne Cedex 2, France
| | | | | | | | | |
Collapse
|
47
|
Matiz C, Ferguson PJ, Zaenglein A, Groh B, Bingham CA. Papular xanthomas and erosive arthritis in a 3 year old girl, is this a new MRH variant? Pediatr Rheumatol Online J 2009; 7:15. [PMID: 19814780 PMCID: PMC2770547 DOI: 10.1186/1546-0096-7-15] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 10/08/2009] [Indexed: 11/10/2022] Open
Abstract
Xanthomatous skin lesions and arthritis in children are not a common association. We present the case of a 3 year old girl who presented with xanthomatous lesions in the periungual region of both hands, around the nares and on her forehead, associated with significant arthritis that was clinically compatible with multicentric reticulohistiocytosis. However, pathology of the xanthomatous lesions was more suggestive of papular xanthoma, a disease that is not associated with arthritis. Based on her presentation and the negative lipid workup, she was treated for presumed multicentric reticulohistiocytosis. Multiple treatment strategies were utilized, with improvement on a combination of infliximab, methotrexate, and prednisone. We review the different diagnoses that should be considered in children with xanthomas and arthritis as well as the different pharmacologic therapies used in children with multicentric reticulohistiocytosis.
Collapse
Affiliation(s)
- Catalina Matiz
- Division of Pediatric Rheumatology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Andrea Zaenglein
- Department of Dermatology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Brandt Groh
- Division of Pediatric Rheumatology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Catherine April Bingham
- Division of Pediatric Rheumatology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
48
|
|
49
|
Benucci M, Sulla A, Manfredi M. Cardiac engagement in multicentric reticulohistiocytosis: report of a case with fatal outcome and literature review. Intern Emerg Med 2008; 3:165-8. [PMID: 18265939 DOI: 10.1007/s11739-008-0102-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 01/18/2007] [Indexed: 10/22/2022]
|
50
|
Codriansky KA, Rünger TM, Bhawan J, Kantarci A, Kissin EY. Multicentric reticulohistiocytosis: a systemic osteoclastic disease? ACTA ACUST UNITED AC 2008; 59:444-8. [PMID: 18311766 DOI: 10.1002/art.23320] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|