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Finsterer J. Erdheim-Chester disease requires extensive prospective and thorough work-up for multisystem involvement. Cardiovasc Pathol 2024; 71:107638. [PMID: 38555005 DOI: 10.1016/j.carpath.2024.107638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024] Open
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Kulkarni AM, Gayam PKR, Aranjani JM. Advances in Understanding and Management of Erdheim-Chester Disease. Life Sci 2024; 348:122692. [PMID: 38710283 DOI: 10.1016/j.lfs.2024.122692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
Erdheim Chester Disease (ECD) is a rare histiocytic disorder marked by infiltration of organs with CD68+ histiocytes. ECD stems from mutations of BRAF and MAP2K1 in hematopoietic stem and progenitor cells (HSPCs), which further differentiate into monocytes and histiocytes. Histopathology reveals lipid-containing histiocytes, which test positive for CD68 and CD133 in immunohistochemistry. Signs and symptoms vary and depend on the organ/s of manifestation. Definitive radiological results associated with ECD include hairy kidney, coated aorta, and cardiac pseudotumor. Treatment options primarily include anti-cytokine therapy and inhibitors of BRAF and MEK signaling.
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Affiliation(s)
- Aniruddha Murahar Kulkarni
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prasanna Kumar Reddy Gayam
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jesil Mathew Aranjani
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Wong A, Sharma A, Ramcharitar R. Cardiovascular manifestations of Erdheim-Chester disease: A narrative review with two cases. Vasc Med 2024; 29:313-319. [PMID: 38469821 DOI: 10.1177/1358863x241228271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Erdheim-Chester disease (ECD) is a rare 'L' (Langerhans) group histiocytic neoplasm that affects a multitude of organ systems, causing osteosclerotic bone lesions, periaortic encasement ('coated' aorta), retroperitoneal fibrosis involving kidneys and ureters ('hairy kidney'), and infiltration of the central nervous system. Cardiovascular involvement can occur in up to 70% of patients and is usually found during computed tomography/magnetic resonance imaging evaluation. When present, cardiovascular symptoms can have wide variability in presentation from asymptomatic to pericarditis, fatal cardiac tamponade, myocardial infarction, conduction abnormalities, heart failure, renal artery stenosis, and claudication. Cardiac involvement found on imaging includes right atrial pseudotumor, right atrioventricular groove infiltration, and pericardial effusions. ECD can involve the large- and medium-sized arteries, often seen as periarterial thickening (commonly coating the aorta) with stenosis/occlusion. Although more cardiovascular ECD cases have begun to be published in the literature, more data are needed on the outcomes of these patients, as well as how cardiovascular manifestations respond to treatment of ECD.
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Affiliation(s)
- Alan Wong
- Department of Vascular Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aditya Sharma
- Department of Vascular Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Randy Ramcharitar
- Department of Vascular Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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Shi X, Sun G, Li T, Xu M, Liu Y, Wang Z, Hou Y. Erdheim‑Chester disease of multisystem involvement with delayed diagnosis: A case report and literature review. Exp Ther Med 2024; 27:159. [PMID: 38476885 PMCID: PMC10928972 DOI: 10.3892/etm.2024.12447] [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: 05/31/2023] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
Erdheim-Chester disease (ECD) is a rare tumor of histiocytic origin, characterized by foamy or lipid-laden histiocytes mixed or surrounded by fibrosis that infiltrate multiple organs. Misdiagnosis is common due to the diversity of clinical presentations. The present study reported a case of ECD with the involvements of bone, cardiac, aorta and retroperitoneum. The patient had no obvious clinical symptoms and no noteworthy foamy histiocytes or Touton giant cells were found on pathological examination, delaying the diagnosis. The patient was a young male found to have pericardial effusion on physical examination, and computed tomography (CT) revealed soft tissue infiltrates in the retroperitoneum and around the aorta. A mediastinal biopsy revealed fibrous connective tissue with small-vessel hyperplasia and acute-chronic inflammatory cell infiltration. The initial diagnosis was retroperitoneal fibrosis (RPF), and hormonal and tamoxifen treatments were administered. The patient presented with oliguria, eyelid edema and fever four years later. A repeat CT revealed an increase in the extent of tissue infiltration and pericardial effusion compared with the previous CT. Subsequent cardiac magnetic resonance imaging revealed massive thickening in the form of fibrotic tissue infiltrating the heart and surrounding thoracic and abdominal aorta. Single photon emission CT revealed multiple areas of increased bone metabolism, particularly symmetrical involvement of the long bones of both lower extremities. A biopsy of the perirenal tissue revealed fibrous tissue and a small number of lymphocytes and macrophages [typical foamy histiocytes observed via x200 magnification and hematoxylin-eosin (HE) staining, no presence of xanthogranuloma or Touton giant cells]. After a comprehensive evaluation and ruling out other diseases, the diagnosis of ECD was determined. The prognosis of this disease is poor; early diagnosis is critical and requires accurate judgment by clinicians. Biopsies of all involved sites and refinement of genetic tests to guide treatment, if possible, are both necessary.
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Affiliation(s)
- Xiaotong Shi
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong 261053, P.R. China
| | - Guangzhi Sun
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, Shandong 250000, P.R. China
| | - Tongguan Li
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, School of Clinical Medicine, Shandong First Medical University, Jinan, Shandong 250117, P.R. China
| | - Mengjiao Xu
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, School of Clinical Medicine, Shandong First Medical University, Jinan, Shandong 250117, P.R. China
| | - Yixuan Liu
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong 261053, P.R. China
| | - Zhankui Wang
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, Jinan, Shandong 250000, P.R. China
| | - Yanfeng Hou
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, Jinan, Shandong 250000, P.R. China
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Finsterer J. Double Subclavian Steal Syndrome As Initial Manifestation of Erdheim-Chester Disease: A Case Report. Cureus 2023; 15:e50427. [PMID: 38222166 PMCID: PMC10784865 DOI: 10.7759/cureus.50427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Erdheim-Chester disease (ECD) is a histiocytosis that infiltrates all organs, but especially large arteries such as the aorta and its branches, which become sheathed and lead to multiple stenoses or even occlusions. Subclavian steal syndrome (SSS) has not been reported in ECD. A 68-year-old female was diagnosed with ECD due to the typical sheathing of the aorta and its major branches. Five years previously, asymptomatic SSS due to stenosis of the left subclavian artery was incidentally diagnosed. In the following years, occlusion of the subclavian and left vertebral artery, and stenosis of basilar artery and right middle cerebral artery occurred. The abnormal cerebral perfusion had consequences on the perfusion of the left upper extremity and was presumably responsible for falls. Basilar and middle cerebral artery stenosis is rare in ECD and vertebral artery occlusion and double subclavian steal have not been reported in ECD. This case is the first to show that the initial manifestation of ECD can be unilateral SSS and that subclavian artery occlusion can even lead to double SSS. Patients with SSS should undergo a thorough diagnostic evaluation to detect rare causes of SSS, such as ECD.
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Affiliation(s)
- Josef Finsterer
- Neurology, Neurology and Neurophysiology Center, Vienna, AUT
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