[Langerhans'cell histiocytosis of bone]

[Sclerosing cholangitis revealing Langerhans cell histiocytosis in a 15-month-old child]

INTRODUCTION

Langerhans cell histiocytosis (LCH) is a rare disease that mainly affects young children. Sclerosing cholangitis may occur in 10-15% of patients with the multivisceral form. We report the case of a 15-month-old child who presented sclerosing cholangitis revealing LCH.

OBSERVATION

A 15-month-old child was hospitalized for cholestatic jaundice. He was the son of consanguineous parents and had repeated ear infections. One month before his hospitalization, he developed febrile jaundice. Initial clinical examination showed hepatosplenomegaly, with cholestasis, bicytopenia, and biological inflammatory syndrome. The digestive radiological studies revealed hepatomegaly and a regular thickening of the intestinal wall with an extension to the biliary tree. During his hospitalization, the infant developed stubborn ascites, lymphadenopathy, and skin lesions. Skull radiographs revealed punched-out lesions. The skin biopsy confirmed the diagnosis of histiocytosis X. Chemotherapy was started. The child died after the first course of treatment as a consequence of liver failure.

CONCLUSION

Sclerosing cholangitis may complicate LCH, mainly in its multivisceral form. On average, sclerosing cholangitis develops 2 years after diagnosis in children. It is rarely indicative of the diagnosis, which is mainly based on radiological examinations. Liver involvement is a factor of poor prognosis. It precipitates the occurrence of biliary cirrhosis. Usually, sclerosing cholangitis responds poorly to Langerhans histiocytosis treatment and liver transplantation must be considered.

Langerhans cell histiocytosis revealed by painful hip: a case report

Langerhans cell histiocytosis is a rare disease in childhood. It has a very polymorphous clinical expression, ranging from a single bony disease to a multisystemic disease involving vital organs. Prognosis has been improved by use of chemotherapy. We report a 2-year-old girl with multifocal Langerhans cell histiocytosis of bone and skin, revealed by a pain of the left hip and a limp trailing from 2 months. The diagnosis has been established by histological exam. The patient received chemotherapy and steroids. Outcome was favourable over 6-month follow-up. Trailing limp should evoke diagnosis of Langerhans cell histiocytosis. Skin biopsy should be preferred to a bone biopsy because of its safety.