1
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Lam TO, Ip ECC, Lau WWH, Chan AWS, Cheung CMT, Li JJX, Ng JKM, Tam LS. Mutilating arthropathy with skin nodules. Ann Rheum Dis 2024:ard-2024-226186. [PMID: 39117581 DOI: 10.1136/ard-2024-226186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/27/2024] [Indexed: 08/10/2024]
Affiliation(s)
- Tsz On Lam
- The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Edric Chi Ching Ip
- The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Wendy Wan Hang Lau
- The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Agnes Wai Sze Chan
- The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | | | - Joshua Jing Xi Li
- The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Joanna Ka Man Ng
- The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Lai-Shan Tam
- The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
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2
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Mandyam S, Onteddu J, Ray R, Basso R, Bader F, Onteddu NK. Multicentric Reticulohistiocytosis Presenting As Acute Pericarditis With Moderate-Sized Pericardial Effusion: A Case Report and Review of Multicentric Reticulohistiocytosis Treatment. Cureus 2023; 15:e39953. [PMID: 37416020 PMCID: PMC10319645 DOI: 10.7759/cureus.39953] [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: 06/04/2023] [Indexed: 07/08/2023] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare, class IIb non-Langerhans cell histiocytosis associated with skin and joint involvement. It is more prevalent (80%) in Caucasian females in their fifth to sixth decade of life. Patients usually demonstrate symptoms and signs of symmetric polyarthritis and papulonodular cutaneous lesions. In addition to skin and joints, multiple organs can be involved, such as the lung (pleural effusion, interstitial fibrosis, hilar lymphadenopathy), heart (pericardial effusion, myocarditis), gastrointestinal system, and urogenital system (genital tract and kidney). Pericardial involvement is a rare manifestation, and around three cases have been reported in the literature so far. Our case report is a valuable contribution to the literature, which aids clinicians in contemplating MRH as one of the differentials among patients presenting with pericardial effusion. We described the characteristics of MRH along with its differentiating features from other autoimmune conditions and management.
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Affiliation(s)
| | | | - Rubela Ray
- Internal Medicine, Bankura Sammilani Medical College, Bankura, IND
| | - Rafaela Basso
- Internal Medicine, Southeast Health Medical Center, Dothan, USA
| | - Fadi Bader
- Internal Medicine, Southeast Health Medical Center, Dothan, USA
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3
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Parihar M, Kashif A, Neema S. Multicentric reticulohistiocytosis: A diagnostic challenge. Med J Armed Forces India 2023; 79:352-355. [PMID: 37193515 PMCID: PMC10182282 DOI: 10.1016/j.mjafi.2021.05.001] [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: 06/17/2020] [Accepted: 05/01/2021] [Indexed: 11/26/2022] Open
Abstract
Multicentric reticulohistiocytosis, also called as lipoid dermato-arthritis is a rare form of non-Langerhans cell histiocytosis characterised by nodular and papular skin lesions containing characteristic bizarre multinucleate giant cells with ground glass cytoplasm. The disease commonly involves the skin, mucosa, synovium, and internal organs with cutaneous nodules and progressive erosive arthritis being the most common presenting features. We report a case of a 61-year-old male presenting with multiple swellings over distal part of fingers for 6 years without involvement of joints. A diagnosis of multicentric histiocytosis was made based on typical histopathological features of sheets of histiocytes and multinucleate giant cells with ground glass eosinophilic cytoplasm. The disease has a low incidence and about 300 cases have been reported so far in literature. The present case is being reported as it is uncommon for the disease to present in absence of arthritis.
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Affiliation(s)
- M.K.S. Parihar
- Graded Specialist (Pathology), Command Hospital (Northern Command), C/o 56 APO, India
| | - A.W. Kashif
- Associate Professor, Department of Pathology, Armed Forces Medical College, Pune, India
| | - Shekhar Neema
- Associate Professor, Department of Dermatology, Armed Forces Medical College, Pune, India
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4
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Fan J, Jiang T, Qin Y, Ding Q, Cheng X, He D. Multicentric reticulohistiocytosis with eosinophilic gastroenteritis: An unusual relationship. Int J Rheum Dis 2023. [PMID: 36823772 DOI: 10.1111/1756-185x.14625] [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: 12/18/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare disease with poorly defined therapeutic strategies. Here, we report the case of a patient with eosinophilic gastroenteritis who developed MRH after 5 years. The patient presented with disabling and rapidly progressive polyarthralgia, eosinophilic gastroenteritis, and resistance to first-line therapies. However, there was a marked improvement in the arthritis symptoms following treatment with tofacitinib. This presentation provides a useful perspective for the therapeutic management of complex scenarios involving MRH.
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Affiliation(s)
- Junyu Fan
- Department of Rheumatology, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Ting Jiang
- Department of Rheumatology, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Yingying Qin
- Department of Rheumatology, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Qin Ding
- Department of Rheumatology, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Xia Cheng
- Department of Rheumatology, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Dongyi He
- Department of Rheumatology, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.,Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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5
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Mariotti EB, Corrà A, Lemmi E, Laschi L, Aimo C, Quintarelli L, Volpi W, Nacci F, Verdelli A, Ruffo di Calabria V, Guiducci S, Caproni M. Multicentric Reticulohistiocytosis Associated with an Early Form of Systemic Lupus Erythematosus: A Case Report of a Rare Disease, with Mini Review of the Literature. J Clin Med 2022; 11:6529. [PMID: 36362761 PMCID: PMC9658768 DOI: 10.3390/jcm11216529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 11/01/2022] [Indexed: 08/10/2023] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is the most frequently described form of reticulohistiocytosis (RH), and it is classified as a class IIb non-Langerhans cell histiocytosis. It has been designated as multicentric, being characterized by multisystemic involvement. In fact, although mainly involving the skin, along with the joints, it is a systemic inflammatory condition potentially involving every internal organ. As MRH-related skin findings can mimic rheumatoid nodules or Gottron papules, the histopathology of the cutaneous lesions is often necessary for the correct diagnosis. Approximately one-third of MRH patients have confirmed concomitant autoimmune disorders. A wide variety of autoimmune disorders associated with the disease have been reported in the literature, suggesting immune dysfunction as a factor in the pathophysiology of MRH. A case of MRH associated with autoimmune manifestation is reported in the context of a mini review of the literature, with a focus on clinical presentation, treatments, and treatment outcomes. Moreover, eight cases of MRH associated with autoimmune diseases are briefly discussed.
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Affiliation(s)
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Elisa Lemmi
- Section of Anatomical Pathology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Lucrezia Laschi
- Section of Anatomical Pathology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Lavinia Quintarelli
- Rare Disease Skin Unit, Section of Dermatology, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
| | - Walter Volpi
- Section of Dermatology, Azienda USL Toscana Centro, 50125 Florence, Italy
| | - Francesca Nacci
- Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, 50125 Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Azienda USL Toscana Centro, 50125 Florence, Italy
| | | | - Serena Guiducci
- Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, 50125 Florence, Italy
| | - Marzia Caproni
- Rare Disease Skin Unit, Section of Dermatology, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
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6
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Gaussem A, Dusser P, Huynh V, Galeotti C, Schvartz A, Jaume L, Rossi-Semerano L, Koné-Paut I, Borocco C. Atypical polyarticular juvenile idiopathic arthritis revealing multicentric reticulohistiocytosis with pulmonary involvement. Rheumatology (Oxford) 2022; 62:e122-e123. [PMID: 36063043 DOI: 10.1093/rheumatology/keac480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/01/2022] [Accepted: 08/13/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna Gaussem
- Paediatric Rheumatology, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
| | - Perrine Dusser
- Paediatric Rheumatology, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
| | - Van Huynh
- Paediatric Radiology, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
| | - Caroline Galeotti
- Paediatric Rheumatology, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
| | - Adrien Schvartz
- Paediatric Rheumatology, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France.,University of Paris-Saclay, Paris, France
| | - Léa Jaume
- Paediatric Rheumatology, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
| | | | - Isabelle Koné-Paut
- Paediatric Rheumatology, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France.,University of Paris-Saclay, Paris, France
| | - Charlotte Borocco
- Paediatric Rheumatology, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
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7
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Vyas A, Krishna S, Mahendran R, Balamurugan T, Kaur C, Herath D. Coral red beads and arthritis. Clin Exp Dermatol 2022; 47:1410-1414. [PMID: 35611447 DOI: 10.1111/ced.15168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
We report a patient presenting with cutaneous papulonodular lesions associated with painful stiff joints. Histopathological examination showed positivity for CD68 and CD45. There was no atypia.
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Affiliation(s)
- Aparna Vyas
- Department of Dermatology, Croydon University Hospital, Croydon Health Services NHS Trust, London, UK
| | - Sreedhar Krishna
- Department of Dermatology, Croydon University Hospital, Croydon Health Services NHS Trust, London, UK
| | - Rajini Mahendran
- Department of Dermatology, Croydon University Hospital, Croydon Health Services NHS Trust, London, UK
| | | | - Charanjit Kaur
- Department of Histopathology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Dimalee Herath
- Department of Dermatology, Croydon University Hospital, Croydon Health Services NHS Trust, London, UK
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8
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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.
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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
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9
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Tang Z, Wang X, Xia Z, Wang Z, Zhao Y, Liu Y. Case Report: Multicentric Reticulohistiocytosis Associated With Posterior Mediastinal Adenosquamous Carcinoma, Antinuclear Antibody Positivity and Lupus Anticoagulant Positivity. Front Immunol 2022; 12:749669. [PMID: 35069525 PMCID: PMC8777097 DOI: 10.3389/fimmu.2021.749669] [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: 07/29/2021] [Accepted: 12/13/2021] [Indexed: 02/05/2023] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare systemic disease of non-Langerhans cell histiocytosis. A number of studies in the literature have documented that it can coexist with malignancy or autoimmune disease, making it difficult to determine the most appropriate therapy. Here, we present a case study of MRH associated with posterior mediastinal adenosquamous carcinoma along with antinuclear antibody positivity and lupus anticoagulant positivity. The patient experienced 6 months of clinical benefit after surgical resection and chemoradiotherapy of the mediastinal malignancy. This case adds to the available literature on multicentric reticulohistiocytosis associated with different types of malignancy and provides supplementary clinical data on the coexistence of this syndrome with malignancy and immune system abnormalities. To the best of our knowledge, this is the first case study describing MRH accompanied by posterior mediastinal adenosquamous carcinoma and lupus anticoagulant positivity. The unknown aetiology and polymorphic clinical presentation of MRH warrants further investigation.
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Affiliation(s)
- Ziyi Tang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangpeng Wang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Zijing Xia
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongming Wang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zhao
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
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10
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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.
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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
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11
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Progressive Nodular Histiocytosis: Report of a Case and Review of the Literature. Case Rep Pathol 2021; 2021:5531820. [PMID: 34567817 PMCID: PMC8463211 DOI: 10.1155/2021/5531820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Progressive nodular histiocytosis (PNH) is a rare condition characterized by progressive eruption of multiple yellowish-brown papules and nodules on the skin and mucous membranes. We present the case of a 37-year-old Caucasian man with gradually increased appearance of nodular lesions on the forehead and right temple. These lesions were initially diagnosed as xanthomas and did not respond to intralesional injections of triamcinolone. Additional biopsy revealed an intense dermal infiltrate of foamy mononuclear epithelioid cells with a minor admixture of plasma cells, lymphocytes, and scattered multinucleated giant cells. On immunohistochemical staining, the lesional cells were positive for CD163 and CD68 and negative for CD1a, thus confirming a mononuclear-macrophage lineage. The clinical presentation and the histological impression lead to the diagnosis of PNH. This condition could be challenging, mimicking microscopically similar lesions of the non-Langerhans cell histiocytosis group. Although uncommon, PNH stands out due to its clinical and microscopic features and should be taken into consideration in the differential diagnosis of cutaneous histiocytoses.
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12
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Dell'Antonia M, Atzori L, Pilloni L, Ferreli C. Multicentric reticulohistiocytosis revealing breast cancer: Report of a case with dermoscopic, radiological and therapeutic aspects. Australas J Dermatol 2021; 62:527-529. [PMID: 34398451 PMCID: PMC9292180 DOI: 10.1111/ajd.13687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 01/28/2023]
Affiliation(s)
- Massimo Dell'Antonia
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Atzori
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Pilloni
- Pathology Service, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Caterina Ferreli
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Nguyen Y, Huynh S, de Clippele D, Vignon-Pennamen MD, Petit A, Frumholtz L. Multicentric reticulohistiocytosis associated with organizing pneumonia. Joint Bone Spine 2021; 88:105192. [PMID: 33892199 DOI: 10.1016/j.jbspin.2021.105192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Yann Nguyen
- Department of Dermatology, APHP, Saint-Louis Hospital, Université de Paris, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - Sandra Huynh
- Department of Dermatology, APHP, Saint-Louis Hospital, Université de Paris, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - Donatienne de Clippele
- Department of Dermatology, APHP, Saint-Louis Hospital, Université de Paris, 1, avenue Claude Vellefaux, 75010 Paris, France
| | | | - Antoine Petit
- Department of Dermatology, APHP, Saint-Louis Hospital, Université de Paris, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - Laure Frumholtz
- Department of Dermatology, APHP, Saint-Louis Hospital, Université de Paris, 1, avenue Claude Vellefaux, 75010 Paris, France.
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Olabi B, Abbas A, Shah J, Tidman MJ, Ayob S, Abhishek A. Multicentric reticulohistiocytosis: an association with chronic sagittal sinus thrombosis. Clin Exp Dermatol 2020; 46:554-556. [PMID: 32875639 DOI: 10.1111/ced.14433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023]
Affiliation(s)
- B Olabi
- Department of Dermatology, Lauriston Building, Edinburgh, UK
| | - A Abbas
- Histopathology Department, Queen's Medical Centre, Nottingham, UK
| | - J Shah
- Departments of, Department of, Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M J Tidman
- Department of Dermatology, Lauriston Building, Edinburgh, UK
| | - S Ayob
- Department of, Dermatology, NHS Treatment Centre, Nottingham, UK
| | - A Abhishek
- Academic Rheumatology, Clinical Sciences Building, City Hospital Nottingham, Nottingham, UK.,Nottingham NIHR-BRC, Nottingham, UK.,Department of Rheumatology, Queens Medical Centre, Nottingham, UK
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Multicentric Reticulohistiocytosis Exhibiting Positive HLA-B*07 and HLA-B*08: A Case Report. ACTA ACUST UNITED AC 2020; 56:medicina56090456. [PMID: 32911791 PMCID: PMC7560105 DOI: 10.3390/medicina56090456] [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: 08/17/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022]
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare cause of destructive inflammatory arthritis involving both small, as well as larger joints. We report the case of a 40-year-old Caucasian female with a family history of neoplasia who was referred to our service witha two-month history of inflammatory joint pain. On examination, the patient had inflammatory arthritis, mainly involving the peripheral joints, sacroiliac joint pain, and numerous papulonodular mucocutaneous lesions, including periungual “coral beads”. Imaging tests revealed erosive arthritis with synovitis and tenosynovitis, sacroiliac joint changes, as well as papulonodular mucosal lesions in the nasal vestibule, the oropharyngeal mucosa, and supraglottic larynx. She tested positive for HLA-B*07 (Human Leukocyte Antigen B*07) and HLA-B*08, ANA (antinuclear antibodies), RF (rheumatoid factor), anti-Ro52, anti-SSA/Ro, and anti-SSB/La antibodies. The skin biopsy was suggestive of MRH, showing a histiocyte infiltrate and frequent giant multinucleated cells. The patient exhibited favorable outcomes under Methotrexate, then Leflunomide. However, she displayed worsening clinical symptoms while under Azathioprine. To our knowledge, this is the first case of MRH to exhibit positive HLA-B*07 together with HLA-B*08. The rarity of MRH, its unknown etiology and polymorphic clinical presentation, as well as its potential neoplastic/paraneoplastic, and autoimmune nature demand extensive investigation.
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Kim S, Khatchaturian EM, Dehesa L. Multicentric reticulohistiocytosis: A case report with response to adalimumab. Clin Case Rep 2020; 8:1560-1563. [PMID: 32884795 PMCID: PMC7455448 DOI: 10.1002/ccr3.2926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
Although MRH can mimic rheumatoid arthritis, its ability to rapidly progress to arthritis mutilans and association with malignancy in up to 25% of patients warrant prompt recognition and treatment along with age-appropriate malignancy work-up.
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Affiliation(s)
- Shirley Kim
- Department of Internal MedicineUCSF‐FresnoFresnoCAUSA
| | | | - Luis Dehesa
- Department of DermatologyUCSF‐FresnoFresnoCAUSA
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