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Yang CY, Chiang PH, Yen CF, Shih IH, Chen GH. Diverse and rare clinical manifestations of Langerhans cell histiocytosis. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_12_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lin SC, Lee WI, Jaing TH, Yang CP, Hung IJ, Chang TY, Huang JL, Chen LC, Ou LS, Yao TC, Chen SH. The influence of clinical features mimicking primary immunodeficiency diseases (mPID) on children with Langerhans cell histiocytosis (LCH) - Four with mPID among 39 LCH children from one referral center during 18-year period. Immunobiology 2019; 225:151877. [PMID: 31862125 DOI: 10.1016/j.imbio.2019.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recurrent or refractory infections can be a warning sign of primary immunodeficiency diseases (PID). Such mimicking PID (mPID) can occur in patients with Langerhans cell histiocytosis (LCH). Because some cases with refractory molluscum contagiosum-like lesions and persistent otorrhea are finally diagnosed with LCH, we wondered whether such mPID can occur in LCH children and affect on their prognosis. METHODS We retrospectively reviewed all children with LCH at our institute from 2001 to 2018. A complete medical review of sex, age, symptoms, treatment course, and outcome comparison was performed. RESULTS Of 39 enrolled LCH patients, three had persistent otorrhea and one had refractory molluscum contagiosum-like lesions despite aggressive antibiotic therapy. These four cases with mPID had significantly higher rates of multi-system involvement, recurrence and 5-month more lag time, but no risk organ (liver, spleen and bone marrow) involvement compared to those without mPID, although bone and skin were the most involved in both groups. Overall, the lag-time in multi-system was longer than that in single-system involvement (median 2.5 vs. 1.0 months; p = 0.003). The diagnosis-age of risk organ involvement was younger than those without (median 8 vs. 43 months; p = 0.004). There were no significant differences in diagnosis-age, single/multi-system and risk organ involvement between remission and recurrence groups. All were alive excluding four who were lost to follow-up. CONCLUSIONS The LCH children with mPID had greater lag time, multi-system involvement, recurrence and more refractory treatment including transplantation despite the ratio of bone and skin lesions equal to those without mPID.
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Affiliation(s)
- Shiuan-Chen Lin
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-I Lee
- Primary Immunodeficiency Care and Research (PICAR) Institute, Taiwan; Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Tang-Her Jaing
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Ping Yang
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Iou-Jih Hung
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Li-Chen Chen
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Liang-Shiou Ou
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Tran G, Huynh TN, Paller AS. Langerhans cell histiocytosis: A neoplastic disorder driven by Ras-ERK pathway mutations. J Am Acad Dermatol 2018; 78:579-590.e4. [DOI: 10.1016/j.jaad.2017.09.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/29/2017] [Accepted: 09/10/2017] [Indexed: 12/13/2022]
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