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Momin B, Martini A, Fike J. Progressive intertriginous plaques in a patient with fatigue and diarrhea. JAAD Case Rep 2024; 52:71-73. [PMID: 39286826 PMCID: PMC11404049 DOI: 10.1016/j.jdcr.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Affiliation(s)
- Bahar Momin
- Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Angela Martini
- Department of Dermatology, UT Health San Antonio, San Antonio, Texas
| | - Jesse Fike
- Department of Dermatology, UT Health San Antonio, San Antonio, Texas
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Sedain G, Khanal K, Pandey A, Parajuli S, Sherpa PL, Adhikari S, Thakuri A, Kattel A. Challenges in diagnosis and management of Langerhans Cell Histiocytosis in a 13-month-old child: a rare case report. Ann Med Surg (Lond) 2024; 86:5611-5617. [PMID: 39239026 PMCID: PMC11374230 DOI: 10.1097/ms9.0000000000002430] [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: 05/31/2024] [Accepted: 07/26/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction Langerhans Cell Histiocytosis is a rare condition characterized by the proliferation of abnormal Langerhans cells in the skin and mucosa. It is mostly seen in children between 1 and 3 years old. Although the skeleton accounts for 80% of infiltration and the skin accounts for 33%, it can affect other organs as well. Case presentation The authors report a case of a 13-month-old male with fever, rash, and nontender swelling in the frontal, temporal, and infraorbital regions. Imaging showed diffusion restriction in the frontal, left parietal, right sphenoid, right temporal bones, and right maxillary antrum. Biopsy and immunohistochemistry from the right maxilla confirmed the diagnosis. The patient was treated with vinblastine and prednisolone for 3 months, resulting in reduced swelling and no fever on follow-up. Discussion Langerhans Cell Histiocytosis (LCH), formerly Histiocytosis X, has diverse clinical manifestations and is classified as localized or disseminated based on organ involvement. It is associated with viral infections, communication defects, and cytokine processes, with BRAF mutations and the MAPK/ERK pathway implicated. Diagnosis involves clinical, radiological, histological, and immunophenotypic methods, including identifying Birbeck granules in Langerin-positive cells. Treatment varies by disease extent, with vinblastine and prednisolone for children with multisystem disease and tailored approaches for adults. Conclusion Despite atypical presentation, thorough evaluation confirmed Langerhans Cell Histiocytosis in a pediatric patient. This highlights the necessity of considering Langerhans Cell Histiocytosis in differential diagnoses for persistent cutaneous lesions and bony swellings. Prompt detection and timely action are essential for successful treatment and better results.
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Affiliation(s)
- Gopal Sedain
- Department of Neurosurgery, Institute of Medicine, Tribhuvan University Teaching Hospital
| | - Kunjan Khanal
- Department of Internal Medicine, Greencity Hospital Private Limited, Basundhara
| | - Asim Pandey
- Department of Pediatrics, Civil Service Hospital of Nepal, Minbhawan
| | | | - Pasang L Sherpa
- Department of Internal Medicine, Horizon Hospital Private Limited, Sesmati
| | - Sujan Adhikari
- Department of General Surgery, Kathmandu Medical College and Teaching Hospital, Sinamangal
| | - Aruna Thakuri
- Department of Internal Medicine, Nepal Armed Police Force Hospital, Balambu
| | - Aashiya Kattel
- Department of Pathology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Zhang G, Wang X, Wang Y, Li Q, Zhang S, Jiang L, Deng W, Liu X, Wang J. Dermoscopy and reflectance confocal microscopy finding of different anatomic sites of Langerhans cell histiocytosis. Skin Res Technol 2024; 30:e13584. [PMID: 38235933 PMCID: PMC10795093 DOI: 10.1111/srt.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Recognizing Langerhans cell histiocytosis (LCH) might be a challenge due to its rarity. Reflectance confocal microscopy (RCM) and dermoscopy were emergent promising non-invasive technique as auxiliary tools in diagnosis of different skin conditions. However, the RCM and dermoscopic features of LCH had been less investigated. To reveal the common RCM and dermoscopic features of LCH. MATERIALS AND METHODS Forty cases of LCH were retrospectively analyzed according to age, locations, clinical, RCM, and dermoscopic features from September 2016 to December 2022. To reveal the differences and common in clinical, RCM, and dermoscopic features that occur in different anatomic location. RESULTS In the study, sites of predilection include the trunk 31/40 (77.5%), extremity 21/40 (52.5%), face 14/40 (35%), scalp 11/40 (27.5%), vulvar 4/40 (10%), and nail 2/40 (5%). All LCHs had the common RCM features. There were significant differences in clinical and dermoscopic features for age and lesion anatomic site. The common dermoscopic features for scalp, face, trunk, and extremity were the erythematous scaly rash, purplish-red globules or patches, scar-like streaks with ectatic vessels. While the features for nail LCH were purpuric striae, onycholysis and purulent scaly rash, and the erosive erythematous plaque and purulent scaly rash for vulvar LCH. The common RCM features of all LCH showed a focal highly reflective dense image in the surface keratin layer, epidermis architectural disarray, obscuration of dermo-epidermal junction, numerous polygonal, large, medium reflective, short dendrites cells in the epidermis, and dermis. All LCH involving the vulvar and nail did not manifest skin lesions. CONCLUSION RCM and dermoscopy showed promising value for diagnosis and differentiation of LCH.
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Affiliation(s)
- Gaolei Zhang
- Department of Dermatology and VenereologyCapital Institute of PediatricsPeking University Teaching HospitalBeijingChina
| | - Xingjia Wang
- Department of Dermatology and VenereologyCapital Institute of PediatricsPeking University Teaching HospitalBeijingChina
| | - Yuhan Wang
- Department of Dermatology and VenereologyCapital Institute of PediatricsPeking University Teaching HospitalBeijingChina
| | - Qian Li
- Department of Dermatology and VenereologyCapital Institute of PediatricsPeking University Teaching HospitalBeijingChina
| | - Sheng Zhang
- Department of Dermatology and VenereologyCapital Institute of PediatricsPeking University Teaching HospitalBeijingChina
| | - Lixiao Jiang
- Department of Dermatology and VenereologyCapital Institute of PediatricsPeking University Teaching HospitalBeijingChina
| | - Wei Deng
- Department of Dermatology and VenereologyCapital Institute of PediatricsPeking University Teaching HospitalBeijingChina
| | - Xiaoyan Liu
- Department of Dermatology and VenereologyCapital Institute of PediatricsPeking University Teaching HospitalBeijingChina
| | - Jianhua Wang
- Beijing Municipal Key Laboratory of Child Development and NutriomicsTranslational Medicine LaboratoryCapital Institute of PediatricsBeijingChina
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Menghani G, Kaur N, Gupta K, Vyas K. Langerhans cell histiocytosis presenting as blueberry muffin baby with associated mediastinal mass. Indian J Dermatol Venereol Leprol 2021; 87:701-703. [PMID: 34379945 DOI: 10.25259/ijdvl_867_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Gaurav Menghani
- Department of Dermatology Venereology and Leprology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Navneet Kaur
- Department of Dermatology Venereology and Leprology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Kalpana Gupta
- Department of Dermatology Venereology and Leprology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Kapil Vyas
- Department of Dermatology Venereology and Leprology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
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Shukla P, Verma P, Kushwaha R, Verma S, Yadav G, Nazar AH. Langerhans cell histiocytosis in an adult female with atypical swellings. Indian J Dermatol Venereol Leprol 2021; 87:254-259. [PMID: 33769735 DOI: 10.25259/ijdvl_651_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 04/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Prakriti Shukla
- Department of Dermatology, Venereology and Leprosy, Lucknow, Uttar Pradesh, India
| | - Parul Verma
- Department of Dermatology, Venereology and Leprosy, Lucknow, Uttar Pradesh, India
| | | | - Shailendra Verma
- Department of Clinical Haematology, KGMU, Lucknow, Uttar Pradesh, India
| | - Geeta Yadav
- Department of Pathology Lucknow, Uttar Pradesh, India
| | - Aftab Hasan Nazar
- Department of Nuclear Medicine, SGPGI, Lucknow, Uttar Pradesh, India
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Leung AKC, Lam JM, Leong KF. Childhood Langerhans cell histiocytosis: a disease with many faces. World J Pediatr 2019; 15:536-545. [PMID: 31456157 DOI: 10.1007/s12519-019-00304-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a group of diseases characterized by the proliferation and accumulation of Langerhans cells. Clinical presentations of LCH vary widely. DATA SOURCES A PubMed search was conducted using Clinical Queries with the key term "Langerhans cell histiocytosis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. This paper is based on, but not limited to, the search results. RESULTS Generally, patients with LCH can be divided into two groups based on the extent of involvement at diagnosis, namely, single-system LCH and multisystem LCH. The involvement may be unifocal or multifocal. Patients with isolated bone lesions typically present between 5 and 15 years of age, whereas those with multisystem LCH tend to present before 5 years of age. The clinical spectrum is broad, ranging from an asymptomatic isolated skin or bone lesion to a life-threatening multisystem condition. Clinical manifestations include, among others, "punched out" lytic bone lesion, seborrheic dermatitis-like eruption, erythematous/reddish-brown crusted/scaly papules/maculopapules/plaques/patches, and eczematous lesions, diabetes insipidus, hepatosplenomegaly, cytopenias, lymphadenopathy, and an acute fulminant disseminated multisystem condition presenting with fever, skin rash, anemia, thrombocytopenia, lymphadenopathy, and hepatosplenomegaly. The diagnosis is clinicopathologic, based on typical clinical findings and histologic/immunohistochemical examination of a biopsy of lesional tissue. Positive CD1a, S100, and/or CD207 (Langerin) immunohistochemical staining of lesional cells is required for a definitive diagnosis. Watchful waiting is recommended for patients with skin-only LCH. Patients with symptomatic or refractory skin-only LCH may be treated with topical tacrolimus/corticosteroids, topical nitrogen mustard, oral methotrexate, or oral hydroxyurea. The current recommended first-line therapy for patients with multisystem LCH is 12 months therapy with prednisone and vinblastine. Mercaptopurine is added for patients with risk organ involvements. CONCLUSIONS Because of the broad spectrum of clinical manifestations and the extreme diversity of disease, LCH remains a diagnostic dilemma. Morphological identification of LCH cells and positive immunochemical staining with CD1a, S100, and/or CD207 (Langerin) of lesional cells are necessary for a definitive diagnosis.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, #200, 233, 16th Avenue NW, Calgary, AB, T2M 0H5, Canada.
| | - Joseph M Lam
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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Localized Acral Sclerosing Langerhans Cell Histiocytosis: A New Form of Presentation of Cutaneous Langerhans Cell Histiocytosis. Am J Dermatopathol 2019; 42:356-359. [PMID: 31725482 DOI: 10.1097/dad.0000000000001572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare proliferative disorder, more frequent in children, characterized by an abnormal accumulation of Langerhans cells admixed with eosinophils, lymphocytes, neutrophils, and macrophages. The clinical presentation is variable and depends on whether a single or multiple organs are affected. Skin lesions are common in LCH (40% of cases) and represent a frequent form of presentation (in up to 80% of cases). Cutaneous manifestations of LCH are highly variable, frequently presenting as crusted papules or scaly seborrheic-like lesions localized in the scalp. We report the first case of a localized acral sclerosing LCH, a new form of LCH. This case highlights the broad and surprising form of presentation of LCH which may be overlooked and can significantly delay its diagnosis. The development of systemic disease may occur months to years after the initial skin presentation. Prompt diagnosis and treatment may prevent progression to systemic disease, as documented in some cases.
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Mahmood S, Raza M, Nusrat K, Marsia S, Abbas A. Infiltrating the Heart and Kidney: A Rare Pediatric Case of Multisystem Langerhans Cell Histiocytosis from Pakistan. Cureus 2019; 11:e4315. [PMID: 31183295 PMCID: PMC6538118 DOI: 10.7759/cureus.4315] [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: 11/16/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare, clonal disease of the monocyte-macrophage system, varying in its clinical presentation from mere self-healing skin and bone lesions to life-threatening multi-system disease. In descending order of frequency, the disease is known to involve the skeleton, skin, lymph nodes and lesser often, the liver, spleen, lungs, hematopoietic and central nervous systems. Here, we present a pediatric case of multi-system LCH in a five-year-old child, unique in its evident cardiac and renal involvement alongside other organ systems and important in how the diagnosis was aided by a fine needle aspiration cytology instead of the costlier histopathological procedures, in a setting with limited resources.
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Affiliation(s)
- Samar Mahmood
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Mohammad Raza
- Pediatrics, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Khushboo Nusrat
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Shayan Marsia
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Awais Abbas
- Pediatrics, Dow University of Health Sciences (DUHS), Karachi, PAK
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