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Zang Y, Xu L, Fan R, Cheng L, Xu Y. Extensive yellowish masses in bilateral orbit and neck. J Dermatol 2024; 51:e145-e146. [PMID: 38414144 DOI: 10.1111/1346-8138.17166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Yinshan Zang
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Lingxiao Xu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ran Fan
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Lu Cheng
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Yan Xu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
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2
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Fay CJ, Iriarte C, Moslehi D, Lam J, Katsyv I, LeBoeuf NR. Ulcerating necrobiotic xanthogranuloma: A clinical sign to reconsider progression from MGUS to multiple myeloma. JAAD Case Rep 2023; 40:1-3. [PMID: 37663892 PMCID: PMC10470407 DOI: 10.1016/j.jdcr.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Affiliation(s)
- Christopher J. Fay
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
| | - Christopher Iriarte
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Dorsa Moslehi
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jimmy Lam
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Igor Katsyv
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nicole R. LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Center for Cutaneous Oncology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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3
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Ramirez Marquez E, Ayala Rodríguez SC, De Jesús Rodríguez E, Montes JR, Noy Malave MA, Oliver AL. Xanthogranuloma of the Eyelid: A Case Report. Cureus 2023; 15:e42477. [PMID: 37637556 PMCID: PMC10451097 DOI: 10.7759/cureus.42477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
We report on the case of a Hispanic woman with necrobiotic xanthogranuloma (NBX) whose disease was managed based on her symptoms. She underwent a diagnostic and debulking surgical intervention and surveillance for hematologic malignancy. This 56-year-old patient presented with a six-year history of enlarging masses and swelling around her eyes, with intermittent inflammation, associated pain, and occasional redness. Her past medical history was remarkable for asthma and nasal polyps. Upon external examination, she had severe fullness of the upper lids with yellow plaques and palpable masses along them, nontender palpation, the absence of visible erythema, and blepharoptosis in both eyes. The patient presented with bilateral visual field constriction due to mechanical obstruction. An orbital computed tomography scan revealed a dense diffuse lesion involving the pre- and postseptal tissues and invading the orbit of the right eye. A facial magnetic resonance imaging scan revealed infiltration of the postseptal spaces within both orbits. A skin and soft tissue biopsy from the bilateral periorbital regions of both eyes confirmed the diagnosis of NBX. A workup for underlying hematologic malignancies, including plasma cell dyscrasias and lymphoproliferative disorders, was unremarkable. The patient underwent diagnostic and debulking surgery in an attempt to improve her visual function. Subsequently, she was scheduled for ongoing monitoring of her disease progression.
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Affiliation(s)
| | - Sofía C Ayala Rodríguez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Edgar De Jesús Rodríguez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Jose Raul Montes
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | | | - Armando L Oliver
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
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4
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Shahriari N, Mazori DR, Merola JF. Intravenous immunoglobulin-refractory necrobiotic xanthogranuloma successfully treated with tofacitinib 2% cream. JAAD Case Rep 2022; 32:41-43. [PMID: 36632562 PMCID: PMC9826807 DOI: 10.1016/j.jdcr.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Neda Shahriari
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,Correspondence to: Neda Shahriari, MD, Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue Boston, MA 02115.
| | - Daniel R. Mazori
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Joseph F. Merola
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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5
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DiLorenzo A, Russomanno K, Ajayi A, Cardis MA. Ulcerating yellow plaques on the legs. JAAD Case Rep 2021; 14:62-64. [PMID: 34277911 PMCID: PMC8263516 DOI: 10.1016/j.jdcr.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ashley DiLorenzo
- Department of Dermatology, Medstar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia.,Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Kristen Russomanno
- Department of Dermatology, Medstar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia.,Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Ayodeji Ajayi
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Michael A Cardis
- Department of Dermatology, Medstar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia
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Adam Z, Pour L, Řehák Z, Dvořáková K, Koukalová R, Feit J, Kameník P, Krejčí M, Štork M, Krejčí M, Sandecká V, Boichuk I, Král Z. Complete remission of necrobiotic xanthogranuloma after disappearance of monoclonal immunoglobulin induced by bortezomib, lenalidomid and dexamethasone. Vnitr Lek 2021; 67:352-356. [PMID: 35459378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Necrobiotic xanthogranuloma (NXG) is a rare chronic condition, belonging to the group non-Langerhans cell histiocytoses, which is relevant due to the possibility of extracutaneous involvement and association with systemic diseases, particularly monoclonal gammopathy, MGUS and multiple myeloma. The case reported here NXG was diagnosed after 1 years of evolution in patient with asymptomatic multiple myeloma. After treatment with bortezomib, lenalidomid and dexamethasone, there was evident abrupt decrease of monoclonal immunoglobulin to not measurable level (complete remission of multiple myeloma) and in the same time was evident disappearance of cutaneous and hepatic lesions of NXG on FDG-PET/CT. The etiopathogenetic association of monoclonal immunoglobulin with NXG is documented in this case report with disappearance of NXG in the time of disappearance of monoclonal immunoglobulin.
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de Mello RB, do Vale ECS. Necrobiotic xanthogranuloma associated with smoldering multiple myeloma: satisfactory response to cyclophosphamide, dexamethasone, and thalidomide. An Bras Dermatol 2019; 94:337-340. [PMID: 31365665 PMCID: PMC6668937 DOI: 10.1590/abd1806-4841.20198500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022] Open
Abstract
Necrobiotic xanthogranuloma is a rare chronic condition, belonging to the group C non-Langerhans cell histiocytoses, which is relevant due to the possibility of extracutaneous involvement and association with systemic diseases, particularly hematologic malignancies. The case reported here was only diagnosed after nine years of evolution and was associated with plasma cell dyscrasia. After treatment with cyclophosphamide, dexamethasone, and thalidomide, there was a reduction of cutaneous lesions and serum levels of monoclonal protein.
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Affiliation(s)
- Renan Bernardes de Mello
- Dermatology Service, Hospital das Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Abstract
Necrobiotic xanthogranuloma (NXG) is a chronic, progressive non-Langerhans histiocytic granulomatous disease. While case reports describing periorbital involvement of NXG are frequent, only a few case reports describing ocular involvement, such as scleritis and uveitis, exist. Herein, we present a case presenting initially as bilateral anterior and posterior scleritis, as well as a chronic bilateral granulomatous panuveitis, and discuss the immunosuppressant options that should be considered for this disease with protean manifestations.
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Affiliation(s)
- John A Gonzales
- 1 F.I. Proctor Foundation, University of California , San Francisco, San Francisco, California.,2 Department of Ophthalmology, University of California , San Francisco, San Francisco, California
| | - Anna Haemel
- 3 Department of Dermatology, University of California , San Francisco, San Francisco, California
| | - Andrew J Gross
- 4 Department of Rheumatology, University of California , San Francisco, San Francisco, California
| | - Nisha R Acharya
- 1 F.I. Proctor Foundation, University of California , San Francisco, San Francisco, California.,2 Department of Ophthalmology, University of California , San Francisco, San Francisco, California
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Szalat R, Pirault J, Fermand JP, Carrié A, Saint-Charles F, Olivier M, Robillard P, Frisdal E, Villard EF, Cathébras P, Bruckert E, Chapman MJ, Giral P, Guerin M, Lesnik P, Le Goff W. Physiopathology of necrobiotic xanthogranuloma with monoclonal gammopathy. J Intern Med 2014; 276:269-84. [PMID: 24428816 PMCID: PMC4279948 DOI: 10.1111/joim.12195] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
RATIONALE Xanthomatosis associated with monoclonal gammopathy includes hyperlipidaemic xanthoma (HX), normolipidaemic xanthoma (NX) and necrobiotic xanthogranuloma (NXG). All three pathologies are characterized by skin or visceral lesions related to cholesterol accumulation, monoclonal immunoglobulin (MIg) and hypocomplementemia. The pathophysiology underlying NXG remains unknown although the involvement of MIg is suspected. OBJECTIVE To provide further insights into the pathophysiology of NXG, we evaluated the plasma lipid phenotype, mechanisms involved in cellular cholesterol accumulation and role of MIg in an analysis of blood and plasma markers of inflammation in 16 patients with xanthomatosis [NXG (n = 8) and NX (n = 8)] associated with monoclonal IgG relative to the relevant controls. RESULTS The lipid profile of patients with NXG was characterized by a low HDL-C phenotype and an abnormal distribution of HDL particles. Sera from patients with NXG induced cholesterol accumulation in human macrophages. This accumulation was due in part to a significant reduction in the HDL capacity to promote cholesterol efflux from macrophages, which was not found in the case of NX. The MIg of NXG and NX patients was tested positively by ELISA to recognize a large spectrum of lipoproteins. High plasma levels of pro-inflammatory cytokines (TNFα and IL-6), soluble cytokine receptors (sIL-6R, sTNFRI and sTNFRII), adhesion molecules (VCAM-1 and ICAM-1) and chemokines (MCP-1, IL-8 and MIP-1α) were observed in both patients with NXG and NX, revealing a specific xanthoma inflammatory signature which was inversely correlated with plasma levels of anti-inflammatory HDL. However, patients with NXG were distinguished by elevated levels of IL-15 and a marked increase in the rate of intermediate CD14++CD16+ monocytes. CONCLUSION This study revealed that NXG is characterized by impaired macrophage lipid homeostasis associated with a systemic inflammatory profile that may result from the interaction of MIg and lipoproteins.
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Affiliation(s)
- R Szalat
- Département d'immunologie Clinique, Hôpital Saint Louis, Paris, France; EA3963, Université Paris 7 Denis Diderot, INSERM, IFR105, Institut Universitaire d'Hématologie, Paris, France
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Abstract
Necrobiotic xanthogranuloma (NXG) is a rare granulomatous condition that is often associated with a paraproteinemia and in some cases multiple myeloma. We report a case of isolated NXG that responded very well to total glucosides of paeony treatment. Characteristic clinical and histological features of NXG are presented, as well as a discussion regarding management and the use of glucosides of paeony. Treatment with total glucosides of paeony is an effective, safe treatment, which avoids the side effects associated with systemic corticosteroid or cytotoxic agent therapy.
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Affiliation(s)
- Shuang Li
- Departments of Dermatology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Mohsenin A, Sinard J, Huang JJ. Necrobiotic xanthogranuloma and chronic lymphocytic leukemia of the conjunctiva masquerading as scleritis and uveitis. Clin Ophthalmol 2012; 6:2045-7. [PMID: 23271884 PMCID: PMC3526909 DOI: 10.2147/opth.s35743] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This report describes a unique case of coexisting necrobiotic xanthogranuloma and chronic lymphocytic leukemia in a patient presenting with scleritis and uveitis. A 53-year-old Caucasian man diagnosed with anterior uveitis and scleritis for the prior year was referred to our uveitis clinic for further evaluation. Prior uveitis/scleritis workup performed by the referring ophthalmologist was negative. Examination demonstrated unilateral uveitis and posterior scleritis along with bilateral conjunctival lesions. Incisional biopsy of the conjunctiva was carried out. The excised tissue was sent fresh for histopathologic studies. Slit-lamp examination revealed bilateral yellow-white bulbar conjunctival lesions, 1+ conjunctival injection OU, stellate keratic precipitates OS with 25 cells per high-powered field. Funduscopic examination was significant for subretinal fluid OS. Conjunctival biopsy revealed necrobiotic xanthogranuloma and chronic lymphocytic leukemia. Systemic workup demonstrated paraproteinemia consistent with necrobiotic xanthogranuloma and a complete blood count consistent with leukemia. This case demonstrates an atypical presentation of necrobiotic xanthogranuloma and concomitant chronic lymphocytic leukemia presenting in the form of uveitis, scleritis, and conjunctival infiltration. Masquerade syndromes, such as necrobiotic xanthogranuloma and leukemia, must be kept in mind when treating patients with uveitis or scleritis with negative workups.
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Affiliation(s)
- Amir Mohsenin
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
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