Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 2685       

   Table of Contents      
CLINICAL IMAGE
Year : 2019  |  Volume : 149  |  Issue : 1  |  Page : 78-79

Multisystem involvement of Langerhans cell histiocytosis in an adult


1 Department of Medical Oncology, Istanbul University Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
2 Department of Hematology, Haseki Training & Research Hospital, Istanbul 34098, Turkey

Date of Submission30-Oct-2017
Date of Web Publication22-Apr-2019

Correspondence Address:
Nilay Sengul Samanci
Department of Medical Oncology, Istanbul University Cerrahpasa Medical Faculty, Istanbul 34098
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1726_17

Rights and Permissions

How to cite this article:
Samanci NS, Ayer M. Multisystem involvement of Langerhans cell histiocytosis in an adult. Indian J Med Res 2019;149:78-9

How to cite this URL:
Samanci NS, Ayer M. Multisystem involvement of Langerhans cell histiocytosis in an adult. Indian J Med Res [serial online] 2019 [cited 2019 Oct 21];149:78-9. Available from: http://www.ijmr.org.in/text.asp?2019/149/1/78/256702

†Patient's consent obtained to publish clinical information and images.


Clinical ImageA 27 yr old man admitted to the Internal Medicine department of Haseki Training and Research Hospital, Turkey, in January 2015 with complaints of painful, itchy, red papules on his palms and soles for the past four months. He had diabetes insipidus in his medical history. Physical examination revealed diminished breath sounds and hepatomegaly. On his palms and soles erythematous-vesicle-squamous-crusty, lesions were seen [Figure 1]A. Aspartate aminotransferase: 587 U/l, alanine transaminase: 291 U/l, alkaline phosphatase (ALP): 696 U/l, gamma-glutamyl transferase (GGT): 1004 U/l, total bilirubin: 26 mg/dl, direct bilirubin:13 mg/dl were measured in the laboratory. Computed tomography findings reveal pleural thickening in the right hemithorax and bullous emphysematous lesions in both lungs, the largest measured 8 cm [Figure 1]B. Magnetic resonance cholangiopancreatography findings were compatible with sclerosing cholangitis. A tube was inserted endoscopically to the bile duct. The punch biopsies were taken from petechial lesions on the hands. Biopsy sections revealed epidermal hyperkeratosis with intra- and subepidermal pustules and at the base of pustules, histiocytes, eosinophilic infiltration of inflammatory cells containing polymorphs were seen. Histiocytic cells had a positive reaction with CD1a and it was consistent with the Langerhans cell histiocytosis group disease [Figure 2]A and [Figure 2]B). After ursodeoxycholic acid and bile duct tube treatment, the value of the ALP, GGT and bilirubin decreased. The treatment consisted of systemic chemotherapy with vinblastine and prednisone. The patient died because of the respiratory failure.
Figure 1: (A) Erythematous-vesicle-squamous-crusty lesions on palms (arrows). (B) Computed tomography chest showing bullous emphysematous lesions in both lungs (arrows).

Click here to view
Figure 2: (A) Epidermal hyperkeratosis with intra- and subepidermal pustules (arrow); and histiocytes, eosinophilic infiltration of inflammatory cells containing polymorphs and congested capillaries with extravasated red blood cell (H and E, ×100). (B) Positive immunohistochemistry for antigen CD1a (H and E, ×CD1a, ×400).

Click here to view


Acknowledgment: Authors thank Saime Gül Barut for histological assessment.

Conflicts of Interest: None.




    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Article Figures

 Article Access Statistics
    Viewed170    
    Printed0    
    Emailed0    
    PDF Downloaded98    
    Comments [Add]    

Recommend this journal