Indian Journal of Medical Research

CLINICAL IMAGE
Year
: 2018  |  Volume : 148  |  Issue : 3  |  Page : 351--352

Langerhans cell histiocytosis


Manish Kumar1, Anil S Menon2,  
1 Department of Oncology, Command Hospital, Lucknow 226 002, India
2 Department of Endocrinology, Command Hospital, Lucknow 226 002, India

Correspondence Address:
Anil S Menon
Department of Endocrinology, Command Hospital, Lucknow 226 002
India




How to cite this article:
Kumar M, Menon AS. Langerhans cell histiocytosis.Indian J Med Res 2018;148:351-352


How to cite this URL:
Kumar M, Menon AS. Langerhans cell histiocytosis. Indian J Med Res [serial online] 2018 [cited 2020 Sep 30 ];148:351-352
Available from: http://www.ijmr.org.in/text.asp?2018/148/3/351/245292


Full Text

A two years old girl† was admitted to the Pediatric ward of Command Hospital, Lucknow, India, in May 2013 with polyuria and polydipsia. Her height, weight and developmental milestones were appropriate for age. Plasma glucose (random, 86 mg/dl), serum sodium [132 mEq/l (normal range 135-145)], and serum osmolality [284 mOsm/kg (285-295)], were normal. However, urine osmolality was 34 mOsm/kg (normal range 300-900). Magnetic resonance imaging (MRI) brain showed normal pituitary stalk thickness and absence of posterior pituitary bright spot [Figure 1]. Based on the symptoms, hypo-osmolar urine and findings of the MRI brain, she was diagnosed to have central diabetes insipidus (DI) and started on desmopressin nasal spray.{Figure 1}

One year later, she developed induration over the right gluteal region which later developed into fistula [Figure 2]. Biopsy of the wall revealed numerous Langerhans cells (reniform nucleus and abundant pink cytoplasm) with characteristic immunoreactivity for CD1a antigen [Figure 3] and [Figure 4]. Skeletal survey and positron emission tomography-computed tomography (PET-CT) did not show any other organ involvement. She was diagnosed to have multisystem Langerhans cell histiocytosis (pituitary and skin) and treated with chemotherapy (prednisolone, vinblastine and 6-mercaptopurine) which led to the healing of cutaneous lesion. The patient has been on follow up for the last three years; though in clinical remission she is continued on desmopressin spray due to the persistence of DI.{Figure 2}{Figure 3}{Figure 4}

Conflicts of Interest: None.