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A long-term survival case of Erdheim-Chester disease on maintenance hemodialysis. CEN Case Rep 2022; 11:289-294. [PMID: 34978674 DOI: 10.1007/s13730-021-00680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022] Open
Abstract
Erdheim-Chester disease, a rare non-Langerhans histiocytosis, involves multiple organs, including kidney. Renal dysfunction sometimes occurs, and is attributed to ureteral obstruction and renal artery stenosis by histiocytic infiltration. However, to our knowledge, case reports of end-stage renal disease requiring renal replacement therapy due to Erdheim-Chester disease are very few. Here, we report a 69-year-old woman who was diagnosed with Erdheim-Chester disease 10 years ago. She had multiple organ involvement, such as bone, skin, heart, pituitary gland, kidney, and retroperitoneum. She had been treated with interferon-alpha, but discontinued after 2 years due to depression and repeated infection. She did not desire treatment with other drugs, so we continued supportive care. Her renal function gradually deteriorated, and hemodialysis was initiated 4 years ago. Subsequently, she is still doing well without any major symptoms. This report describes an unusual case of Erdheim-Chester disease requiring maintenance hemodialysis that longer prognosis than expected was obtained regardless of multiple organ involvement and no specific treatment after interferon-alpha cessation.
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O'Brien K, Dave R, Shekhar S, Hannah-Shmouni F, Comis LE, Solomon BI, Chen M, Gahl WA, FitzGibbon E, Gochuico BR, Estrada-Veras JI. Survivorship Issues in Adult Patients With Histiocytic Neoplasms. J Natl Compr Canc Netw 2021; 19:1312-1318. [PMID: 34781266 PMCID: PMC10481619 DOI: 10.6004/jnccn.2021.7096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Adult-onset histiocytoses (AOH), primarily Rosai-Dorfman disease (RDD), Erdheim-Chester Disease (ECD), and adult Langerhans cell histiocytosis (ALCH), are a group of related histiocytic neoplastic disorders featuring multisystemic manifestations. The disorders are largely incurable, and are essentially chronic neoplastic diseases with a variable prognosis. Prompt diagnosis and treatment is important to prevent debilitating and even life-threatening complications. Survivorship issues abound in AOH, due to their multisystemic manifestations and the sometimes recalcitrant chronic inflammation, which can lead to other debilitating complications such as fatigue, weakness, and pain. Because these disorders are rare, few healthcare professionals are proficient in their management; therefore the aim of these guidelines is to offer guidance on how to manage patients, and how to create survivorship care plans through the efforts of an interdisciplinary team.
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Affiliation(s)
- Kevin O'Brien
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Rahul Dave
- Inova Fairfax-Virginia Commonwealth University College of Medicine, Falls Church, Virginia
| | - Skand Shekhar
- Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Fady Hannah-Shmouni
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Leora E Comis
- Rehabilitation Medicine Department, Clinical Center, NIH, Bethesda, Maryland
| | - Beth I Solomon
- Speech Language Pathology Section, Rehabilitation Medicine Department, Mark O. Hatfield Clinical Research Center, NIH, Bethesda, Maryland
| | - Marcus Chen
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland; and
| | - William A Gahl
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | - Bernadette R Gochuico
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Juvianee I Estrada-Veras
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland
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Kidney Transplantation for Erdheim-Chester Disease. Case Rep Transplant 2020; 2020:3954165. [PMID: 32765921 PMCID: PMC7374202 DOI: 10.1155/2020/3954165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 01/19/2023] Open
Abstract
Erdheim-Chester disease is a rare inflammatory disease that infiltrates skeletal and extra-skeletal tissue. Chronic kidney disease (CKD) in Erdheim-Chester disease is usually attributed to retroperitoneal lesions that lead to urologic obstruction and hydronephrosis. In this report, we describe a patient diagnosed with Erdheim-Chester disease who eventually developed end-stage kidney disease (ESKD). After complete remission of Erdheim-Chester disease by vemurafenib therapy and 2 years of hemodialysis, the patient underwent a deceased donor kidney transplantation with basiliximab induction and tacrolimus/mycophenolic acid maintenance. After conversion of mycophenolic acid to azathioprine due to cost, acute cellular rejection had occurred, and he was treated with steroid therapy. The patient remained in complete remission from Erdheim-Chester disease and dialysis-free 16 months after transplant. Kidney transplantation is another treatment option for those patients with Erdheim-Chester disease who suffer from renal failure in the setting of complete remission.
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Erdheim–Chester disease: a rapidly evolving disease model. Leukemia 2020; 34:2840-2857. [DOI: 10.1038/s41375-020-0944-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 01/19/2023]
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Merai H, Collas D, Bhagat A, Mandalia U. Erdheim-Chester Disease: A Case Report and Review of the Literature. J Clin Imaging Sci 2020; 10:37. [PMID: 32637228 PMCID: PMC7332465 DOI: 10.25259/jcis_68_2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/23/2020] [Indexed: 12/23/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare form of non-Langerhans’ cell histiocytosis characterized by xanthogranulomatous infiltration of foamy histiocytes surrounded by fibrosis. ECD may be asymptomatic or present as a multi-systemic disease with life-threatening manifestations, most commonly involving the skeletal system. Immunohistochemical staining demonstrates cells that are CD68+, CD1a–, and S100– with an absence of Birbeck granules. We report a case of a 69-year old male patient who presented with neurological symptoms – eventually thought to be separate to his diagnosis of ECD. It represents the ability to diagnose ECD based just on radiological findings in an otherwise asymptomatic individual.
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Affiliation(s)
- Hema Merai
- Departments of Radiology, Watford General Hospital, Watford, Hertfordshire, United Kingdom
| | - David Collas
- Departments of Neurology, Watford General Hospital, Watford, Hertfordshire, United Kingdom
| | - Ashish Bhagat
- Departments of Radiology, Watford General Hospital, Watford, Hertfordshire, United Kingdom
| | - Uday Mandalia
- Departments of Radiology, Watford General Hospital, Watford, Hertfordshire, United Kingdom
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Erdheim-Chester Disease Presenting as a Solid Renal Mass. Urology 2017; 100:e1-e2. [DOI: 10.1016/j.urology.2016.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/07/2016] [Accepted: 10/18/2016] [Indexed: 11/23/2022]
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Multisystem Radiologic Manifestations of Erdheim-Chester Disease. Case Rep Radiol 2016; 2016:2670495. [PMID: 27340583 PMCID: PMC4906176 DOI: 10.1155/2016/2670495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 04/03/2016] [Accepted: 04/12/2016] [Indexed: 11/18/2022] Open
Abstract
Erdheim-Chester Disease is a rare form of multiorgan non-Langerhans' cell histiocytosis that affects individuals between the ages of 50 and 70 with an equal distribution among males and females. It is associated with significant morbidity and mortality that is mostly due to infiltration of critical organs. Some of the sites that Erdheim-Chester Disease affects include the skeletal system, central nervous system, cardiovascular system, lungs, kidneys (retroperitoneum), and skin. The most common presenting symptom of Erdheim-Chester Disease is bone pain although a large majority of patients are diagnosed incidentally during a workup for a different disease process. Diagnosing Erdheim-Chester Disease is challenging due its rarity and mimicry to other infiltrative processes. Therefore, a multimodality diagnostic approach is employed with imaging being at the forefront. As of date, a comprehensive radiologic review of the manifestations of Erdheim-Chester Disease has rarely been reported. Here we present radiologic findings of an individual suffering from Erdheim-Chester Disease.
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Vermeiren P, Van Laecke S, Cuvelier C, De Loose D, Vanholder R. Progressive dysphagia caused by Erdheim-Chester disease. QJM 2014; 107:1015-7. [PMID: 22466415 DOI: 10.1093/qjmed/hcs061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Vermeiren
- From the Renal Division, Department of Pathology and Department of Gastroenterology, Ghent University Hospital, Belgium
| | - S Van Laecke
- From the Renal Division, Department of Pathology and Department of Gastroenterology, Ghent University Hospital, Belgium
| | - C Cuvelier
- From the Renal Division, Department of Pathology and Department of Gastroenterology, Ghent University Hospital, Belgium
| | - D De Loose
- From the Renal Division, Department of Pathology and Department of Gastroenterology, Ghent University Hospital, Belgium
| | - R Vanholder
- From the Renal Division, Department of Pathology and Department of Gastroenterology, Ghent University Hospital, Belgium
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Clinical considerations and key issues in the management of patients with Erdheim-Chester Disease: a seven case series. BMC Med 2014; 12:221. [PMID: 25434739 PMCID: PMC4248471 DOI: 10.1186/s12916-014-0221-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/03/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Erdheim-Chester Disease (ECD), a non Langerhans' cell histiocytosis of orphan nature and propensity for multi-systemic presentations, comprises an intricate medical challenge in terms of diagnosis, treatment and complication management. OBJECTIVES The objectives are to report the clinical, radiological and pathological characteristics, as well as cardinal therapeutic approaches to ECD patients and to provide clinical analyses of the medical chronicles of these complex patients. METHODS Patients with biopsy proven ECD were audited by a multi-disciplinary team of specialists who formed a coherent timeline of all the substantial clinical events in the evolution of their patients' illness. RESULTS Seven patients (five men, two women) were recruited to the study. The median age at presentation was 53 years (range: 39 to 62 years). The median follow-up time was 36 months (range: 1 to 72 months). Notable ECD involvement sites included the skeleton (seven), pituitary gland (seven), retroperitoneum (five), central nervous system (four), skin (four), lungs and pleura (four), orbits (three), heart and great vessels (three) and retinae (one). Prominent signs and symptoms were fever (seven), polyuria and polydipsia (six), ataxia and dysarthria (four), bone pain (four), exophthalmos (three), renovascular hypertension (one) and dyspnea (one). The V600E BRAF mutation was verified in three of six patients tested. Interferon-α treatment was beneficial in three of six patients treated. Vemurafenib yielded dramatic neurological improvement in a BRAF mutated patient. Infliximab facilitated pericardial effusion volume reduction. Cladribine improved cerebral blood flow originally compromised by perivenous lesions. CONCLUSIONS ECD is a complex, multi-systemic, clonal entity coalescing both neoplastic and inflammatory elements and strongly dependent on impaired RAS/RAF/MEK/ERK signaling.
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Mazor RD, Manevich-Mazor M, Shoenfeld Y. Erdheim-Chester Disease: a comprehensive review of the literature. Orphanet J Rare Dis 2013; 8:137. [PMID: 24011030 PMCID: PMC3849848 DOI: 10.1186/1750-1172-8-137] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/04/2013] [Indexed: 12/15/2022] Open
Abstract
Erdheim-Chester Disease (ECD) is a rare form of non Langerhans' cell histiocytosis. Individuals affected by this disease are typically adults between their 5th and 7th decades of life. Males and females are almost equally affected. The multi systemic form of ECD is associated with significant morbidity, which may arise due to histiocytic infiltration of critical organ systems. Among the more common sites of involvement are the skeleton, central nervous system, cardiovascular system, lungs, kidneys (retroperitoneum) and skin. The most common presenting symptom of ECD is bone pain. The etiology of ECD is unknown yet thought to be associated with an intense TH1 immune response. It may also be associated with the V600E BRAF mutation, as described in as many as half of the patients in recent studies. Bilateral symmetric increased tracer uptake on 99mTc bone scintigraphy affecting the periarticular regions of the long bones is highly suggestive of ECD. However, definite diagnosis of ECD is established only once CD68(+), CD1a(−) histiocytes are identified within a biopsy specimen. At present, this obscure ailment embodies numerous challenges to medical science. Given its rarity, it is diagnostically elusive and requires a high level of clinical suspicion. Therapeutically, it is of limited alternatives. Currently, interferon-α is the most extensively studied agent in the treatment of ECD and serves as the first line of treatment. Treatment with other agents is based on anecdotal case reports and on the basis of biological rationale. Nevertheless, cladribine (2CDA), anakinra and vemurafenib are currently advocated as promising second line treatments for patients whose response to interferon-α is unsatisfactory. Overall, the 5 year survival of ECD is 68%. Herein, the authors mustered and brought about a panoramic consolidation of all the relevant facts regarding ECD. This work highlights the different clinical, radiological and pathological manifestations associated with ECD, the differential diagnoses, the various treatment options and the acknowledged science explaining the disease.
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Affiliation(s)
- Roei D Mazor
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.
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Gil Ortega M, López Lozano E, Girela Baena E, Navarro Martinez N. [Erdheim-Chester disease: report of a case with retroperitoneal involvement treated with interferon alpha-2a]. Med Clin (Barc) 2013; 141:227-8. [PMID: 23452672 DOI: 10.1016/j.medcli.2012.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/02/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Lee HJ, Lee KY, Shin DY, Lee YG, Choi SY, Moon KC, Han IK, Kim TM. A case of erdheim-chester disease with asymptomatic renal involvement. Cancer Res Treat 2012; 44:146-50. [PMID: 22802754 PMCID: PMC3394865 DOI: 10.4143/crt.2012.44.2.146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 02/09/2011] [Indexed: 11/26/2022] Open
Abstract
Erdheim-Chester disease is a rare non-Langerhans-cell histiocytosis involving bones and multiple organs. Its clinical course can vary, from an asymptomatic state to a fatal disease, with renal involvement being a common cause of death. A 41-year-old man presented with a 10-month history of bilateral lower limb pain. Left perirenal soft-tissue infiltration had been found incidentally two years earlier. No progression of the lesion or deterioration of renal function was observed for a period of two years. At admission, plain radiography and magnetic resonance imaging of the patient's lower limbs showed patchy osteosclerosis. Biopsy of the tibia revealed histiocytic infiltration, which was found to be positive for CD68 and negative for CD1a. This report describes an unusual case of Erdheim-Chester disease involving a stationary course of disease with no specific treatment for a long period of time.
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Affiliation(s)
- Hyun Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Current World Literature. Curr Opin Rheumatol 2012; 24:119-22. [DOI: 10.1097/bor.0b013e32834f0d5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Raina R, Simon JF, Marion CR, Valeria A, Navaneethan SD, Heresi GA, Guzman JA, Wehbe E, Nally JV. Unusual cases of hydronephrosis with retroperitoneal fibrosis: mystery revealed. Clin Kidney J 2011; 4:313-317. [PMID: 21969844 PMCID: PMC3182259 DOI: 10.1093/ndtplus/sfr076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/27/2011] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rupesh Raina
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James F. Simon
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chad R. Marion
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Arrossi Valeria
- Department of Anatomic Pathology, Pathology Laboratory and Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sankar D. Navaneethan
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gustavo A. Heresi
- Department of Anatomic Pathology, Pathology Laboratory and Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jorge A. Guzman
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edgard Wehbe
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph V. Nally
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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