Nail features in Langerhans cell histiocytosis

Extensive nail changes in a toddler with multisystemic Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH) is a multisystem disorder involving various organs. Nail changes in LCH are extremely rare. We present this case report of extensive nail changes in an 18-month-old child with multisystem LCH.

Nail changes in Langerhans cell histiocytosis: a possible marker of multisystem disease

We describe a child with a 6-month history of onycholysis, subungual hyperkeratosis, and hemorrhages in most of her fingernails and toenails. Nail involvement preceded the identification of osteolytic lesions at the mastoid on a cranial computed tomography scan, which was performed because of repeated episodes of acute otitis media. Some weeks later, a small number of erythematous papules developed over the trunk and face. The diagnosis of Langerhans cell histiocytosis was made by histopathologic examination of bone, skin, and bed and matrix nail biopsies. Response to treatment with vinblastine and prednisone was excellent. Nail changes in Langerhans cell histiocytosis are extremely uncommon, particularly as the presenting manifestation of the disease. The role of nail involvement as an unfavorable prognostic sign is unclear.

Langerhans cell histiocytosis with involvement of nails and lungs in an adolescent

Skin and/or pulmonary involvement occur frequently in Langerhans cell histiocytosis (LCH) whereas nail involvement is rare. Herein, we present a case of LCH with initial nail disease and subsequent lung involvement causing recurrent pneumothoraces. Systemic chemotherapy was applied and intrapleural bleomycine and thoracoscopic pleurodesis with talc were performed. Although prognosis is not satisfactory in LCH with recurrent pneumothorax and nail involvement, the patient is under follow-up with no evidence of skin lesions, nail involvement, and pneumothorax for the last 10 months.

Nail involvement in langerhans cell histiocytosis

Nail involvement, which is distinctly uncommon in Langerhans cell histiocytosis (LCH), is characterized by various features like longitudinal grooving, purpuric striae, hyperkeratosis, subungual pustules, deformity, loss of nail plate, paronychia, onycholysis, and pitting. Here the authors report the case of a child who presented with isolated nail unit changes due to Langerhans cell histiocytosis before the evolution of systemic features. The authors suggest that LCH should be considered in differential diagnoses of nail changes that are resistant to therapy.

Histiocitosis de células de Langerhans

Histiocytoses originate from the proliferation of mononuclear phagocytes in different tissues. These entities make up a heterogeneous group, and are mainly classified as Langerhans cell histiocytoses and non-Langerhans cell histiocytoses. Langerhans cell histiocytoses have as a common characteristic the proliferation of dendritic antigen-presenting cells with phenotypical and ultrastructural characteristics of Langerhans cells. Infiltration may be limited to one organ, or may be disseminated. The prognosis and the treatment especially depend on the age of the patient and the number and dysfunction of the organs involved. Its etiopathogenesis is unknown, although most researchers currently believe that an alteration in the regulation of the immunological system occurs in these patients.

Nail changes in Langerhans cell histiocytosis

Nail changes in Langerhans cell histiocytosis are distinctly uncommon. Paronychial erythema, swelling and subungual pustules of the fingernails and toenails were cardinal, and were supported by diffuse as well as dense collections of mononuclear Langerhans cells evidenced by microscopic investigation. Oral administration of co-trimoxazole (800 mg sulphamethoxazole + 160 mg trimethoprim) every 12 h, 50 mg/d cyclophosphamide and 80 mg/d predinisolone were the mainstay of treatment, supported by scalp tar shampoo and local betamethasone lotion application.