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Saeger W, Luebke AM, Mekoula ST, Pahnke JM. [Xanthogranulomatous adrenalitis : A rare and difficult differential diagnosis of adrenal gland tumors]. Pathologie (Heidelb) 2024; 45:218-222. [PMID: 38472383 PMCID: PMC11045564 DOI: 10.1007/s00292-024-01312-x] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/14/2024]
Abstract
A radiologically diagnosed tumor in a 29-year-old woman with a fever of around 39 °C was operated on under the suspicion of cholecystitis or a liver abscess. A solid tumor was found in the adrenal gland and resected. The frozen section findings did not reveal a clear diagnosis of entity and assignment. Histologically, the tumor was found to consist of densely clustered large histiocyte-like cells with expression of vimentin, CD68, and CD163 as well as negativity for keratin, langerin, and SMA. We diagnosed xanthogranulomatous adrenalitis and discussed the differential diagnoses (Langerhans cell histiocytosis, Rosai-Dorfman disease, malakoplakia, Erdheim-Chester disease).
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Affiliation(s)
- Wolfgang Saeger
- Institut für Pathologie des Universitätsklinikums Hamburg-Eppendorf, Universität Hamburg, UKE, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Andreas M Luebke
- Institut für Pathologie des Universitätsklinikums Hamburg-Eppendorf, Universität Hamburg, UKE, Martinistr. 52, 20246, Hamburg, Deutschland
| | - S T Mekoula
- Klinik für Urologie und Kinderurologie des St. Barbara-Hospital, Gladbeck, Deutschland
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Gagliardo CM, Giammanco A, Vaglio A, Pegoraro F, Cefalù AB, Averna M, Noto D. Erdheim-Chester disease as complex clinical presentation and diagnosis: A case report and concise review of literature. Medicine (Baltimore) 2024; 103:e37870. [PMID: 38669404 PMCID: PMC11049690 DOI: 10.1097/md.0000000000037870] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Erdheim-Chester disease (ECD) is a rare multisystemic disease characterized by the infiltration of multiple organs by foamy CD68 + CD1a-histiocytes. The genetic background consists of gain-of-function somatic mutations in the mitogen-activated protein kinase pathway. The purpose of the present paper is to make a contribution to the scientific literature on ECD by reporting our experience with a complex clinical case report, along with a concise review of the literature. We discussed the unusual clinical presentation, the complex diagnostic process and the comparison with other published cases. PATIENT CONCERNS A 70-year-old man presented with arthralgia due to multiple bone areas of sclerosis, first diagnosed with metastases of a prostatic neoplasm. Sequential thorax-abdomen, femoral and homer contrast-enhanced computed tomography (CT) showed pericardial effusion, pulmonary fibrosis, and perirenal fibrous tissue as "hairy kidneys." He underwent. Three bone biopsies were unsuccessful to reach diagnosis. DIAGNOSES A xanthelasma biopsy showed histopathological signs compatible with ECD; genetic analysis showed the mutation BRAFV600E. INTERVENTIONS The patient underwent targeted therapy with vemurafenib (BRAF-inhibitor), discontinued 2 weeks later due to the onset of a diffuse erythematous papular rash on the trunk and limbs. OUTCOMES At the 1-year follow-up, there was only progression of chronic kidney disease (CKD). LESSONS The present case report describes how ECD diagnosis could represent a challenge for clinicians, owing to its heterogeneous clinical presentation. Early diagnosis followed by prompt therapy is essential for modifying the natural history of the disease.
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Affiliation(s)
- Carola M. Gagliardo
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| | - Antonina Giammanco
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Francesco Pegoraro
- Department of Health Science, University of Florence, Florence, Italy
- Pediatric Hematology and Oncology Unit, Meyer Children’s University Hospital IRCCS, Florence, Italy
| | - Angelo B. Cefalù
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| | - Maurizio Averna
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
| | - Davide Noto
- Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence “G. D. Alessandro” (PROMISE), University of Palermo, Palermo, Italy
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Morimoto A, Sakamoto K, Kudo K, Shioda Y. [Central nervous system disorders secondary to histiocytoses: neurodegeneration with potential for improvement]. Rinsho Shinkeigaku 2024; 64:85-92. [PMID: 38281751 DOI: 10.5692/clinicalneurol.cn-001899] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Histiocytoses, including Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD), are inflammatory myeloid tumors in which monocyte lineage cells aggregate in various organs, causing tissue damage. Most of these tumors harbor oncogenic mutations in mitogen-activated protein kinase (MAPK) pathway genes, typified by BRAFV600E. Some patients with LCH develop bilateral symmetrical cerebellar lesions and brain atrophy several years after diagnosis when the initial symptoms disappear, leading to cerebellar ataxia and higher cerebral dysfunction. A similar neurological disorder has also been reported in ECD. This neurological disorder can be improved with MAPK inhibitors. When patients with this neurological disorder are identified among neurodegeneration of unknown etiology or histiocytosis patients and treated early with MAPK inhibitors, the disorder can be reversible.
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Affiliation(s)
| | | | - Ko Kudo
- Department of Pediatrics, Hirosaki University School of Medicine
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development
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Khatalin MA, Alesrawi M, Shakour H, Yildirim O, Radad M, Camurdan VB. Urology Clinical Challenge: A Rare Case of Erdheim-Chester Disease. Urology 2024; 183:e314-e315. [PMID: 37774855 DOI: 10.1016/j.urology.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Mai Al Khatalin
- Al-Hussein Salt New Hospital, Internal Medicine Department, Salt, Jordan
| | | | - Husam Shakour
- Abdali Hospital, Internal Medicine Department, Amman, Jordan.
| | - Onur Yildirim
- Istanbul University-Cerrahpasa, Department of Radiology, Istanbul, Turkey
| | - Maryana Radad
- Al-Hussein Salt New Hospital, Internal Medicine Department, Salt, Jordan
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Zeng Y, Wang Q, Wang X, Jiang X, Yao H, Tang X. Erdheim-Chester Disease Involving the Left Uterine Adnexa: Mimicking an Ovarian Carcinoma Clinically. Int J Surg Pathol 2023; 31:1532-1537. [PMID: 36855299 DOI: 10.1177/10668969231157780] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis (LCH) that results in multiorgan disease involving the skin, bones, lungs, and kidneys. Female reproductive system manifestation of ECD was rare. Herein, we report a case of ECD involving the left ovary and fallopian tube. A 69-year-old woman presented with abdominal pain for 20 days. Magnetic resonance imaging revealed a solid and cystic mass on the left pelvic cavity. Histological examination revealed ovarian and fallopian tube infiltration by abundant histiocytes, with single small nuclei and foamy cytoplasm, reactive small lymphocytes, and plasma cells. Based on histopathological and immunohistochemical findings of positivity for CD68, CD163, and BRAF V600E and negativity for CD1α and S100, the molecular finding of BRAF V600E mutation, the patient was diagnosed with ECD. Positron emission tomography examination did not reveal any other lesions. The patient recovered well 12 months after surgery without any treatment. ECD involving the left fallopian tube and ovary was rare and needed to be differentiated from LCH, Rosai-Dorfman disease (RDD), juvenile xanthogranuloma (JXG), IgG4+-related disease (IgG4+RD), and metastatic signet ring cell carcinoma.
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Affiliation(s)
- Ying Zeng
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Qianhui Wang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Xue Wang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Xin Jiang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Hui Yao
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Xuefeng Tang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
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Rass HBA, Abuawad M, Abueideh Y, Malhis EL. Erdheim-Chester Disease with Renal Mass Presentation: Report of the First Case From Palestine and a Review of the Literature. Am J Case Rep 2023; 24:e941912. [PMID: 37974387 PMCID: PMC10665577 DOI: 10.12659/ajcr.941912] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/16/2023] [Accepted: 10/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Erdheim-Chester disease (ECD), a form of non-Langerhans-cell histiocytosis, is extremely rare. The mean age of individuals with ECD is in their 50s. Histiocytic infiltration of vital organ systems is a potential cause of substantial morbidity, which is associated with the multisystemic form of ECD. This report presents the first case of ECD with renal abnormalities in Palestine. CASE REPORT A 54-year-old woman with no medical or surgical history presented with 6 months of bilateral flank pain with no radiation or fever. A physical examination revealed only bilateral flank pain. Urine tests showed microhematuria. Laboratory test results showed increased serum creatinine levels (1.21 mg/dL) and microcytic anemia. A CT scan revealed significant multi-organ abnormalities, including renal abnormalities with a hairy kidney sign, pericardial effusion, and an osteolytic lesion of the spine. The hairy kidney sign is pathognomonic for ECD, so the renal mass was biopsied to confirm the diagnosis. The biopsy showed foamy histiocytes, lymphocytes, and plasma cells. Foamy histiocytes were CD68-positive and negative for S100, CD1a, and HMB45. PAx5 and CD3 immunostaining showed T-predominant B-lymphocyte mixtures. CONCLUSIONS In the setting of systemic symptoms and imaging abnormalities such as presence of the hairy kidney sign, pericardial effusion, and osteolytic lesion of the spine, it is necessary to examine the possibility of ECD and proceed with a biopsy for confirmation. This is the first case in Palestine to be reported and the second case worldwide with a renal mass as an atypical presentation.
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Affiliation(s)
| | - Mohammad Abuawad
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yazan Abueideh
- Department of Internal Medicine, St. Marienhospital, Vechta, Germany
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Álvarez-Bravo G. A new phenotype of myorhythmia: Oculofacial myorhythmia in a patient with Erdheim Chester disease. Parkinsonism Relat Disord 2023; 116:105889. [PMID: 37832228 DOI: 10.1016/j.parkreldis.2023.105889] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
Oculofacial myorhythmia (OFM) is a movement disorder characterized by slow, rhythmic, and repetitive movement that affects the periorbital and perioral muscles. This abnormal movement is classified as a tremor and is highly suggestive of brainstem lesions. Unlike the oculomasticastory myorhythmia, the oculofacial pattern has rarely been reported to date. We present a patient diagnosed with Erdheim Chester disease who two years after the diagnosis developed an oculofacial myorhythmia. We additionally provide a pathological framework based on evolutionary changes on neuroimaging which could explain the appearance of this very rare movement disorder. No cases of OFM have been described in patients with ECD to date. To our knowledge we are reporting the first case of oculofacial myorhythmia secondary to Erdheim Chester disease. To conclude, oculofacial myorhytmia could be a late-onset clinical manifestation of ECD with brainstem involvement.
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Affiliation(s)
- Gary Álvarez-Bravo
- Unit of Neuroimmunology and Multiple Sclerosis of Girona, University Hospital Josep Trueta of Girona, Department of Neurology, Movement Disorders Unit, University of Girona, 10 Albereda Street, Girona, 17004, Spain.
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Bozan E, Darçın T, Yaman S, Yiğenoğlu TN, Kızıl Çakar M, Dal MS, Altuntaş F. An effective treatment in Erdheim Chester disease: vemurafenib: a case report. J Med Case Rep 2023; 17:426. [PMID: 37821987 PMCID: PMC10568759 DOI: 10.1186/s13256-023-04153-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/30/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Erdheim Chester disease (ECD) is a rare disease with multisystemic involvement in the group of non-langerhans cell histiocytosis. Although nearly 100 years have passed since its definition, the number of cases reported all over the world is below 1000. In addition to the rarity of the disease, low awareness seems to play a role in this. CASE PRESENTATION 47-year-old white caucasian women patient who presented to our clinic with symptoms of weakness-fatigue as well as increasing pain in the knees and ptosis in the left eye. Result of the patient's bone biopsy, ECD was considered pathologically and BRAF V600E mutation was shown molecularly. After presenting the clinical, laboratory and other examination results of the case, the dramatic response seen with targeted therapy will be discussed. CONCLUSIONS BRAF V600E mutation is frequently seen in ECD. Vemurafenib plays an active role in targeted therapy.
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Affiliation(s)
- Ersin Bozan
- Department of Hematology and Bone Marrow Transplantation Center, Hematology and Bone Marrow Transplantation Unit, Health Sciences University Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey.
| | - Tahir Darçın
- Department of Hematology and Bone Marrow Transplantation Center, Hematology and Bone Marrow Transplantation Unit, Health Sciences University Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Samet Yaman
- Department of Hematology and Bone Marrow Transplantation Center, Hematology and Bone Marrow Transplantation Unit, Health Sciences University Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Department of Hematology and Bone Marrow Transplantation Center, Hematology and Bone Marrow Transplantation Unit, Health Sciences University Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Merih Kızıl Çakar
- Department of Hematology and Bone Marrow Transplantation Center, Hematology and Bone Marrow Transplantation Unit, Health Sciences University Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology and Bone Marrow Transplantation Center, Hematology and Bone Marrow Transplantation Unit, Health Sciences University Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Fevzi Altuntaş
- Department of Hematology and Bone Marrow Transplantation Center, Hematology and Bone Marrow Transplantation Unit, Health Sciences University Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
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Goyal G. Paging all ENT specialists: Sinus manifestations of Erdheim-Chester disease. Br J Haematol 2023; 203:152-153. [PMID: 37525388 DOI: 10.1111/bjh.19020] [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: 07/18/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Iaconelli A, Leccisotti L, Rovere G, Ruggio A, Crea F. Histiocytes from the body to the heart: a complex case of cardiac and multi-organ involvement of Erdheim-Chester disease. Eur Heart J 2023; 44:3704. [PMID: 37515379 DOI: 10.1093/eurheartj/ehad458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Affiliation(s)
- Antonio Iaconelli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Leccisotti
- UOC Di Medicina Nucleare, Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Giuseppe Rovere
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
| | - Aureliano Ruggio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Rafati Fard A, Thornton J, Coles A. Novel paraneoplastic mechanism for cerebellar ataxia in Erdheim-Chester disease. BMJ Case Rep 2023; 16:e255681. [PMID: 37696611 PMCID: PMC10496709 DOI: 10.1136/bcr-2023-255681] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
We report a case of BRAF-mutation positive Erdheim-Chester disease presenting with a cerebellar ataxia. This is the first such case to be reported without structural MRI abnormalities but with a single intrathecally produced oligoclonal band. Now that the histiocytoses have been recharacterised as neoplastic, we speculate that the mechanism of the ataxia in our case is paraneoplastic. We highlight the importance of searching for BRAF mutations in this disease, as their presence leads to effective personalised treatments.
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Affiliation(s)
- Amir Rafati Fard
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Juliet Thornton
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Yeager LB, Grimes JM, Dal Col AK, Shah NV, Bogomolny D, Debelenko L, Marr BP. Ophthalmologic Findings in Pediatric Erdheim-Chester Disease: A Literature Review With a Novel Case Report. Ophthalmic Plast Reconstr Surg 2023; 39:419-426. [PMID: 36877575 DOI: 10.1097/iop.0000000000002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
PURPOSE The authors aim to describe the ophthalmologic manifestations of pediatric Erdheim-Chester disease (ECD). METHODS The authors describe a novel case of ECD presenting as isolated bilateral proptosis in a child and provide a comprehensive review of the documented pediatric cases to observe overall trends and ophthalmic manifestations of disease. Twenty pediatric cases were identified in the literature. RESULTS The mean age at presentation was 9.6 years (1.8-17 years) with a mean time of symptom presentation to diagnosis of 1.6 years (0-6 years). Nine patients (45%) had ophthalmic involvement at diagnosis, 4 who presented with ophthalmic complaints: 3 with observable proptosis and 1 with diplopia. Other ophthalmic abnormalities included eyelid findings of a maculopapular rash with central atrophy on the eyelids and bilateral xanthelasmas, neuro-ophthalmologic findings of a right hemifacial palsy accompanied by bilateral optic atrophy and diplopia, and imaging findings of orbital bone and enhancing chiasmal lesions. No intraocular involvement was described, and visual acuity was not reported in most cases. CONCLUSIONS Ophthalmic involvement occurs in almost half of documented pediatric cases. Typically presenting with other symptoms, the case highlights that isolated exophthalmos may be the only clinical sign, and ECD should be included in the differential diagnosis of bilateral exophthalmos in children. Ophthalmologists may be the first to evaluate these patients, and a high index of suspicion and an understanding of the varied clinical, radiographic, pathologic, and molecular findings are critical for prompt diagnosis and treatment of this unusual disease.
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Affiliation(s)
- Lauren B Yeager
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Joseph M Grimes
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alexis K Dal Col
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nirav V Shah
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Dmitry Bogomolny
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Larisa Debelenko
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, U.S.A
| | - Brian P Marr
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
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Abstract
Histiocytosis is a group of rare diseases characterized by inflammation and accumulation of cells derived from monocytes and macrophages in different tissues. The symptoms are highly variable, from mild forms with involvement of a single organ to severe multisystem forms that can be life compromising. The diagnosis of histiocytosis is based on the clinic, radiological findings and pathological anatomy. A biopsy of the affected tissue is recommended in all cases as it may have therapeutic implications. During the last decade, some mutations have been identified in the affected tissue that condition activation of the MAPK/ERK and PI3K/AKT pathway, in a variable proportion depending on the type of histiocytosis. In this review we mainly focus on Langerhans Cell Histiocytosis, Erdheim-Chester Disease and Rosai-Dorfman Disease.
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Affiliation(s)
- Gemma Rocamora-Blanch
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España.
| | - Fina Climent
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Xavier Solanich
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
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Aaroe A, Kurzrock R, Goyal G, Goodman AM, Patel H, Ruan G, Ulaner G, Young J, Li Z, Dustin D, Go RS, Diamond EL, Janku F. Successful treatment of non-Langerhans cell histiocytosis with the MEK inhibitor trametinib: a multicenter analysis. Blood Adv 2023; 7:3984-3992. [PMID: 36857436 PMCID: PMC10410131 DOI: 10.1182/bloodadvances.2022009013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/25/2023] [Accepted: 02/17/2023] [Indexed: 03/03/2023] Open
Abstract
Erdheim-Chester disease (ECD) and Rosai-Dorfman disease (RDD) are rare non-Langerhans cell histiocytoses (non-LCHs), for which therapeutic options are limited. MAPK pathway activation through BRAFV600E mutation or other genomic alterations is a histiocytosis hallmark and correlates with a favorable response to BRAF inhibitors and the MEK inhibitor cobimetinib. However, there has been no systematic evaluation of alternative MEK inhibitors. To assess the efficacy and safety of the MEK inhibitor trametinib, we retrospectively analyzed the outcomes of 26 adult patients (17 with ECD, 5 with ECD/RDD, 3 with RDD, and 1 with ECD/LCH) treated with orally administered trametinib at 4 major US care centers. The most common treatment-related toxicity was rash (27% of patients). In most patients, the disease was effectively managed at low doses (0.5-1.0 mg trametinib daily). The response rate of the 17 evaluable patients was 71% (73% [8/11] without a detectable BRAFV600E achieving response). At a median follow-up of 23 months, treatment effects were durable, with a median time-to-treatment failure of 37 months, whereas the median progression-free and overall survival were not reached (at 3 years, 90.1% of patients were alive). Most patients harbored mutations in BRAF (either classic BRAFV600E or other BRAF alterations) or alterations in other genes involved in the MAPK pathway, eg, MAP2K, NF1, GNAS, or RAS. Most patients required lower than standard doses of trametinib but were responsive to lower doses. Our data suggest that the MEK inhibitor trametinib is an effective treatment for ECD and RDD, including those without the BRAFV600E mutation.
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Affiliation(s)
- Ashley Aaroe
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Razelle Kurzrock
- WIN Consortium for Precision Medicine, Paris, France
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Aaron M. Goodman
- Division of Hematology and Oncology, University of California San Diego, La Jolla, CA
| | - Harsh Patel
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Gordon Ruan
- Division of Hematology and Department of Radiology, Mayo Clinic, Rochester, MN
| | - Gary Ulaner
- Hoag Family Cancer Institute, Newport Beach, CA
| | - Jason Young
- Division of Hematology and Department of Radiology, Mayo Clinic, Rochester, MN
| | - Ziyi Li
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Derek Dustin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ronald S. Go
- Division of Hematology and Department of Radiology, Mayo Clinic, Rochester, MN
| | - Eli L. Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
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Aggarwal A, Taychert M, Hasanin L, Doll D, Basuino MG, Hasanein H. Erdheim-Chester Disease: A Case Report of BRAF V600E-Negative, MAP2K1-Positive ECD Diagnosed by Blood Next-Generation Sequencing Assay and a Brief Literature Review. Oncology (Williston Park) 2023; 37:298-302. [PMID: 37499251 DOI: 10.46883/2023.25921001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare type of non-Langerhans cell histiocytosis. However, its prevalence has increased significantly the past few years due to increased awareness about the disorder, and 1500 cases have been reported worldwide. It is often a multisystemic disease with skeletal, cardiovascular, urologic, renal, retroperitoneal, pulmonary, endocrine, cutaneous, and neurologic involvement. MAPK pathway mutations, such as BRAF activating and MAP2K1 mutations, play a key role in its pathogenesis. In addition to the characteristic clinical, radiological, and histopathological findings, identifying underlying mutations helps diagnose and treat patients with highly effective targeted therapies such as BRAF and MEK inhibitors. We report a case of a man, aged 55 years, with an extensive and prolonged course of an unexplained multisystemic disease, later diagnosed with BRAF V600E-negative and MAP2K1-positive ECD on cell-free DNA testing. Additionally, we review common clinical manifestations, mutations, diagnoses, and targeted therapies for ECD.
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Guvercin AR, Guvercin B, Çakır E, Yazar U. Erdheim-Chester disease misdiagnosed as meningioma of the pontocerebellar angle: A case report and review of literature. INDIAN J PATHOL MICR 2023; 66:644-647. [PMID: 37530361 DOI: 10.4103/ijpm.ijpm_1121_21] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Erdheim-Chester Disease (ECD) is a rare non-Langerhans form of systemic histiocytosis of unknown etiology with multiple organ involvement. It most commonly affects the long bones, lungs, heart, retroperitoneum, eyes, and kidneys and less commonly the brain and spinal cord. Although there are very few cases of supratentorial ECD mimicking intracranial meningioma reported in literature, to the best of our knowledge, there are no reports on ECD mimicking infratentorial pontocerebellar angle meningioma. The present study reports a case of ECD mimicking pontocerebellar angle meningioma. This study aimed to emphasize the importance of systemic evaluation using a multidisciplinary approach as well as the need for considering ECD as a differential diagnosis of xanthomatous meningioma.
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Affiliation(s)
- Ali Rıza Guvercin
- Department of Neurosurgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Beyhan Guvercin
- Department of Nephrology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Emel Çakır
- Department of Pathology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Uğur Yazar
- Department of Neurosurgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
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17
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Reiner AS, Bossert D, Buthorn JJ, Sigler AM, Gonen S, Fournier D, Brewer K, Corkran J, Goyal G, Allen CE, McClain KL, Atkinson TM, Lynch KA, Mao JJ, Panageas KS, Diamond EL. Patient-reported fatigue and pain in Erdheim-Chester disease: a registry-based, mixed methods study. Haematologica 2023; 108:1685-1690. [PMID: 36546452 PMCID: PMC10230438 DOI: 10.3324/haematol.2022.282287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Anne S Reiner
- Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center
| | - Dana Bossert
- Department of Neurology; Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Carl E Allen
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kenneth L McClain
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Kathleen A Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center
| | - Eli L Diamond
- Department of Neurology; Memorial Sloan Kettering Cancer Center.
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18
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Banks SA, Bhatti MT, Go RS, Abeykoon JP, Acosta-Medina AA, Hazim AZ, Goyal G, Young JR, Koster MJ, Vassallo R, Ryu JH, Davidge-Pitts CJ, Ravindran A, Sartori Valinotti JC, Bennani NN, Shah MV, Rech KL, Garrity JA, Tobin WO. Ophthalmologic Involvement in Adults with Histiocytic Disorders: Clinical Presentation and Treatment Outcomes. Ophthalmology 2023; 130:77-86. [PMID: 35932838 DOI: 10.1016/j.ophtha.2022.07.031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/08/2022] [Accepted: 07/28/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the clinical presentation, treatment, and outcomes in adult patients with histiocytic disorders with ocular, orbital, optic nerve, or cavernous sinus involvement. DESIGN Observational, retrospective chart review. PARTICIPANTS Adult patients (age ≥ 18 years) at Mayo Clinic from January 1, 1996, to July 1, 2021, with histiocytic disorders. Inclusion criteria were (1) histiocytic disorder by biopsy and appropriate clinical phenotype; (2) available medical records; and (3) ocular, orbital, optic nerve, or cavernous sinus involvement. METHODS Retrospective chart review. MAIN OUTCOME MEASURES Response to therapy, measured in clinical and radiographic impact. RESULTS Thirty-two patients were identified: 7 with Langerhans cell histiocytosis (LCH); 15 with Erdheim-Chester disease (ECD); 1 with mixed LCH/ECD phenotype; 8 with Rosai-Dorfman disease (RDD); and 1 with mixed RDD/ECD phenotype. Ophthalmologic involvement was part of the initial presentation in 69% of patients (22/32). Eyelid edema (13/32, 41%) and proptosis (12/32, 38%) were the most frequent presentations. Isolated orbital or cavernous sinus involvement was present in 3 of 7 patients with LCH and 1 of 8 patients with RDD. Optic nerve sheath involvement was present in 2 of 7 LCH patients, 14 of 15 ECD patients, and 1 RDD/ECD patient. Diffuse (> 75%) orbital involvement was seen in 12 of 15 ECD patients and 1 of 7 LCH patients. Ocular involvement was seen in 1 of 15 ECD patients, 6 of 8 RDD patients, and 1 of 1 mixed RDD/ECD patient. The cavernous sinuses were involved in 1 of 7 LCH patients, 5 of 15 ECD patients, and both mixed phenotype patients. Visual acuity was affected in 14 patients (14/24, 58%) with a median logarithm of the minimum angle of resolution visual acuity of 0.1 (range, -0.12 to 3). BRAF V600E mutations were found in 75% (3/4) of LCH patients and 91% (10/11) of ECD patients. Patients received a variety of treatment, and response was variable across disease types. CONCLUSIONS Orbital involvement was more commonly seen in LCH and ECD, whereas ocular involvement was more common in RDD. Visual acuity may be impacted from ocular involvement or compression of the optic nerve with diffuse orbital involvement.
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Affiliation(s)
- Samantha A Banks
- Division of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - M Tariq Bhatti
- Division of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Ronald S Go
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jithma P Abeykoon
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Aldo A Acosta-Medina
- Division of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Antonious Z Hazim
- Division of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Gaurav Goyal
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason R Young
- Division of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Matthew J Koster
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Caroline J Davidge-Pitts
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Aishwarya Ravindran
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - N Nora Bennani
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Karen L Rech
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - James A Garrity
- Division of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - W Oliver Tobin
- Division of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.
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19
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Azoulay LD, Ganzel C, Bravetti M, Amoura Z, Cluzel P, Cohen-Aubart F, Haroche J. NT-proBNP and High-Sensitivity Cardiac Troponin T Fail to Detect Cardiac Involvement in Erdheim-Chester Disease. Mayo Clin Proc 2022; 97:2165-2167. [PMID: 36333021 DOI: 10.1016/j.mayocp.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 03/21/2023]
Affiliation(s)
- Lévi-Dan Azoulay
- Sorbonne Université Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Chezi Ganzel
- Department of Hematology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marine Bravetti
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Département d'Imagerie Cardio-Vasculaire et de Radiologie Interventionnelle, Hôpital Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Philippe Cluzel
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Département d'Imagerie Cardio-Vasculaire et de Radiologie Interventionnelle, Hôpital Pitié-Salpêtrière, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Julien Haroche
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
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20
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Abstract
We report on a 47-year-old patient suffering from bilateral gonalgia, weight loss and night sweats without fever of several months' duration. Diagnostic work-up for infectious and autoimmune diseases showed no abnormal results. A CT scan showed extensive foci of sclerosis throughout the axial skeleton. In the trephine biopsy, foamy cell infiltrates were found with expression of histiocytic markers without expression of Langerhans cell markers. Molecular analysis revealed a low allelic BRAF V600E and BCOR mutation. The diagnosis of Erdheim-Chester disease (ECD) was made. The histologic findings and molecular findings, the clinical and radiologic presentation before and 6 months after therapy as well as possible differential diagnoses of this very rare disease are discussed.
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Affiliation(s)
- Michael Mayr
- Institut für Pathologie und Mikrobiologie, Klinik Ottakring, Montleartstraße 37, 1160, Wien, Österreich.
| | - Niklas Zojer
- 1. Medizinische Abteilung - Zentrum für Onkologie und Hämatologie mit Ambulanz und Palliativstation, Klinik Ottakring, Wien, Österreich
| | - Siroos Mirzaei
- Institut für Nuklearmedizin mit PET-Zentrum, Klinik Ottakring, Wien, Österreich
| | - Andreas Chott
- Institut für Pathologie und Mikrobiologie, Klinik Ottakring, Montleartstraße 37, 1160, Wien, Österreich
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21
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Polk C, Weida C, Patel N, Leonard M. Erdheim-Chester disease presenting as meningitis with hypoglycorrhachia: A case report. Medicine (Baltimore) 2022; 101:e30585. [PMID: 36123925 PMCID: PMC9478310 DOI: 10.1097/md.0000000000030585] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Erdheim-Chester disease (ECD) commonly has neurologic manifestations but rarely presents with meningitis and hypoglycorrhachia. Here, were present a case of ECD with a clinical and laboratory presentation initially thought to be bacterial meningitis with sepsis. METHODS We report a case of a 79-year-old with history of enigmatic bone pain and peritoneal nodules who presented with meningitis. After failure to improve on antibiotic therapy other etiologies of hypoglycorrhachia including sarcoid, tuberculosis, and fungal and carcinomatous meningitis were considered. However, no definite diagnosis could be made based on radiologic, serologic, microbiologic, and molecular testing and the patient failed to improve on empiric therapy including antibiotics, antifungals, and tuberculosis and steroid therapy. RESULTS Ultimately, autopsy revealed a new diagnosis of ECD manifesting as meningitis, a rare presentation of a rare disease. CONCLUSION Although only reported in one other case to our knowledge, ECD can present with meningitis with hypoglycorrhachia.
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Affiliation(s)
- Christopher Polk
- Division of Infectious Diseases, Atrium Health, Charlotte, NC
- *Correspondence: Christopher Polk, MD, Department of Medicine, Carolinas Medical Center, 1000 Blythe Blvd, MEB 5th floor, Charlotte, NC 28203 (e-mail: )
| | - Carol Weida
- Department of Pathology, Atrium Health, Charlotte, NC
| | - Nikhil Patel
- Division of Pulmonary and Critical Care, Atrium Health, Charlotte, NC
| | - Michael Leonard
- Division of Infectious Diseases, Atrium Health, Charlotte, NC
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22
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Wadayama T, Shimizu M, Kimura I, Baba K, Beck G, Nagano S, Morita R, Nakagawa H, Shirano M, Goto T, Norose K, Hikosaka K, Murayama S, Mochizuki H. Erdheim-Chester Disease Involving the Central Nervous System with Latent Toxoplasmosis. Intern Med 2022; 61:2661-2666. [PMID: 35135916 PMCID: PMC9492489 DOI: 10.2169/internalmedicine.8564-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/02/2021] [Indexed: 12/25/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis characterized by the infiltration of foamy histiocytes into multiple organs. We herein report a case of ECD with central nervous system (CNS) involvement in a 63-year-old man who also presented a positive result for Toxoplasma gondii nested polymerase chain reaction testing of cerebrospinal fluid. Since anti-Toxoplasma treatment proved completely ineffective, we presumed latent infection of the CNS with T. gondii. This case suggests the difficulty of distinguishing ECD with CNS involvement from toxoplasmic encephalitis and the possibility of a relationship between the pathogeneses of ECD and infection with T. gondii.
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Affiliation(s)
- Tomoya Wadayama
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Mikito Shimizu
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Ikko Kimura
- Graduate School of Frontier Biosciences, Osaka University, Japan
| | - Kousuke Baba
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Goichi Beck
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Seiichi Nagano
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Ryo Morita
- Department of Infectious Diseases, Osaka City General Hospital, Japan
| | - Hidenori Nakagawa
- Department of Infectious Diseases, Osaka City General Hospital, Japan
| | - Michinori Shirano
- Department of Infectious Diseases, Osaka City General Hospital, Japan
| | - Tetsushi Goto
- Department of Infectious Diseases, Osaka City General Hospital, Japan
| | - Kazumi Norose
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Japan
| | - Kenji Hikosaka
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Japan
| | - Shigeo Murayama
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
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23
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Tang Y, Wu Z, Wei ZM, Sun H, Jin ZY. [Characterization of Endocrine Glands Involved in Erdheim-Chester Disease]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2022; 44:428-432. [PMID: 35791940 DOI: 10.3881/j.issn.1000-503x.14477] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective To investigate the clinical and imaging characteristics of endocrine glands involved in Erdheim-Chester disease (ECD).Methods A retrospective analysis was performed on 48 ECD cases pathologically diagnosed from January 2014 to October 2020 in Peking Union Medical College Hospital,including 22 cases of endocrine gland involvement.The clinical,imaging,and pathological characteristics were summarized. Results Pituitary was involved in 17 cases (17/48,35.4%),adrenal gland in 8 cases (8/48,16.7%),and both pituitary and adrenal gland in 3 cases (3/48,6.25%).The most common symptom in patients with pituitary involvement was central diabetes insipidus (13/17,76.5%),and the T1-weighted imaging showed posterior pituitary hypersignal disappearance,pituitary stalk thickening,and abnormally enhanced pituitary nodules.The most common symptom in patients with adrenal gland involvement was adrenal function reduction (3/8,37.5%),and the CT scanning showed diffuse thickening of adrenal glands.BRAF V600E mutation was positive in 13 (13/22,59.1%) cases with ECD involving endocrine glands.Conclusion Pituitary and adrenal glands are the most common sites of ECD involving endocrine glands.A definite diagnosis can be achieved by combining clinical,imaging,and pathological characteristics for timely treatment.
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Affiliation(s)
- Yi Tang
- Department of Endocrinology,Fushun Central Hospital,Fushun,Liaoning 113006,China
| | - Zhe Wu
- Department of Radiology,State Key Laboratory of Complex Severe and Rare Diseases,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
- Department of Radiology,Fushun Central Hospital,Fushun,Liaoning 113006,China
| | - Ze-Min Wei
- Department of Endocrinology,Fushun Central Hospital,Fushun,Liaoning 113006,China
| | - Hao Sun
- Department of Radiology,State Key Laboratory of Complex Severe and Rare Diseases,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Zheng-Yu Jin
- Department of Radiology,State Key Laboratory of Complex Severe and Rare Diseases,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
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24
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Hanson A, Freeman JW. Erdheim-Chester Disease: A Mysterious Illness Causing Obscure Neurologic Syndromes. S D Med 2022; 75:206-208. [PMID: 35724348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Erdheim-Chester disease (ECD) is a very rare form of non-Langerhans histiocytic disorder which affects multiple systems and can present in a variety of different ways. We present two patients diagnosed with ECD whose symptoms, progression and treatment differ dramatically.
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Affiliation(s)
- Alex Hanson
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Jerome W Freeman
- Department of Neurosciences, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Sanford Health, Sioux Falls, South Dakota
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25
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Affiliation(s)
- Patrycja Chrostowska
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Miśkiewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
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26
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Guo X, Xu Y, Wan K, Chen Y. Sick sinus syndrome associated with Erdheim-Chester disease was reversed by interferon-alpha treatment. Korean J Intern Med 2022; 37:245-246. [PMID: 34126666 PMCID: PMC8747911 DOI: 10.3904/kjim.2021.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- Xinli Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Wan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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27
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Tojo A. [An overview of histiocytosis]. Rinsho Ketsueki 2022; 63:363-367. [PMID: 35662158 DOI: 10.11406/rinketsu.63.363] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Histiocytosis is a syndrome characterized by fever, pain, and other symptoms caused by the neoplastic proliferation of atypical cells of the macrophage-dendritic cell lineage and surrounding inflammatory cell infiltration. The diagnosis is confirmed by the immune-histological features of biopsied specimens. From this viewpoint, histiocytosis is divided into Langerhans cell histiocytosis (LCH) (CD1a+/CD207+/CD14±/CD68±) and non-LCH, including Erdheim-Chester disease (ECD), juvenile xanthogranuloma, and Rosai-Dorfman disease (CD1a-/CD207-/CD14++/CD68++). Genetic alterations occur at the cellular level in hematopoietic progenitor cells, and environmental factors are assumed to influence tumor development. The genomic analysis of the lesions involved revealed driver mutations primarily in the MAPK pathway, including BRAF-V600E, and the PI3K pathway. This strongly suggests that abnormalities in these signaling pathways play a role in pathogenesis. Steroids, vinca alkaloids, cytarabine, and cladribine are commonly used to treat histiocytosis. However, efficacy has not been fully confirmed in any of them. In recent years, the efficacy of BRAF inhibitors and MEK inhibitors has been reported mainly in therapy-resistant and refractory cases of LCH and ECD.
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28
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Salazar LC, Moreno LÁ, Jaramillo LE, Cabrera EV. Erdheim-Chester disease: First pediatric case report in Colombia. Biomedica 2021; 41:615-624. [PMID: 34936247 PMCID: PMC8715983 DOI: 10.7705/biomedica.5651] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/17/2021] [Indexed: 11/21/2022]
Abstract
The Erdheim-Chester’s disease is extremely rare in children. We present the case of a 12-year-old girl with histological and radiological diagnosis of this disease and mutation of the BRAF gene, who developed multisystemic compromise requiring treatment with dabrafenib. We identified 22 reports of this condition among children worldwide and this is the second pediatric case in Latin America. Diagnostic imaging is critical to confirm Erdheim-Chester disease and for the surgical planning of the biopsy. Additionally, we identified the parasellar dark sign, which has previously been reported on lymphocytic hypophysitis. This report contributes to the current practice as it shows the clinical presentation and the diagnostic workout of this disease in pediatrics.
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Affiliation(s)
- Luis Carlos Salazar
- Departamento de Radiología e Imágenes Diagnósticas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Luz Ángela Moreno
- Departamento de Radiología e Imágenes Diagnósticas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Unidad Funcional de Imágenes Diagnósticas, Fundación Hospital de La Misericordia, Bogotá, D.C., Colombia.
| | - Lina Eugenia Jaramillo
- Departamento de Patología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Laboratorio de Patología, Fundación Hospital de La Misericordia, Bogotá, D.C., Colombia.
| | - Edgar Vladimir Cabrera
- Servicio de Oncohematología Pediátrica, Fundación Hospital de La Misericordia, Bogotá, D.C., Colombia.
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29
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Abstract
The historic term 'histiocytosis' meaning 'tissue cell' is used as a unifying concept for diseases characterized by pathogenic myeloid cells that share histological features with macrophages or dendritic cells. These cells may arise from the embryonic yolk sac, fetal liver or postnatal bone marrow. Prior classification schemes align disease designation with terminal phenotype: for example, Langerhans cell histiocytosis (LCH) shares CD207+ antigen with physiological epidermal Langerhans cells. LCH, Erdheim-Chester disease (ECD), juvenile xanthogranuloma (JXG) and Rosai-Dorfman disease (RDD) are all characterized by pathological ERK activation driven by activating somatic mutations in MAPK pathway genes. The title of this Primer (Histiocytic disorders) was chosen to differentiate the above diseases from Langerhans cell sarcoma and malignant histiocytosis, which are hyperproliferative lesions typical of cancer. By comparison LCH, ECD, RDD and JXG share some features of malignant cells including activating MAPK pathway mutations, but are not hyperproliferative. 'Inflammatory myeloproliferative neoplasm' may be a more precise nomenclature. By contrast, haemophagocytic lymphohistiocytosis is associated with macrophage activation and extreme inflammation, and represents a syndrome of immune dysregulation. These diseases affect children and adults in varying proportions depending on which of the entities is involved.
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Affiliation(s)
- Kenneth L McClain
- Texas Children's Cancer Center, Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Camille Bigenwald
- Department of Oncological Sciences and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Collin
- Human Dendritic Cell Lab, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Julien Haroche
- Department of Internal Medicine, Institut E3M French Reference Centre for Histiocytosis, Pitié-Salpȇtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, and University of Cincinnati, Cincinnati, OH, USA
| | - Miriam Merad
- Department of Oncological Sciences and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Picarsic
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karina B Ribeiro
- Faculdade de Ciȇncias Médicas da Santa Casa de São Paulo, Department of Collective Health, São Paulo, Brazil
| | - Carl E Allen
- Texas Children's Cancer Center, Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA
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Abstract
A 3-year-old girl was admitted to our hospital with diabetes insipidus and a left eye proptosis. During investigation of diabetes insipidus, an extensive osteolytic mass, involving skull base and maxillo-facial bones, was revealed. Biopsy exhibited dense infiltrate of foamy histiocytes, which were positive for CD68 and CD163 and negative for CD1a and S100 confirming histopathological diagnosis of Erdheim-Chester disease. Treatment with dabrafenib was initiated, with good response and no side effects.
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Affiliation(s)
- Sofia Costa
- Pediatric Oncology, Centro Hospitalar e Universitario de Coimbra EPE, Hospital Pediátrico, Coimbra, Portugal
| | - Maria José Julião
- Department of Pathology, Coimbra University Hospital, Coimbra, Portugal
| | - Sónia Silva
- Pediatric Oncology, Centro Hospitalar e Universitario de Coimbra EPE, Hospital Pediátrico, Coimbra, Portugal
| | - Manuel João Brito
- Pediatric Oncology, Centro Hospitalar e Universitario de Coimbra EPE, Hospital Pediátrico, Coimbra, Portugal
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Kaiafa G, Pilalas D, Koletsa T, Daios S, Arsos G, Hatzidakis A, Protopapas A, Stamatopoulos K, Savopoulos C. Diagnosing a Patient with Erdheim-Chester Disease during the COVID-19 Pandemic. ACTA ACUST UNITED AC 2021; 57:medicina57101001. [PMID: 34684037 PMCID: PMC8540257 DOI: 10.3390/medicina57101001] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022]
Abstract
Background: Erdheim-Chester disease (ECD) is a rare hematopoietic neoplasm of histiocytic origin characterized by an insidious course. The coronavirus disease 2019 (COVID-19) pandemic has put an enormous strain on healthcare systems worldwide both directly and indirectly, resulting in the disruption of healthcare services to prevent, diagnose and manage non-COVID-19 disease. Case Presentation: We describe the case of a 58-year-old male patient with sporadic episodes of self-resolving mild fever and anemia of chronic disease with onset two years before the current presentation. Positron emission/computed tomography scan revealed the presence of moderately hypermetabolic perirenal tissue masses. In order to achieve diagnosis, repeated perirenal tissue biopsies were performed, and the diagnostic evaluation was complicated by the strain put on the healthcare system by the COVID-19 pandemic. The patient contracted SARS-CoV-2 and required hospitalization, but recovered fully. No further ECD target organ involvement was documented. Treatment options were presented, but the patient chose to defer treatment for ECD. Conclusion: A high index of suspicion and multidisciplinary team collaboration is paramount to achieve diagnosis in rare conditions such as ECD. Disruptions in healthcare services in the pandemic milieu may disproportionately affect people with rare diseases and further study and effort is required to better meet their needs in the pandemic setting.
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Affiliation(s)
- Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
- Correspondence: ; Tel.: +30-231-099-4779
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
| | - Triantafyllia Koletsa
- Department of Pathology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Stylianos Daios
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
| | - Georgios Arsos
- 3rd Department of Nuclear Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece;
| | - Adam Hatzidakis
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Adonis Protopapas
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Center for Research and Technology Hellas, 57001 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.D.); (A.P.); (C.S.)
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Tavakoli M, Roghaee S, Gunturu M, Omuro AM, Lam BL, Mendoza-Santiesteban CE. Erdheim-Chester Disease Presenting With Diplopia: A Challenging Diagnosis With Effective Treatment. J Neuroophthalmol 2021; 41:e324-e325. [PMID: 32956221 DOI: 10.1097/wno.0000000000001076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mehdi Tavakoli
- University of Miami Miller School of Medicine (MT, SR, MG, BLL, CEM-S), Bascom Palmer Eye Institute, Miami, Florida; Department of Ophthalmology and Visual Sciences (MT), University of Alabama at Birmingham, Callahan Eye Hospital, Birmingham, Alabama; Department of Neurology (MG), University of Mississippi Medical Center, Jackson, Mississippi; and Department of Neurology (AMO), University of Miami Miller School of Medicine, Miami, Florida
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Ippolito D, Ragusi M, Maino C, Pecorelli A, Giandola T, Franzesi CT, Sironi S. Erdheim-Chester Disease and Langerhans Cell Histiocytosis: A Case of Overlap Syndrome. Oncologist 2021; 26:e345-e346. [PMID: 33111453 PMCID: PMC7873331 DOI: 10.1002/onco.13579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
Only 500 cases of Erdheim‐Chester disease have been reported in the literature to date. To increase awareness of this rare disease, this letter to the editor describes the unusual case of a woman who was diagnosed with mixed histiocytosis: Erdheim‐Chester disease and Langerhans cell histiocytosis.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Maria Ragusi
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Anna Pecorelli
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Bergamo, BG, Italy
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Brychtová M, Vlachová M, Gregorová J, Krejčí M, Adam Z, Ševčíková S. Erdheim-Chester disease. Klin Onkol 2021; 34:434-439. [PMID: 34911328 DOI: 10.48095/ccko2021434] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Erdheim-Chester disease is a rare inflammatory myeloid clonal disease which is classified into histiocytoses. It is characterized by excessive production and accumulation of foamy histiocytes and Touton giant cells in various tissues and organs. Foamy histiocytes and Touton giant cells produce proinflammatory cytokines and chemokines and contain somatic mutations in genes activating the MAPK/ERK signaling pathway, but also in genes activating the PI3K/AKT signaling pathway. BRAFV600E is the most common somatic mutation. Furthermore, somatic mutations in the MAP2K1, KRAS, NRAS, ARAF or PIK3CA genes are abundant. Erdheim-Chester dis-ease is a multisystemic disease in which any organ can be affected, especially the long bones of the lower extremities, but also the cardiovascular system, retroperitoneum, endocrine system, central nervous system, lungs, skin or orbit. The dia-gnosis is difficult because of the various manifestations of this disease. The disease occurs mainly in adults and is more common in men than in women. Targeted treatment by kinase inhibitors, interferon a, cytokine blockers or cladribine is used for the treatment.
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Ruan GJ, Goyal G, Shah MV, Cohen-Aubart F, Amoura Z, Straetmans N, Benameur N, Haroche J, Go RS. Acute Pancreatitis From Treatment With BRAF Inhibitors in Erdheim-Chester Disease: A Report From 2 Tertiary Referral Centers. Pancreas 2021; 50:e6-e8. [PMID: 33370037 DOI: 10.1097/mpa.0000000000001704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Shekhar S, Sinaii N, Irizarry-Caro JA, Gahl WA, Estrada-Veras JI, Dave R, Papadakis GZ, Tirosh A, Abel BS, Klubo-Gwiezdzinska J, Skarulis MC, Gochuico BR, O’Brien K, Hannah-Shmouni F. Prevalence of Hypothyroidism in Patients With Erdheim-Chester Disease. JAMA Netw Open 2020; 3:e2019169. [PMID: 33119105 PMCID: PMC7596581 DOI: 10.1001/jamanetworkopen.2020.19169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis affecting multiple organs and commonly caused by somatic pathogenic variants in BRAF V600E and mitogen-activated protein kinase genes. Clinical features of ECD result from histiocytic involvement of various tissues; while endocrine involvement in ECD occurs frequently, the prevalence of central or primary hypothyroidism has not been thoroughly investigated. OBJECTIVE To assess hypothalamus-pituitary-thyroid (HPT) dysfunction in patients with ECD. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 61 patients with ECD who were enrolled in a natural history study at a tertiary care center between January 2011 and December 2018. ECD was diagnosed on the basis of clinical, genetic, and histopathological features. Data were analyzed in March 2020. EXPOSURE Diagnosis of ECD. MAIN OUTCOMES AND MEASURES Main outcome was the prevalence of thyroid dysfunction in adults with ECD compared with community estimates. Patients underwent baseline evaluation with a thyroid function test, including thyrotropin, free thyroxine (fT4), and total thyroxine (T4), and sellar imaging with magnetic resonance imaging or computed tomography scan. The association of HPT dysfunction was assessed for differences in age, sex, body mass index, BRAF V600E status, high sensitivity C-reactive protein level, sellar imaging, and pituitary hormonal dysfunction. RESULTS A total of 61 patients with ECD (46 [75%] men; mean [SD] age, 54.3 [10.9] years) were evaluated. Seventeen patients (28%) had hypothyroidism requiring levothyroxine therapy. The prevalence of both central and primary hypothyroidism were higher than community estimates (central hypothyroidism: 9.8% vs 0.1%; odds ratio, 109.0; 95% CI, 37.4-260.6; P < .001; primary hypothyroidism: 18.0% vs 4.7%; OR, 4.4; 95% CI, 2.1-8.7; P < .001). Patients with hypothyroidism (both primary and central), compared with patients with euthyroidism, had higher body mass index (median [interquartile range] 31.4 [28.3-38.3] vs 26.7 [24.4-31.9]; P = .004) and a higher prevalence of panhypopituitarism (7 [47%] vs 3 [7%]; P < .001). Among patients with hypothyroidism, those with central hypothyroidism, compared with patients with primary hypothyroidism, had a lower mean (SD) body mass index (28.3 [2.6] vs 36.3 [5.9]; P = .007) and higher frequencies of abnormal sellar imaging (5 [83%] vs 3 [27%]; P = .050) and panhypopituitarism (5 [83%] vs 3 [27%]; P = .050). CONCLUSIONS AND RELEVANCE In this cohort study, a higher prevalence of central and primary hypothyroidism was identified in patients with ECD compared with the community. There should be a low threshold for testing for hypothyroidism in patients with ECD, and treatment should follow standard guidelines.
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Affiliation(s)
- Skand Shekhar
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Ninet Sinaii
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jorge A. Irizarry-Caro
- Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - William A Gahl
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Rahul Dave
- Inova Fairfax-Virginia Commonwealth University College of Medicine, Falls Church
| | - Georgios Z. Papadakis
- Department of Radiology, Medical School, University of Crete, Heraklion, Greece
- Foundation for Research and Technology Hellas, Computational Biomedicine Laboratory, Heraklion, Greece
| | - Amit Tirosh
- Neuroendocrine Tumor Service, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brent S. Abel
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Joanna Klubo-Gwiezdzinska
- Thyroid Tumors and Functional Thyroid Disorders Section, Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Monica C. Skarulis
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Bernadette R. Gochuico
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Kevin O’Brien
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Fady Hannah-Shmouni
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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37
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Abstract
Erdheim-Chester disease (ECD) is a rare but increasingly recognized multi-system disorder. Its diagnosis and treatment require integration of clinical information, imaging studies, and pathology studies. Of note, ECD can now be defined as a clonal myeloid disorder due to mutations which activate mitogen-activated protein kinase (MAPK) pathways and where an inflammatory milieu is important in the pathogenesis and clinical manifestations of the disease. Biopsy demonstrating characteristic histopathologic features in addition to clinical and radiographic features, most often sclerosing long bone involvement, is required to establish a diagnosis. Detection of somatic MAPK pathway mutations can also assist in the differential diagnosis of ECD and related histiocytic neoplasms. Also, genetic analysis establishing BRAF and RAS mutational status is critical in all ECD patients, as these features will impact therapy with MAPK inhibition. Therapy is recommended at diagnosis in all patients, except for those patients with minimally symptomatic disease. Prospective therapeutic trials are essential to furthering therapeutic progress in ECD.
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Affiliation(s)
- Gordon Starkebaum
- University of Washington, Division of Rheumatology, 1959 NE Pacific St., Box 356428, Seattle, WA, 98195-6428, USA.
| | - Paul Hendrie
- Division of Hematology, University of Washington, 1959 NE Pacific St., Box 358081, Seattle, WA, 98195-6428, USA.
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Delporte G, Delcorde I, Rorive A, Jeugmans A, Moonen M, Koopmansch B, Moonen G, Delvenne P. [Erdheim-Chester disease : a case report]. Rev Med Liege 2020; 75:213-217. [PMID: 32267108] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report the case of a 47-year-old woman with unexplained inflammatory syndrome and asthenia. Imaging findings show bilateral abnormalities of femurs and tibias, suggesting an Erdheim-Chester disease, which is confirmed by a bone marrow biopsy of the left femur. The BRAF V600E mutation is detected, allowing the administration of targeted therapies such as BRAF and MEK inhibitors that lead to the improvement of symptoms.
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Affiliation(s)
- G Delporte
- Service d'Anatomie pathologique, CHU Liège, Belgique
| | | | - A Rorive
- Service d'Oncologie médicale, CHU Liège, Belgique
| | - A Jeugmans
- Service de Rhumatologie, CHU Liège, Belgique
| | - M Moonen
- ) Service de Cardiologie, CHU Liège, Belgique
| | | | - G Moonen
- Professeur ordinaire émérite, ULiège, Belgique
| | - P Delvenne
- Service d'Anatomie pathologique, CHU Liège, Belgique
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Abstract
Erdheim-Chester disease is a rare infiltrative histiocytic disorder with around 800 cases being reported worldwide. Patients most commonly present with skeletal pain, but the condition has been shown to affect multiple other organs. We describe a rare presentation in which the disease infiltrated the sinuses and affected an ex-RAF pilot's vision. After extensive investigation of the elusive diagnosis, repeating of a molecular test using polymerase chain reaction analysis allowed for identification of a mutation (BRAF V600) ultimately leading to the diagnosis of Erdheim-Chester disease.
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Affiliation(s)
- J D E Lee
- Queen Elizabeth Hospital, Birmingham, UK
| | - C Gill
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Muzaffar
- Queen Elizabeth Hospital, Birmingham, UK
| | - S Ahmed
- Queen Elizabeth Hospital, Birmingham, UK
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Ruan GJ, Goyal G, Go RS. 43-Year-Old Man With Polyuria and Bone Pain. Mayo Clin Proc 2020; 95:e13-e18. [PMID: 32029098 DOI: 10.1016/j.mayocp.2019.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/20/2019] [Accepted: 07/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Gordon J Ruan
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Gaurav Goyal
- Fellow in Hematology, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Ronald S Go
- Advisor to resident and fellow and Consultant in Hematology, Mayo Clinic, Rochester, MN.
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Picarsic J, Pysher T, Zhou H, Fluchel M, Pettit T, Whitehead M, Surrey LF, Harding B, Goldstein G, Fellig Y, Weintraub M, Mobley BC, Sharples PM, Sulis ML, Diamond EL, Jaffe R, Shekdar K, Santi M. BRAF V600E mutation in Juvenile Xanthogranuloma family neoplasms of the central nervous system (CNS-JXG): a revised diagnostic algorithm to include pediatric Erdheim-Chester disease. Acta Neuropathol Commun 2019; 7:168. [PMID: 31685033 PMCID: PMC6827236 DOI: 10.1186/s40478-019-0811-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 02/06/2023] Open
Abstract
The family of juvenile xanthogranuloma family neoplasms (JXG) with ERK-pathway mutations are now classified within the "L" (Langerhans) group, which includes Langerhans cell histiocytosis (LCH) and Erdheim Chester disease (ECD). Although the BRAF V600E mutation constitutes the majority of molecular alterations in ECD and LCH, only three reported JXG neoplasms, all in male pediatric patients with localized central nervous system (CNS) involvement, are known to harbor the BRAF mutation. This retrospective case series seeks to redefine the clinicopathologic spectrum of pediatric CNS-JXG family neoplasms in the post-BRAF era, with a revised diagnostic algorithm to include pediatric ECD. Twenty-two CNS-JXG family lesions were retrieved from consult files with 64% (n = 14) having informative BRAF V600E mutational testing (molecular and/or VE1 immunohistochemistry). Of these, 71% (n = 10) were pediatric cases (≤18 years) and half (n = 5) harbored the BRAF V600E mutation. As compared to the BRAF wild-type cohort (WT), the BRAF V600E cohort had a similar mean age at diagnosis [BRAF V600E: 7 years (3-12 y), vs. WT: 7.6 years (1-18 y)] but demonstrated a stronger male/female ratio (BRAF V600E: 4 vs WT: 0.67), and had both more multifocal CNS disease ( BRAFV600E: 80% vs WT: 20%) and systemic disease (BRAF V600E: 40% vs WT: none). Radiographic features of CNS-JXG varied but typically included enhancing CNS mass lesion(s) with associated white matter changes in a subset of BRAF V600E neoplasms. After clinical-radiographic correlation, pediatric ECD was diagnosed in the BRAF V600E cohort. Treatment options varied, including surgical resection, chemotherapy, and targeted therapy with BRAF-inhibitor dabrafenib in one mutated case. BRAF V600E CNS-JXG neoplasms appear associated with male gender and aggressive disease presentation including pediatric ECD. We propose a revised diagnostic algorithm for CNS-JXG that includes an initial morphologic diagnosis with a final integrated diagnosis after clinical-radiographic and molecular correlation, in order to identify cases of pediatric ECD. Future studies with long-term follow-up are required to determine if pediatric BRAF V600E positive CNS-JXG neoplasms are a distinct entity in the L-group histiocytosis category or represent an expanded pediatric spectrum of ECD.
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Affiliation(s)
- J Picarsic
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - T Pysher
- Department of Pathology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - H Zhou
- Department of Pathology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - M Fluchel
- Department of Pediatric Hematology-Oncology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - T Pettit
- Children's Hematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - M Whitehead
- Department of Pathology, Christchurch Hospital, Christchurch, New Zealand
| | - L F Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - B Harding
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - G Goldstein
- Department of Pediatric Hematology-Oncology, Hadassah University Hospital, Jerusalem, Israel
| | - Y Fellig
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - M Weintraub
- Acquired Brain Injury Service, Alyn Pediatric and Adolescent Rehabilitation Hospital, Jerusalem, Israel
| | - B C Mobley
- Department of Pathology, Vanderbilt Hospital, Nashville, USA
| | - P M Sharples
- Department of Pediatric Neurology, Bristol Royal Hospital for Children, Bristol, England
| | - M L Sulis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - E L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Jaffe
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Magee Women's Hospital, Pittsburgh, PA, USA
| | - K Shekdar
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Santi
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Goyal G, Young JR, Koster MJ, Tobin WO, Vassallo R, Ryu JH, Davidge-Pitts CJ, Hurtado MD, Ravindran A, Sartori Valinotti JC, Bennani NN, Shah MV, Rech KL, Go RS. The Mayo Clinic Histiocytosis Working Group Consensus Statement for the Diagnosis and Evaluation of Adult Patients With Histiocytic Neoplasms: Erdheim-Chester Disease, Langerhans Cell Histiocytosis, and Rosai-Dorfman Disease. Mayo Clin Proc 2019; 94:2054-2071. [PMID: 31472931 DOI: 10.1016/j.mayocp.2019.02.023] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 12/25/2022]
Abstract
Histiocytic neoplasms, a rare and heterogeneous group of disorders, primarily include Erdheim-Chester disease, Langerhans cell histiocytosis, and Rosai-Dorfman disease. Due to their diverse clinical manifestations, the greatest challenge posed by these neoplasms is the establishment of a diagnosis, which often leads to a delay in institution of appropriate therapy. Recent insights into their genomic architecture demonstrating mitogen-activated protein kinase/extracellular signal-regulated kinase pathway mutations have now enabled potential treatment with targeted therapies in most patients. This consensus statement represents a joint document from a multidisciplinary group of physicians at Mayo Clinic who specialize in the management of adult histiocytic neoplasms. It consists of evidence- and consensus-based recommendations on when to suspect these neoplasms and what tests to order for the diagnosis and initial evaluation. In addition, it also describes the histopathologic and individual organ manifestations of these neoplasms to help the clinicians in identifying their key features. With uniform guidelines that aid in identifying these neoplasms, we hope to improve the awareness that may lead to their timely and correct diagnosis.
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Affiliation(s)
- Gaurav Goyal
- Division of Hematology, Mayo Clinic, Rochester, MN.
| | | | | | | | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Maria D Hurtado
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN.
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Affiliation(s)
- Alexander Poellinger
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Joris Hrycyk
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Universitatsspital Bern, Bern, Switzerland.
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Sánchez-Villalobos JM, Jimeno-Almazán A, López-Peña C, Hernández-Hortelano E, Martínez-Francés A, Pérez-Vicente JA. Erdheim-Chester disease mimicking multiple sclerosis or a new association? Mult Scler Relat Disord 2019; 30:94-97. [PMID: 30743087 DOI: 10.1016/j.msard.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 02/07/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis that presents potential impairment of the central nervous system (CNS). Frequent CNS impairment makes ECD a disease worth considering in the differential diagnosis of multiple sclerosis (MS). We report the case of a patient initially diagnosed with relapsing-remitting MS with an atypical course who developed ECD during the disease progression. Given the patient's clinical-radiological characteristics, two diagnostic possibilities were proposed: the coexistence of both diseases or a new presentation of ECD mimicking MS. We conducted a literature review, analyzing the various diagnostic and therapeutic possibilities.
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Affiliation(s)
| | - Amaya Jimeno-Almazán
- Department of Internal Medicine, Santa Lucía University Hospital, Cartagena, Spain
| | - Carmen López-Peña
- Department of Pathological Anatomy, Santa Lucía University Hospital, Cartagena, Spain
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Zhao AL, Wang YN, Wang FD, Niu N, Sun J, Mao YY, Zhou DB, Li J, Cao XX. Successful Treatment of Erdheim-Chester Disease With Coronary Artery Involvement. Can J Cardiol 2018; 34:1688.e9-1688.e11. [PMID: 30527170 DOI: 10.1016/j.cjca.2018.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis and inflammatory myeloid neoplasm with poor prognosis. Symmetric long bone osteosclerosis occurs in nearly all patients, but other organs are often involved. Coronary artery involvement is rare, but was encountered in a patient who experienced angina. Radiologic presentation and histologic findings were consistent with diagnosis of ECD. A soft-tissue mass was found surrounding the right atrium, ascending aorta, and all branches of coronary artery. Interferon-alfa treatment was successful. In conclusion, we recommend coronary artery computed tomography angiography for cardiovascular evaluation of ECD and interferon-alfa to treat ECD.
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Affiliation(s)
- Ai-Lin Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng-Dan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Niu
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Sun
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ying Mao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Alokaily F, Alkathiri R. A 36-year-old man with arthralgia and bone pain. Saudi Med J 2018; 39:951-953. [PMID: 30251741 PMCID: PMC6201017 DOI: 10.15537/smj.2018.9.23589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
[No abstract available].
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Affiliation(s)
- Fahdah Alokaily
- Division of Rheumatology, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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47
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Chertok Shacham E, Ishay A. Central Diabetes Insipidus as an Early Presentation of Erdheim-Chester Disease. Isr Med Assoc J 2018; 20:586-587. [PMID: 30221876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Elena Chertok Shacham
- Endocrinology and Diabetes Unit, Emek Medical Center, Afula, Israel
- Department of Internal Medicine E, Emek Medical Center, Afula, Israel
| | - Avraham Ishay
- Endocrinology and Diabetes Unit, Emek Medical Center, Afula, Israel
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Tomelleri A, Cavalli G, De Luca G, Campochiaro C, D’Aliberti T, Tresoldi M, Dagna L. Treating Heart Inflammation With Interleukin-1 Blockade in a Case of Erdheim-Chester Disease. Front Immunol 2018; 9:1233. [PMID: 29910817 PMCID: PMC5992291 DOI: 10.3389/fimmu.2018.01233] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 02/03/2018] [Accepted: 05/16/2018] [Indexed: 12/30/2022] Open
Abstract
Pericarditis is an inflammatory heart disease, which may be idiopathic or secondary to autoimmune or auto-inflammatory diseases and often leads to severe or life-threatening complications. Colchicine and non-steroidal anti-inflammatory drugs represent the mainstay of treatment, whereas use of corticosteroids is associated with recurrence of disease flares. While effective and safe anti-inflammatory therapies remain an unmet clinical need, emerging clinical and experimental evidence points at a promising role of inhibition of the pro-inflammatory cytokine interleukin-1 (IL-1). We thus evaluated treatment with the IL-1 receptor antagonist anakinra in a case of extremely severe pericarditis with cardiac tamponade and heart failure secondary to Erdheim-Chester disease (ECD), a rare clonal disorder of macrophages characterized by rampant inflammation and multiorgan involvement. A 62-year-old man was admitted to the Emergency Department with severe pericardial effusion requiring the creation of a pleuro-pericardial window. A whole-body contrast-enhanced computed tomography pointed at a diagnosis of ECD with involvement of the heart and pericardium and of the retroperitoneal space. Over the following days, an echocardiography revealed a closure of the pleuro-pericardial window and a relapse of the pericardial effusion. Treatment with anakinra, the recombinant form of the naturally occurring IL-1 receptor antagonist, was started at a standard subcutaneous dose of 100 mg/day. After 2 days, we observed a dramatic clinical improvement, an abrupt reduction of the inflammatory markers, and a reabsorption of the pericardial effusion. Anakinra was maintained as monotherapy, and the patient remained asymptomatic in the absence of disease flares for the following year. Recent studies point at inhibition of IL-1 activity as an attractive treatment option for patients with refractory idiopathic recurrent pericarditis. Anakinra treatment may also have a role in patients with pericarditis in the setting of systemic inflammatory disorders, such as ECD.
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Affiliation(s)
- Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Teresa D’Aliberti
- Department of Internal Medicine and Advanced Therapies, San Raffaele Hospital (IRCCS), Milan, Italy
| | - Moreno Tresoldi
- Department of Internal Medicine and Advanced Therapies, San Raffaele Hospital (IRCCS), Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
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Özden F, Schinke S, Thorns C, Eckey T, Dalhoff K, Münte TF, Tronnier V, Humrich JY, Riemekasten G, Lamprecht P. Detection of anti-neutrophil cytoplasmic and antinuclear autoantibodies favouring misdiagnoses in 5 cases of Erdheim-Chester disease. Clin Exp Rheumatol 2018; 36 Suppl 111:176. [PMID: 29652657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/19/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Filiz Özden
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Germany.
| | - Susanne Schinke
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Germany
| | - Christoph Thorns
- Institute for Pathology, Cath. Mary's-Hospital, Hamburg, Germany
| | - Thomas Eckey
- Institute for Neuroradiology, University of Lübeck, Germany
| | - Klaus Dalhoff
- Department of Internal Medicine III - Pulmonology, University of Lübeck, Germany
| | | | | | - Jens Y Humrich
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Germany
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Germany
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50
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Mehdi ME, Regragui S, Eddou H, Jennane S, Maaroufi HE, Doghmi K, Mikdame M. Erdheim-Chester disease: a rare histiocytosis (case report and review of the literature). Pan Afr Med J 2018; 29:62. [PMID: 29875943 PMCID: PMC5987095 DOI: 10.11604/pamj.2018.29.62.4088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 11/25/2014] [Indexed: 11/25/2022] Open
Abstract
We report a case of Erdheim-chester disease, a rare non-langerhans histiocytosis revealed by polydipsia-polyuria syndrome in a 26 years old woman, trated by interferon with a good response.
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Affiliation(s)
- Mahtat El Mehdi
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Safae Regragui
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Hicham Eddou
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Selim Jennane
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Hicham El Maaroufi
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Kamal Doghmi
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Mohamed Mikdame
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
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