Intralymphatic histiocytosis following placement of a metal implant

Abstract

Intralymphatic histiocytosis (IH) is a rare condition first reported in 1994 by O'Grady et al. Less than 40 cases have been reported, with the majority occurring in patients with rheumatoid arthritis. We present a case of a 72-year-old man who developed an asymptomatic rash on his left upper arm 3 years after placement of a metal implant to stabilize a fractured humerus. Examinations revealed a poorly demarcated erythematous to brown indurated plaque with a pebbly surface overlying the inferior portion of the surgical scar. Biopsy revealed a mixed dermal infiltrate with a complex glomeruloid intravascular accumulation of histiocytes and neutrophils. Histiocytes were identified with immunostaining for CD68. Immunostains for CD31 and D2-40 confirmed the intravascular location of the histiocytes. This reactive process is closely related to reactive angioendotheliomatosis, but is best classified as IH. This is the only case of IH reported in association with a metal implant of the upper arm and the fourth case reported in association with a metal implant. Although the pathogenesis of IH is unknown, a role for lymphatic stasis secondary to chronic inflammation or surgery has been suggested. This is a benign process with a chronic course, and there are no known efficacious treatments.

Pressure Bandage as an Effective Treatment for Intralymphatic Histiocytosis Associated with Rheumatoid Arthritis

“…Thus, it should be noted that intralymphatic histiocytosis occurs not only by association with RA, but also with other lymphostatic conditions like breast cancer and joint replacement. Grekin et al [7] and Rossari et al [8] also reported cases with metal implantation. In 2011, Sakaguchi et al [9] reported a case of intralymphatic histiocytosis that was improved by the use of anti-TNFα treatment.…”

Klinik und Histologie Metallimplantat-assoziierter Hauterscheinungen

“…Das histologische Bild zeigt erweiterte, dünnwandige Gefäße in der retikulären Dermis, die mit ortsständi-gen Histiozyten mit hellem Zytoplasma, vesikulärem, nierenförmigem Zellkern sowie mit Neutrophilen und Lymphozyten ausgefüllt sind. Perivaskuläre Plasmazellen und Lymphozyten sind oft auffindbar [7].…”

Klinische und diagnostische Herausforderungen der Metallimplantatallergie am Beispiel orthopädisch-chirurgischer Implantate

“…Ebenfalls selten wurden Hauteinblutung im Sinne einer Vaskulitis oder Urtikaria durch Metallimplantate beschrieben [31]. Die histologische Untersuchung von implantatassoziierten lokalen Hauterscheinungen ist anzustreben, um seltenere Konstellationen wie retikuläre Erytheme [34] oder eine intralymphatische Histiozytose [35] [37]. Andererseits konnte bei Versagen nichtzementierter M-o-M-Hü endoprothetik die mögliche Relevanz einer Metallallergie in Zusammenschau mit periimplantärer Histologie erhärtet werden [33].…”