Langerhans cell histiocytosis mimicking lichen nitidus with bone involvement

Abstract

We report the case of a 6-month-old Hispanic boy with a 4-month history of widespread pruritic hypopigmented papules mimicking lichen nitidus. The final diagnosis was multisystem non-risk-organ Langerhans cell histiocytosis (LCH), with cutaneous and multiple bone involvement. With this patient and others previously reported in the literature, we suggest an early biopsy of the hypopigmented rash in children.

Cutaneous Langerhans cell histiocytosis presenting with hypopigmented lesions: Report of two cases and review of literature

“…The majority of reported patients had darker skin types, similar to our patients (Table ). There are few case reports of hypopigmented macules or papules as the initial presentation of LCH . In 1 case report, hypopigmented lesions were seen during an episode of recurrence of congenital self‐healing reticulohistiocytosis .…”

“…The hypopigmented presentation of LCH may indicate a better prognosis, with 8 of 13 reported cases spontaneously resolving (see Table ). At the same time, although LCH limited to cutaneous involvement tends to resolve on its own, a few of the previously published cases of hypopigmented LCH reported additional organ involvement, and some children were treated with vinblastine and prednisone . Infants with cutaneous LCH require close surveillance with follow‐up to assess development of multisystemic disease …”

“…They have been described after resolution of active lesions in congenital self‐healing reticulohistiocytosis . Few case reports have described hypopigmented macules as an initial presentation of the disease . We report 2 cases of the hypopigmented variant of LCH and review the literature on this rare clinical presentation.…”

Langerhans cell histiocytosis in an adult female with atypical swellings

“…Many unusual presentations have been reported like diffuse molluscum contagiosum-like umbilicated papules, ulcerative plaque and those mimicking lichen nitidus. [5][6][7] Our patient had pleomorphic lesions later proved to be of histiocytic origin, with the typical papules and crusts in seborrheic distribution and the atypical large swelling at the nape of the neck. The uncommon presentation and the rarity of the condition in adults caused it to evade detection for months.…”

Langerhans cell histiocytosis presenting like lichen planus in a 4-month-old infant

“…LCH is a rare disease that occurs in childhood. 1 The clinical picture varies from SeS unifocal bone or skin disease to disseminated disease. While cutaneous involvement is observed in only 10% of children with SeS LCH, the incidence of cutaneous involvement is significantly higher in children with multisystem disease (53%).…”