Langerhans Cell Histiocytosis Presenting as Uncontrolled Asthma

Abstract

Langerhans cell histiocytosis (LCH) is an uncommon disorder affecting primarily young adult smokers. It is characterized by abnormal proliferation of Langerhans cells, specialized monocyte-macrophage lineage antigen-presenting cells. LCH can affect the lungs in isolation or as part of a systemic disease. Most commonly, the disease presents in the third or fourth decade without gender predominance. Symptoms typically include dyspnea and cough. Commonly, physical examination is unremarkable but cor pulmonale may be observed in advanced disease. The chest radiograph is typically abnormal with nodular or interstitial infiltrates and cystic changes. High-resolution computed tomography of the chest with these findings in the middle and upper lobes of an adult smoker is virtually diagnostic of LCH. Pulmonary function assessment is variable. Asthma has rarely been reported in association with this disorder. There are only three reported cases of the diagnosis of concomitant asthma which have been made in association with the diagnosis of LCH. We present a case in which our patient presented with signs and symptoms of asthma to include confirmatory findings of airway hyperresponsiveness. The diagnosis of LCH was established after the patient failed to respond to conventional treatment for asthma, and further evaluation was completed.

Asthma-like attacks terminated by slow pathway ablation

“…To the best of our knowledge, this is the first case of SVT patient mimicking symptoms of asthma, in the literature. It is well known from the previous reports that asthma attacks resistant to treatment can be the manifestation of diseases such as foreign body aspiration,[ 5 ] pulmonary artery venous malformation,[ 6 ] allergic bronchopulmonary aspergillosis,[ 7 ] Langerhans cell histiocytosis,[ 8 ] and severe mitral stenosis. [ 9 ] Due to the comorbid diseases such as heart failure, panic disorder, obesity, coronary artery disease (CAD), or chronic obstructive pulmonary disease in the elderly, asthma attacks can be drawn with other pulmonary or nonpulmonary diseases.…”