Reddish-Brown Nodules and Papules in an Elderly Man

Abstract

A man in his 70s with a 4-year history of stage IV chronic lymphocytic leukemia (CLL) presented with a 12-month history of an asymptomatic skin eruption. His CLL had been in remission for 2 years after treatment with fludarabine and rituximab before he relapsed and underwent 6 cycles of RCHOP treatment (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). During his CLL relapse, he developed cutaneous nodules on his face that then spread diffusely. The patient denied fevers, arthralgias, bone pain, polydipsia, or polyuria. Physical examination revealed multiple 0.5-to 1.5-cm reddish-brown firm papules and nodules on his cheeks, torso, buttocks, and extensor surfaces of his extremities (Figure, A), sparing his eyelids, palms, soles, and mucous membranes. Triglyceride levels were mildly elevated at 211 mg/dL; otherwise the patient's lipid levels were normal (to convert triglycerides to millimoles per liter, multiply by 0.0113). A biopsy of a representative papule on the thigh was performed, and a routine hematoxylin-eosinstained section (Figure, B) and CD68 immunohistochemically stained section (Figure, C) are shown. Findings of CD1a and S100 stainings were negative.

Progressive nodular histiocytosis: an unusual disorder

“…Ablative lasers like carbon dioxide and excimer have been used for nodules but recurrence within the scars was observed. Multiple sessions of cryotherapy for papules have been tried and may be a good treatment option for localized and small lesions [4,6,13]. Our patient had favorable results with cryotherapy for papules and excellent cosmetic results after surgical resection of nodules.…”

“…Treatment for PNH is difficult and an effective one is not yet available. Excisional surgery for nodules that may cause disfigurement or impairment is recommended, but recurrences are not uncommon [5,13]. Ablative lasers like carbon dioxide and excimer have been used for nodules but recurrence within the scars was observed.…”

“…Electrodesiccation and curettage of disfiguring lesions has been reported in a pediatric patient with satisfactory cosmetic results [2]. Systemic chemotherapeutic agents like vincristine, cyclophosphamide, and prednisolone have been tried without success [4,13]. Oral methotrexate (15mg once/week) was reported successful in one case with complete resolution of lesions and symptoms after six months.…”

“…Long-term follow up of patients with a multidisciplinary approach is recommended to prevent complications. New onset of PNH in a patient with cancer history could indicate recurrence of the malignancy [13].…”

Treatment of Progressive Nodular Histiocytosis With Baricitinib

“…Progressive nodular histiocytosis (PNHC) is an extremely rare non-Langerhans cell histiocytosis characterized by hundreds of yellow-brown papules and nodules without spontaneous resolution. 1,2 To our knowledge, few cases of PNHC have been reported, and treatment is often unsuccessful. Surgical resection and electrodesiccation are often used to treat disfiguring and dysfunctional bulky masses, but the lesions tend to re- cur.…”