Unusual digital nodules. Multicentric reticulohistiocytosis (MRH)

Moreau, E.; Truchetet, F.; Friedel, Jürgen K.; Grandidier, Marie-Hélène; Cuny, J.-F.

doi:10.1001/archderm.128.6.847b

Cited by 12 publications

(14 citation statements)

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“…The mean age of onset is between the fourth and [1,6,7]. The polyarthritis tends to be symmetrical, progressively destructive, and commonly involves the IP joints followed by knees, wrists, hips, ankles, elbows and spine.…”

Section: Discussionmentioning

confidence: 99%

“…The polyarthritis tends to be symmetrical, progressively destructive, and commonly involves the IP joints followed by knees, wrists, hips, ankles, elbows and spine. Morning stiffness is usually present, and common involvement of the DIP joints helps distinguish MR from RA [1,6,7]. Skin eruptions usually consist of copper to pink to reddishbrown papulo-nodules characteristically involving the dorsum of the fingers and nail folds.…”

Section: Discussionmentioning

confidence: 99%

“…Constitutional symptoms including weight loss, myalgias, weakness, and fever may occur. Routine laboratory data are usually nonspecific; nevertheless, elevated ESR and anemia are seen in 12-30% of patients [1,6,7]. There are no specific diagnostic tests for MR; diagnosis is made based on clinical and histological findings.…”

Section: Discussionmentioning

confidence: 99%

“…The most common clinical findings include pink to reddish-brown skin nodules and destructive polyarthritis [1,7]. Up to 25% of patients have associated malignancies, and in some cases the diagnosis of MR may precede the diagnosis of cancer [2,9].…”

Section: Introductionmentioning

confidence: 99%

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Malignancy-associated multicentric reticulohistiocytosis

et al. 2009

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Multicentric reticulohistiocytosis (MR) is a rare systemic disorder of unknown etiology. Up to 25% of patients with MR have associated malignancies. We are reporting a case of a patient with MR who initially had an excellent clinical response to oral methotrexate and prednisone. Subsequent attempts of prednisone taper failed because of disease flare-up. Workup for associated malignancy revealed localized squamous cell carcinoma of the lung. The tumor was resected; methotrexate and prednisone were tapered and discontinued with complete remission of MR. A review of literature and the new advances and treatment modalities for MR is provided.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Malignancy-associated multicentric reticulohistiocytosis

et al. 2009

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“…It usually affects women in the fourth decade of life (60-75%). 6,7 In approximately 45% of patients, polyarthritis is the presenting symptom, followed by cutaneous lesion. In 25% of patients, as with our patient, skin eruption is the initial symptom, and in 30% of patients, the symptoms appear simultaneously.…”

Section: Reportmentioning

confidence: 99%

Multicentric reticulohistiocytosis with lungs and liver involved

Yang

Ding

Deng

2009

Clinical and Experimental Dermatology

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We describe a 56-year-old man with a 2-year history of papulonodules, pruritic and painful on palpation, on the head, trunk, limbs, buttocks and scrotum and a 1.5-year history of rheumatoid arthritis-like joint changes. Biopsies from the nodules on the head and left elbow revealed multinucleated giant cells with eosinophilic 'ground-glass' cytoplasm. Computed tomography revealed that there were scattered nodules in the liver and both lungs. Biopsies taken from nodules in the right lung and liver were consistent with multicentric reticulohistiocytosis. The widely scattered cutaneous papulonodules and the generalized systemic involvement make this patient interesting, and the condition should be differentiated from other diseases in clinicopathological practice.

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Complete remission of multicentric reticulohistiocytosis with combination therapy of steroid, cyclophosphamide, and low‐dose pulse methotrexate. Case report, review of the literature, and proposal for treatment

Liang

Granston

1996

Arthritis & Rheumatism

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We describe a patient with multicentric reticulohistiocytosis in whom complete remission was achieved by sequential combination therapy with steroid, methotrexate, and cyclophosphamide. We reviewed all cases of complete or near-complete remissions of multicentric reticulohistiocytosis reported in the English-language literature and propose a new drug regimen for this rare but potentially disabling disease.Multicentric reticulohistiocytosis is a rare systemic disorder of unknown etiology, characterized by tissue infiltration by histiocytes and multinucleated giant cells. It primarily affects skin, mucous membrane, and joints. Fewer than 200 cases have been reported since the original report by Targett (1,2). The term "multicentric reticulohistiocytosis" was proposed in 1954 by Golts and Laymon (3), and has become widely accepted. Complete remission of the disease has been reported in association with treatment with alkylating agents (4) or methotrexate (5,6) in resistant cases. Herein we describe a patient whose complete remission was achieved by treatment with a combination of steroid, methotrexate, and cyclophosphamide.George C. Liang, MD: Northwestern University Medical School, Chicago, Illinois; Arthur S. Granston CASE REPORTThe patient, a 66-year-old woman, presented in May 1989 with a 6-month history of polyarthritis and a 6-week history of widespread mucocutaneous nodules. Her earlier medical history included hypertension, glaucoma, and stable multiple sclerosis. The arthritis involved her knees, wrists, proximal interphalangeal joints, and metacarpophalangeal joints, in a symmetric pattern. The nodules varied in size (2-20 mm in diameter) and covered all fingers, the forearms, elbows, knees, nasal septum, and tongue. Classic "coral beads" were observed around all nailfolds. Red, confluent, nonpruritic papules were seen on the anterior area of the neck, the upper chest, and the back. Xanthelasmas were noted on both upper eyelids.Laboratory findings were all normal except for elevation of cholesterol levels (cholesterol 244 mg/dl, triglycerides 134 mg/dl, high-density lipoprotein 59 mg/dl, low-density lipoprotein 174 mg/dl). Testing for both rheumatoid factor and antinuclear antibodies yielded negative results. Biopsy of the nodule on the right elbow revealed full-thickness infiltration of the dermis by a dense proliferation of histiocyte-like cells in compact sheets and irregular clusters, with more loosely dispersed cells interspersed between the dermal collagen bundles. The cells were moderately large, oval, polygonal, or slightly elongated, and predominantly mononuclear, generally 10-25 pm in diameter. Multinucleated cells were common, usually containing 2-4 nuclei and rarely, up to 30 nuclei. The nuclei were round-to-oval and slightly pleomorphic, usually 8-14 pm in diameter and uncommonly up to 20 pm, without hyperchrornasia and with small nucleoli. Cytoplasm

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Unusual digital nodules. Multicentric reticulohistiocytosis (MRH)

Cited by 12 publications

References 0 publications

Malignancy-associated multicentric reticulohistiocytosis

Malignancy-associated multicentric reticulohistiocytosis

Multicentric reticulohistiocytosis with lungs and liver involved

Complete remission of multicentric reticulohistiocytosis with combination therapy of steroid, cyclophosphamide, and low‐dose pulse methotrexate. Case report, review of the literature, and proposal for treatment

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