American Journal of Medical Case Reports
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American Journal of Medical Case Reports. 2016, 4(8), 293-295
DOI: 10.12691/ajmcr-4-8-9
Open AccessCase Report

Histiocytosis with Pulmonary Involvement Mimicking Rheumatoid Arthritis

Imene Boukhris1, , Hana Zoubaidi1, Ines kechaou1, Eya Chérif1, Ines mahmoud2, Anis Hariz1, Nédia Znaidi3 and Narjes Khalfallah1

1Internal Medicine Department, University Hospital of Charles Nicolle, Tunis, Tunisia

2Rheumatology Department, University Hospital of Charles Nicolle, Tunis, Tunisia

3Department of Diagnostic Pathology, University Hospital of Charles Nicolle, Tunis, Tunisia

Pub. Date: September 14, 2016

Cite this paper:
Imene Boukhris, Hana Zoubaidi, Ines kechaou, Eya Chérif, Ines mahmoud, Anis Hariz, Nédia Znaidi and Narjes Khalfallah. Histiocytosis with Pulmonary Involvement Mimicking Rheumatoid Arthritis. American Journal of Medical Case Reports. 2016; 4(8):293-295. doi: 10.12691/ajmcr-4-8-9

Abstract

In Langerhans cell histiocytosis pulmonary involvement is often isolated. It is rarely a part of a multifocal form. Tenosynovitis is exceptional. Hand bones involvement is atypical. We report the case of a 75-year-old, non-smoker man, without medical history, who presented with arthritis and fever. Examination found arthritis affecting large and small joints. In biology, there was an inflammatory syndrome. Radiographs of the hands showed erosions of the carpal bones. Doppler ultrasonography of the hands showed active synovitis. Tc99 bone scintigraphy highlighted joint uptake in the hands, knees, spine and right upper jaw. Blood cultures and infectious investigations were negative. Anti-nuclear antibodies and rheumatoid factor were negatives. CT scan showed cystic lung lesions and nodular aspect. Bronchoalveolar lavage fluid revealed positivity of anti-CD1a at 6%. A surgical biopsy showed an infiltrate of eosinophilic cells, positive for CD1a in immunohistochemistry studies. The diagnosis of Langerhans cell histiocytosis was retained.

Keywords:
langerhans cell histiocytosis lung arthritis synovitis bronchoalveolar lavage

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References:

[1]  Arico M, Egeler RM. Clinical aspects of Langerhans cell histiocytosis. Hematol Oncol Clin North Am 1998;12: 247-58.
 
[2]  Glajchen N, Springfield DA, Lipton JM. Langerhans’ cell histiocytosis of the synovium. Am J Roentgenol 1997;169:1751-2.
 
[3]  Santilli D, Lo Monaco A, Cavazzini PL, Trotta F. Multicentric reticulohistiocytosis: a rare cause of erosive arthropathy of the distal interphalangeal finger joints. Ann Rheum Dis 2002;61(6):485-7.
 
[4]  Tazi A. Adult pulmonary Langerhans' cell histiocytosis. Eur Respir J 2006;27:1272-85.
 
[5]  Harpreet S Suri, Eunhee S Yi, Gregorz S Nowakowski, Robert Vassallo. Pulmonary langerhans cell histiocytosis. Orphanet J Rare Dis 2012;7: 16.
 
[6]  Cheng-Wei Li, Man-Hui Li, Jiang-Xiong Li, Ru-Jia Tao, Jin-Fu Xu, Wei-Jun Cao. Pulmonary Langerhans cell histiocytosis: analysis of 14 patients and literature review. J Thorac Dis. 2016;8: 1283-9.
 
[7]  Casolaro MA, Bernaudin JF, Saltini C, Ferrans VJ, Crystal RG. Accumulation of Langerhans’cells on the epithelial surface of the lower respiratory tract in normal subjects in association with cigarette smoking. Am Rev Respir Dis 1988;137:406-11.
 
[8]  Mendez JL, Nadrous HF, Vassalo R, Decker PA, Ryu JH. Pneumothorax in pulmonary Langerhans' cell histiocytosis. Chest 2004;125:1028-32.