Multicentric reticulohistiocytosis in a Malaysian Chinese lady: A case report and review of literature

Department of Dermatology, Sarawak General Hospital, Sarawak, Malaysia.
Dermatology online journal 02/2009; 15(1):2.
Source: PubMed


A 36-year-old Malaysian woman with erosive arthritis presented with multiple asymptomatic skin colored papulonodules on the hands, elbows, knees, ears, and feet; many macules, papules, and plaques were photodistributed. Progressive, erosive arthritis began about 18 months after the onset of skin involvement. Initially the patient was diagnosed to have dermatomyositis due to her skin findings, but later proved to have multicentric reticulohistiocytosis based on the typical histopathological features of histiocytic multinucleated giant cells with eosinophilic ground glass cytoplasm on skin biopsy. Workup for associated diseases including malignancies was negative. Her skin lesions and joint pain responded to treatment with methotrexate and prednisolone.

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    ABSTRACT: Multicentric reticulohistiocytosis (MRH) is a rare form of non-Langerhans histiocytosis that presents with erosive arthritis and skin nodules. Approximately 25% of patients with MRH have an associated malignancy. Dermatomyositis is an inflammatory autoimmune condition that has also been associated with malignancy. To date, 7 cases of MRH have been reported to present with cutaneous features of dermatomyositis. We describe an eighth patient with MRH who presented with dermatomyositis-like features (V-neck erythema, shawl sign, Gottron's papules and periungual erythema), who developed metastatic breast cancer 1 year after diagnosis. We hypothesized that clinical overlap between MRH and dermatomyositis was not as uncommon as review of the literature suggested. Careful review of the physical exam findings and photographs of the 234 papers reporting MRH revealed 27 cases of MRH with dermatomyositis-like features. Of these 27 cases, 7 (26%) were associated with a malignancy. Skin biopsies of the cutaneous features mimicking dermatomyositis revealed pathologic features of MRH. This is a descriptive analysis of published case reports. Based on a review of published case reports, MRH presenting with dermatomyositis-like features is likely fairly common. Histological examination of skin biopsies allows for disease differentiation. Differentiating MRH from dermatomyositis is important for management decisions and comorbidity screening.
    No preview · Article · May 2011 · Dermatology
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    ABSTRACT: A 47-year-old woman had noticed scattered erythema on the forehead about two years previously. These skin eruptions gradually extended to the whole face, neck and forearms with multiple nodules on her hands, accompanied by arthralgia. At her first visit to our hospital, a physical examination revealed aggregated red papules, 3-4 mm in size, on the face, auricles and neck, and small erythemal patches scattered on the forearms. Small brownish red nodules were present on the fingers with the joints swelling. Arthritis of both shoulders and hip joints were observed by computed tomography, and an X-ray roentgenogram showed arthritis of multiple finger joints. A histopathological examination of a skin nodule revealed a diffuse infiltration of histiocyte-like cells with eosinophilic and ground-glass like cytoplasm in the dermis. Multinucleated histiocytes were positive for CD68 and CD10. We diagnosed this case as multicentric reticulohistiocytosis based upon these findings. No evidence suggesting internal malignancy was observed. The patient was treated with oral prednisolone 20 mg/day in combination with oral methotrexate 6 mg/week, which stopped the progression of the arthritis and gradually improved the skin eruptions.
    No preview · Article · Jan 2012 · Nishi Nihon Hifuka
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    ABSTRACT: Multicentric reticulohistiocytosis is a rare systemic disease of unknown etiology. It is characterized by erosive arthritis and skin lesions. Diagnosis and treatment should be performed early to avoid sequelaes. We report the case of a 67-year-old man diagnosed with multicentric reticulohistiocytosis and left hip arthorplasty. The patient consulted for local pain in his left leg. Final diagnosis was left prosthetic dislocation. During admission, a bone scintigraphy with (99m)Tc-HDP and scintigraphy with (67)Ga-citrate was performed, showing no evidence of inflammatory activity in pelvis that contraindicating surgery. Besides it showed bilateral uptake in soft tissue of large joints compatible with persistent inflammatory activity secondary to multicentric reticulohistiocytosis. In this case scintigraphy with (67)Ga-citrate, is a useful tool to assess the recovery and extent of disease.
    No preview · Article · Dec 2012
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