Histiocytosis with Pulmonary Involvement Mimicking Rheumatoid Arthritis

Imene Boukhris^1, , 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

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

Copyright

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