Langerhans cell histiocytosis in a newborn

A full-term female baby was admitted to our hospital at the postnatal age of 37 days with generalized vesiculopapular, crateriform skin lesions. Physical examination revealed a well-nourished baby without fever, hepatosplenomegaly or lymphadenopathy. Laboratory examination was normal except for thrombocytosis (platelet count, 970 x 10(3)/microL). All studies for herpes simplex virus, including culture, polymerase chain reaction and IgM, were negative except for an antigen test from the vesicles for herpes simplex virus type 1, which was positive. Chest X-ray showed increased reticulogranular infiltration over bilateral lung fields and some osteolytic lesions at the left parietal bone. Skin biopsy revealed infiltration of Langerhans cells and eosinophils, plus positive CD1a and S-100 stains. The diagnosis was reconfirmed by a second hospital and chemotherapy was given. In this case report, the differential diagnoses of neonatal vesiculopapular skin lesions, and the classification and outcome of neonatal Langerhans cell histiocytosis are presented.