[Langerhans cell histiocytosis in the elderly]

Area of Science:

• Oncology
• Dermatology
• Pathology

Background:

• Langerhans-cell-histiocytosis (LCH) is a rare myeloid neoplasm.
• LCH predominantly affects children aged 1-3 years, with adult and elderly cases being exceedingly rare.
• The clinical course of LCH is variable, ranging from acute to chronic, with potential for spontaneous remission.

Observation:

• A 73-year-old female presented with a 3.5-year history of chronic, stationary LCH, initially involving skin and liver.
• The patient experienced a cutaneous relapse with more disseminated disease, including the external auditory meatus, after initial response to etoposide.
• Subsequent treatment with topical nitrogen mustard and thalidomide showed improvement, despite noted adverse reactions.

Findings:

• The patient's LCH remained systemically stable for one year after initial treatments.
• Acute dissemination of LCH occurred subsequently, leading to the patient's death within four weeks.
• This case underscores the unpredictable trajectory of LCH, even in elderly individuals with chronic disease.

Implications:

• LCH prognosis in the elderly is challenging due to its unpredictable course and potential for rapid dissemination.
• Therapeutic strategies for LCH must be tailored to the individual patient's current disease status and organ involvement.
• Close monitoring and careful assessment of commonly affected organs are crucial for managing LCH in elderly patients.