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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(02): e43-e47
DOI: 10.1055/s-0044-1786360
Case Report

Langerhans Cell Histiocytosis Mimicking a Meningeal Lesion with Temporal Bone and Muscle Compromise in an Adult Patient: A Case Report

Alejandro Durán-Ojeda 
1   Department of Neurosurgery, NeuroAxis SAS, Bogotá, Colombia
2   Department of Clinical Epidemiology and Biostatics, Universidad de los Andes, Bogotá, Colombia
,
Jefferson Arce
1   Department of Neurosurgery, NeuroAxis SAS, Bogotá, Colombia
,
Santiago Campos-Fajardo 
1   Department of Neurosurgery, NeuroAxis SAS, Bogotá, Colombia
,
Lorena Jacomussi-Alzate
1   Department of Neurosurgery, NeuroAxis SAS, Bogotá, Colombia
3   Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
,
Cristhian Rincón-Carreño 
1   Department of Neurosurgery, NeuroAxis SAS, Bogotá, Colombia
4   Department of Neurosurgery, Universidad Nacional de Colombia, Bogotá, Colombia
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Abstract

Introduction Langerhans cell histiocytosis (LCH) is a rare proliferative systemic disease characterized by the growth of abnormal dendritic cells and wide-ranging organ involvement. This condition can affect individuals of all ages, but most commonly children, with a peak incidence in toddlers. Symptoms may vary depending on the affected organ or system.

Case Report A 43-year-old man presented with a left temporal stabbing headache unresponsive to management with therapy and nonsteroidal anti-inflammatory drugs. Initial evaluation revealed a contrast-enhanced left temporal extra-axial lesion with bone and muscle compromise. Differential diagnoses, including multiple myeloma, were explored. Initial laboratory tests and imaging studies showed no other abnormalities, except for splenomegaly and a residual granuloma in the left lung. En bloc resection of the lesion was recommended. The patient underwent surgical intervention, which included resection of the dural lesion and all borders of an infiltrating tumor within the temporalis muscle and the affected portion of the left temporal bone. Posterior pathological examination revealed LCH. Postoperative course was uneventful. Follow-up appointments were scheduled after pathology results confirmed the diagnosis. Patient has continued follow-up for the following 3 months after the surgical procedure. Further evaluations are pending.

Discussion This case report corresponds to a patient with LCH. These patients are individualized and stratified based on local or systemic involvement to determine the most appropriate type of management. This is a rare case as LCH is rare in older patients and the initial presented lesion initially mimicked a meningioma; however, its atypical behavior and associated lytic compromise led to consideration of possible differential diagnoses.

Conclusion LCH can present with lytic bone lesions, mimicking other conditions, including infiltrative neoplastic lesions. Early diagnosis and appropriate surgical management are essential for optimal patient outcomes. Long-term follow-up is crucial to monitor disease progression and response to treatment.

Keywords

case report - Langerhans cell histiocytosis - adult - bone lesions

Ethical Considerations

We addressed ethical considerations in the publication of this case report in adherence to the Declaration of Helsinki. Patient confidentiality is preserved, and the patient fully understands the nature, benefits, and risks of the research, as well as the academic interest in publishing his medical history. Any potentially identifying information has been omitted or altered. Informed consent was obtained from the patient. No additional institutional review board approvals were required.




Publication History

Received: 15 February 2024

Accepted: 25 March 2024

Article published online:
30 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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