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Orphanet Journal of Rare Diseases

, 8:137

First Online: 08 September 2013Received: 24 April 2013Accepted: 04 September 2013

Abstract

Erdheim-Chester Disease ECD is a rare form of non Langerhans- cell histiocytosis. Individuals affected by this disease are typically adults between their 5th and 7th decades of life. Males and females are almost equally affected. The multi systemic form of ECD is associated with significant morbidity, which may arise due to histiocytic infiltration of critical organ systems. Among the more common sites of involvement are the skeleton, central nervous system, cardiovascular system, lungs, kidneys retroperitoneum and skin. The most common presenting symptom of ECD is bone pain. The etiology of ECD is unknown yet thought to be associated with an intense TH1 immune response. It may also be associated with the V600E BRAF mutation, as described in as many as half of the patients in recent studies. Bilateral symmetric increased tracer uptake on Tc bone scintigraphy affecting the periarticular regions of the long bones is highly suggestive of ECD. However, definite diagnosis of ECD is established only once CD68+, CD1a− histiocytes are identified within a biopsy specimen. At present, this obscure ailment embodies numerous challenges to medical science. Given its rarity, it is diagnostically elusive and requires a high level of clinical suspicion. Therapeutically, it is of limited alternatives. Currently, interferon-α is the most extensively studied agent in the treatment of ECD and serves as the first line of treatment. Treatment with other agents is based on anecdotal case reports and on the basis of biological rationale. Nevertheless, cladribine 2CDA, anakinra and vemurafenib are currently advocated as promising second line treatments for patients whose response to interferon-α is unsatisfactory. Overall, the 5 year survival of ECD is 68%. Herein, the authors mustered and brought about a panoramic consolidation of all the relevant facts regarding ECD. This work highlights the different clinical, radiological and pathological manifestations associated with ECD, the differential diagnoses, the various treatment options and the acknowledged science explaining the disease.

KeywordsErdheim Chester disease Interferon alpha Interleukin-1 BRAF AbbreviationsECDErdheim chester disease

LCHLangerhans cell histiocytosis

JXAJuvenile xanthogranuloma

99mTcMetastable nuclear isomer of technetium-99

CNSCentral nervous system

MRIMagnetic resonance imaging

ECGElectrocardiography

CTComputed tomography

CRPC-reactive protein

ESRErythrocyte sedimentation rate

LHLuteinizing hormone

FSHFollicle-stimulating hormone

ACTHAdrenocorticotropic hormone

GHGrowth hormone

TSHThyroid stimulating hormone

PETPositron emission tomography

FDGFludeoxyglucose

HUMARAHuman androgen-receptor gene assays

MCP1Monocyte chemotactic protein-1

OP-10Interferon-γ inducible protein 10

TNFαTumor necrosis factor alpha

2CDACladribine.

Electronic supplementary materialThe online version of this article doi:10.1186-1750-1172-8-137 contains supplementary material, which is available to authorized users.

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Autor: Roei D Mazor - Mirra Manevich-Mazor - Yehuda Shoenfeld

Fuente: https://link.springer.com/







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