Muhammad Irfan, Javad Hussain, Riaz Lakdawala, Fayyaz Hussain, Javaid Khan.
Pulmonary Langerhans Cell Histiocytosis.
Pak J Chest Med Jan ;9(4):11-4.

A 30 years old engineer, heavy smoker, presented in a surgical clinic with 1 month history of pain in right hip. He was a known case of diabetes mellitus. X-ray pelvis showed a bony lesion at upper right femoral shaft. Excision curettage of the lesion was done and histopathology showed cellular infiltrates composing of cells with grooved nuclei along with multinucleated cells. Immunohistochemical stains were positive for S100 and CD68 stains and negative for leucocyte markers. The features were consistent with LCH. Three months later he again came in orthopedic clinic with 2 months history of increasing backache. MRI of thoracic spine showed compression collapse of D8 vertebral body. Thoracotomy, D8 compectomy and tricortical reconstruction was done. Four months later he presented at a pulmonology clinic with dry cough and exertional dysponea. He was hemodynamically stable at that point and his general physical examination was unremarkable. Chest examination was also normal. Chest radiograph showed diffuse reticulonodular shadowing in both lung fields. C.T chest revealed diffuse, ill defined nodular infiltrations and cystic lesions in both lung fields with sparing of costophrenic angles. There was no hilar or mediastinal lymphadenopathy. The CT scan findings were very much suggestive of PLCH. Spirometry revealed moderate restrictive impairment. He was diagnosed as a case of PLCH and advised to quit smoking. On follow up after 4 months he showed significant improvement in his symptoms.

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