'Bizarre rash: adult-onset cutaneous Langerhans cell histiocytosis

Description

A woman aged 80 years was admitted under the general physicians with a 2-week history of general malaise. She was referred to dermatology for an opinion on a rash which had been present for 6 months. Examination revealed an erythematous, keratotic and papular rash below her breasts (figure 1), in both axillae (figure 2), upper abdomen and lower back. The rash was asymptomatic. The patient had no previous history of skin disease. A 4 mm punch biopsy showed discrete collections of monocytoid and histiocytoid cells within the epidermis expressing S100, CD1a and focal variable Leucocyte Common Antigen (LCA)—features diagnostic of Langerhans cell histiocytosis (LCH). MRI of the head and CT imaging of her chest, abdomen and pelvis did not reveal any other focus of disease, and there were no lytic bone lesions.

Figure 1

Cutaneous Langerhans cell histiocytosis on the chest.

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