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 99mTc 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.
Highlights
History, Classification, Epidemiology, Etiology and Prognosis Erdheim-Chester Disease (ECD) is a rare form of non Langerhans' cell histiocytosis originally described as "Lipid Granulomatosis" in 1930 by Jakob Erdheim and William Chester
It was thought to be a variant of Langerhans' Cell Histiocytosis (LCH) [14,15] and as time went by, ECD developed a unique identity as a singular disease entity in the medical literature, baring specific diagnostic criteria
Summary and future perspectives we have gathered a fair share of the scientific knowledge regarding ECD
Summary
Classification, Epidemiology, Etiology and Prognosis Erdheim-Chester Disease (ECD) is a rare form of non Langerhans' cell histiocytosis originally described as "Lipid Granulomatosis" in 1930 by Jakob Erdheim and William Chester. When submitting the absolute majority of ECD patients to imaging studies, characteristic radiographic changes in the long bones appear (Figure 1) These changes, namely, bilateral cortical sclerosis involving the diametaphyseal regions, are considered virtually pathognomonic [25]. In ECD, bilateral symmetric osteosclerotic lesions are typically observed on radiographs, while abnormally strong labeling of the distal ends of the long bones are observed on 99mTc bone scintigraphs Detecting either of those comprises the radiological diagnostic criterion. Common and uncommon radiological findings of ECD related osseous involvement should be considered in the differential diagnosis alongside other medical conditions on a case by case basis. In cases in which the patient’s chief complaints deviate the physician’s
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