Volume 7 | Issue 1 | January-June 2022 | Page: 19-23 | Bharath HD, Krishnakumar R, Jeffy John

DOI: 10.13107/ijs.2020.v07i01.034

Authors: Bharath HD [1], Krishnakumar R [1], Jeffy John [2]

[1] Department of Spine Surgery, Medical Trust Hospital, Cochin, Kerala, India.
[2] Department of Pathology, Medical Trust Hospital, Cochin, Kerala, India.

Address of Correspondence
Dr. Krishnakumar R,
Department of Spine Surgery, Medical Trust Hospital, Cochin, Kerala, India.
E-mail: krishnakumar.ram@gmaiall.com

Abstract

Background: Back pain in the pediatric population is a common complaint with wide differentials including mechanical cause, musculoskeletal involvement, infectious or inflammatory pathologies, and tumors. Transient back pain is common among children, and in majority of cases resolves without any treatment or with rest and mere hot/cold fomentations. However, pain disproportionate to physical findings and not reduced by pain medications, strongly suggest the presence of a serious underlying pathology. Case presentation: A 13 year old boy presented with a history of mild mid back pain lasting for a week associated with gradually developing deformity of the back, noticed by his parents. There is no history of any injury or fall prior to presentation. He had no history of any other constitutional symptoms. Upon radiological investigations he was found to have an isolated lytic lesion in D9 vertebra with differentials of tubercular/neoplastic/metastatic etiologies. Histopathological examination after biopsy was suggestive of Langerhans cell histiocytosis and was proven by immunohistochemistry. He was managed with conservative line of treatment with analgesics and other supportive care. Discussion: LCH is considered a pediatric disease, and involvement of the pediatric spine in not uncommon. A child presenting with persistent and progressive back pain should be evaluated in detail even if the child is not presenting with any other constitutional symptoms to rule out rare causes of vertebral lytic lesions. There are no cases reported in the literature suggesting LCH of the spine in pediatric population presenting as the deformity of the back. Conservative treatment is a good choice for a patient with LCH without neurological deficits or spinal instability.
Keywords: Spine deformity, Children, LCH, Back pain

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