Langerhans Cell Histiocytosis of Dorsal Spine in a Child Presenting with Deformity of the Back: A Rare Case Report and Review of Literature

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.


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


1. Bernstein RM, Cozen H. Evaluation of back pain in children and adolescents. Am Fam Physician 2007;76:1669 76.
2. Feldman DS, StraightJJ, Badra MI, MohaideenA, Madan SS. Evaluation of an algorithmic approach to pediatric back pain. J Pediatr Orthop 2006;26:353 7.
3. Brown CW, Jarvis JG, Letts M, Carpenter B. Treatment and outcome of vertebral Langerhans cell histiocytosis at the Children’s Hospital of Eastern Ontario. Can J Surg 2005;48:230 6.
4. Khung S, Budzik JF, Amzallag Bellenger E, LambillioteA, Soto Ares G, Cotten A, et al. Skeletal involvement in Langerhans cell histiocytosis. Insights Imaging 2013;4:569 79.
5. Beltran J, Aparisi F, Bonmati LM, Rosenberg ZS, Present D, Steiner GC (1993) Eosinophilic granuloma: MRI manifestations. Skelet Radiol 22(3):157–161
6. Kilborn TN, Teh J, Goodman TR (2003) Paediatric manifestations of Langerhans cell histiocytosis: a review of the clinical and radiological findings. Clin Radiol 58(4):269–278
7. Peng XS, Pan T, Chen LY, Huang G, Wang J. Langerhans’ cell histiocytosis of the spine in children with soft tissue extension and chemotherapy. Int Orthop 2009;33:731 6.
8. Garg S, Mehta S, DormansJP. Langerhans cell histiocytosis of the spine in children. Long term follow up. J Bone Joint Surg Am 2004;86 A: 1740 50.
9. Ghanem I, Tolo VT, D’Ambra P, Malogalowkin MH. Langerhans cell histiocytosis of bone in children and adolescents. J Pediatr Orthop 2003;23:124 30.
10. Azouz EM, Saigal G, Rodriguez MM, Podda A (2005) Langerhans’ cell histiocy tosis: pathology, imaging and treatment of skeletal involvement. Pediatr Radiol 35(2):103–115. doi:10.1007/s00247-004-1262-0
11. Puigdevall M, Bosio S, Hokama J, Maenza R (2008) Langerhans cell histiocytosis of the atlas in the pediatric spine: total reconstitution of the bone lesion after nonoperative treatment. A report of two cases. J Bone Joint Surg 90(9):1994–1997. doi:10.2106/jbjs.g.01352
12. Bertram C, Madert J, Eggers C (2002) Eosinophilic granuloma of the cervical spine. Spine 27(13):1408–1413

How to Cite this Article: HD Bharath, R Krishnakumar, John J Langerhans | Cell Histiocytosis of
Dorsal Spine in a Child Presenting with Deformity of the Back: A Rare Case Report and Review of Literature| International Journal of Spine | January-June 2020; 7(1): 19-23.

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