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» Expert Histio Net » For Professionals » Guidelines » LCH childhood » Differential Diagnosis  · 

Differential Diagnosis

Author(s): Euro Histio Net Work Group for LCH Guidelines (see introduction page), Created: 2011/03/10, last update: 2012/01/23

Sometimes making the diagnosis of LCH may be difficult due to other diseases that may present with similar findings.

Table 6 shows a list of differential diagnoses for the different manifestations of Langerhans Cell Histiocytosis.

Tab. 6. Differential Diagnosis for Manifestations of Langerhans Cell Histiocytosis

Involvement

Manifestation

Possible other condition

Bone
 
 
 
 
 
 
 
 

Vertebra plana
 
 
 
 
 
 
 
 

Ewing sarcoma
Septic osteomyelitis
Chronic relapsing multifocal osteomyelitis (CRMO)
Leukemia
Lymphoma
Aneurysmal bone cyst
Juvenile xanthogranuloma
Myeloma (only described in adults)
Osteoporosis

 

Temporal bone
 
 
 

Chronic otitis media
Mastoiditis
Cholesteatoma
Soft tissue sarcoma

 

Orbit
 
 
 
 
 

Acute infection (preseptal cellulitis)
Dermoid cyst
Rhabdomyosarcoma
Neuroblastoma
Erdheim-Chester disease
Pseudoinflammatory tumor

 

Other lytic lesions
of the long bones
 
 
 
 
 
 

Osteomyelitis
Chronic recurrent multifocal osteomyelitis (CRMO)
Aneurysmal bone cyst
Bone angiomatosis (Gorham disease)
Fibrous dysplasia
Atypical mycobacterial infection
Osteogenic sarcoma
Ewing’s sarcoma

Skin
 
 

Vesicles and bullae (most common in early infancy)
 

Erythema toxicum
Herpes simplex
Chickenpox infection

 

Dermatitis (most frequently scalp, diaper or axilla, may occur up to late infancy)

Seborrheic dermatitis (eczema;
usually no petechiae and marked scaling)
 

 

Nodules
 
 
 
 

Mastocytosis
Juvenile xanthogranuloma
Hashimoto-Pritzker’s self-healing reticulohistiocytosis
Neuroblastoma
Infant leukemia

 

Pruritus (more common),
Petechiae (uncommon)

Scabies (other family members
may be affected)
 

Lung
 
 
 
 
 
 

In particular systemic symptoms and cavitated pulmonary nodules
 
 
 
 

Pneumocystis Carinii cavitated infection
Mycobacterial or other pulmonary infections
Sarcoidosis
Bronchiolar-alveolar carcinoma (only described in adults)
Lymphangio-Leiomyosarcoma (only described in young adult women)
Septic emboli

Liver
 
 
 
 
 
 
 

Jaundice with direct hyperbilirubinemia
Hypo albuminemia
 
 
 
 
 

Chronic destructive cholangitis
Metabolic disease
Hepatitis
Neoplasia obstructing biliary tract
Inherited deficient conjugation of bilirubin
Toxic (Reye syndrome)
Chronic inflammatory bowel disease
Neonatal hemochromatosis