Treatment of recurrent eosinophilic granuloma with systemic therapy.

Abstract

PURPOSE:

To describe the systemic treatment of recurrent eosinophilic granuloma.

METHODS:

Case report and review of Langerhans cell histiocytosis.

RESULTS:

A 9-year-old boy had painful, right upper eyelid swelling. A computed tomography scan showed a right superolateral orbital mass with evidence of bony erosion. Frozen section evaluation was consistent with eosinophilic granuloma. Biopsy and curettage were performed. Systemic work-up was negative for extraorbital disease. Recurrence of the orbital mass 6 weeks after surgery was confirmed by magnetic resonance imaging (MRI). Four weeks after treatment with prednisone and vinblastine, MRI showed a marked decrease in the size of the orbital lesion. Additional treatment with 6-mercaptopurine and methotrexate was initiated, and MRI 6 months later showed complete resolution of the lesion.

CONCLUSIONS:

The treatment of recurrent eosinophilic granuloma is challenging. The goal is to effectively cure the lesion with minimal short-term and long-term side effects. Systemic steroids, vinca alkaloids, antimetabolites, and antifols are preferred because they have less toxicity and mutagenicity. Combination chemotherapy used in conjunction with treatment by a pediatric hematologist/oncologist appears to be an effective method of treating recurrent disease.

• Authors: Alice Song, Thomas E Johnson, Sander R Dubovy, Stuart Toledano
• Journal: Ophthalmic plastic and reconstructive surgery (Ophthalmic Plast Reconstr Surg) Vol. 19 Issue 2 Pg. 140-4 (Mar 2003) ISSN: 0740-9303 [Print] United States
• PMID: 12644761 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Glucocorticoids
• Vinblastine
• Mercaptopurine
• Prednisone

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Child
• Drug Therapy, Combination
• Eosinophilic Granuloma (diagnosis, drug therapy)
• Glucocorticoids (therapeutic use)
• Humans
• Magnetic Resonance Imaging
• Male
• Mercaptopurine (therapeutic use)
• Orbital Diseases (diagnosis, drug therapy)
• Prednisone (therapeutic use)
• Recurrence
• Vinblastine (therapeutic use)
• X-Rays