Juvenile xanthogranuloma (JXG) is a disorder of histiocytes usually as
sociated with cutaneous lesions. It may present a diagnostic dilemma i
n the absence of cutaneous lesions and when deeply located. Differenti
ation of JXG from other childhood histiocytosis syndromes, especially
Langerhans' cell histiocytosis (LCH), is important. We describe an unu
sual case of deep JXG in a 27-month-old girl with multiple omental and
peritoneal nodules presenting with ascites. Although a diagnosis of L
CH was suspected clinically, the absence of Birbeck granules and S-100
protein and T6 antigen negativity, together with CD68 and factor XIII
a positivity, led us to a diagnosis of JXG. Physicians should be aware
of the widening spectrum of manifestations of juvenile xanthogranulom
a.