Langerhans cell histiocytosis presenting in the neonatal period - A retrospective case series

Objectives: To describe the morphologic characteristics of skin lesions, ex tent of extracutaneous disease, and outcomes in patients with neonatal pres entation of Langerhans cell histiocytosis (LCH), and to examine clinical pr edictors of disease prognosis. Design: Retrospective validation Cohort study. Maximum duration of follow-u p was 10 years. Setting: a tertiary care children's hospital in Chicago, Ill. Patients: Nineteen children with cutaneous findings in the first 4 weeks of life and subsequently diagnosed with LCH based on compatible tissue histol ogic analysis, confirmed by electron microscopy and/or immunohistochemical analysis. Main Outcome Measure: Cutaneous lesion morphologic characteristics, extracu taneous manifestations, treatments, and outcomes were tabulated and compare d. Results: The mast common initial skin lesion was erythematous, often cruste d, vesiculopustules. Skin lesion morphologic traits did not correlate with extent of extracutaneous disease. One third of patients had disease limited to the skin and/or mucous membranes. All Of these patients are alive and w ell, and 1 has developed diabetes insipidus. Twelve of the 19 patients had multisystem disease, and 2 died of disease. The results of a multiorgan wor kup performed at the time of diagnosis were predictive of which patients in this cohort manifested multisystem disease. The overall incidence of diabe tes insipidus was 21%. Conclusions: Vesiculopustular lesions are common in congenital/neonatal LCH , but the morphologic characteristics of lesions are not helpful in predict ing the extent of disease. A multiorgan evaluation at the time of diagnosis may be predictive of the probability of multisystem involvement with LCH.