SHM Converge Scientific Abstract ePoster Gallery-1 in a Million: A Case of Langerhans Cell Histiocytosis

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A 23-year-old man developed progressively worsening occipital headaches for one year after a fall. His pain was worse with exercise and lying flat. He also had a history of chronic alopecia treated with finasteride and topical minoxidil, after which he developed multiple cystic scalp lesions that later drained fluid. On exam, he had a small, firm, nonmobile left frontal scalp nodule.<br /><br />Brain CT and MRI revealed a 2.5 × 2.5 cm lytic lesion in the left frontal bone with an epidural soft tissue component, raising concern for an eosinophilic granuloma. PET-CT showed uptake only at the cranial lesion, and skull biopsy confirmed Langerhans cell histiocytosis (LCH) with a BRAF V600E mutation.<br /><br />The discussion emphasizes that LCH is a rare clonal histiocytic neoplasm, occurring in only 1–2 adults per million annually. In adults, the bone, skin, lungs, and pituitary are the most common sites of involvement. The case is notable because the patient had both repeated head trauma and alopecia, which have been proposed as possible associations with LCH. The authors also question whether finasteride or topical minoxidil could be contributing factors, given the timing of the scalp lesions after treatment began.<br /><br />Because the patient presented with headache red flags, including post-traumatic onset, positional worsening, and change in headache quality, neuroimaging was appropriately obtained and led to diagnosis. The report highlights the importance of recognizing warning signs in headache evaluation and adds to limited adult LCH literature, particularly regarding potential links with scalp injury, alopecia, and hair-loss treatments. BRAF-targeted therapy may be an option in cases with BRAF V600E mutations.

Asset Subtitle

Nicole McFarlane

Meta Tag

Author List Minh-Phuong T. Le, Nicole McFarlane

Category Clinical Vignettes

Concept Langerhans Cell Histiocytosis

Concept Adult Langerhans Cell Histiocytosis

Concept Biopsy

Concept BRAF V600 Mutation

Concept Clinical Presentation

Distinguished Non-Finalist

Presenter Organization MGH

Presenting Author Nicole McFarlane

Track Adult

Keywords

Langerhans cell histiocytosis

BRAF V600E

lytic skull lesion

epidural soft tissue mass

occipital headache

head trauma

alopecia

finasteride

topical minoxidil

neuroimaging

Langerhans Cell Histiocytosis

Adult Langerhans Cell Histiocytosis

Biopsy

BRAF V600 Mutation

Clinical Presentation