Chan Zoe, Simpson Lesley, Gallo Pasquale
Neurosurgery, NHS Lothian, Edinburgh, UK.
Oncology, Royal Hospital for Sick Children, Edinburgh, UK.
BMJ Case Rep. 2019 Jul 24;12(7):e228801. doi: 10.1136/bcr-2018-228801.
Multifocal bone Langerhans cell histiocytosis (LCH) is usually treated with prednisolone and vinblastine. We present a case conservatively treated with indomethacin with good clinical and radiological response. A 7-year-old achondroplastic boy presented with worsening thoracic back pain and leg weakness. An admission MRI spine showed a pathological T1 vertebrae fracture with posterior soft tissue extension compressing and distorting the spinal cord. A CT guided biopsy revealed an LCH. Steroids were avoided to reduce osteopenia risk and further vertebral fragility. Considering the risk of a thoracic surgical approach in a child with this background, he was managed conservatively with indomethacin and a Sternal Occipital Mandibular Immobilizer (SOMI) Brace. Pain resolved completely within 6 months and the brace was discontinued. Serial follow-up scans showed progressive resolution of the pathological T1 fracture and complete resolution of the spinal cord compression.
多灶性骨朗格汉斯细胞组织细胞增多症（LCH）通常采用泼尼松龙和长春碱进行治疗。我们报告了1例采用吲哚美辛保守治疗且临床和影像学反应良好的病例。一名7岁的软骨发育不全男孩出现胸背部疼痛加重和腿部无力症状。入院时的脊柱MRI显示T1椎体病理性骨折，伴有后方软组织延伸，压迫并扭曲脊髓。CT引导下活检显示为LCH。为降低骨质减少风险和进一步的椎体脆性，未使用类固醇。考虑到在此背景下对儿童进行开胸手术的风险，对他采用吲哚美辛和胸骨枕下颌固定器（SOMI）支具进行保守治疗。疼痛在6个月内完全缓解，支具停用。系列随访扫描显示病理性T1骨折逐渐愈合，脊髓压迫完全解除。
