Lim Cheong-Su, Cho Jae Hwan
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2020 Jan;99(3):e18794. doi: 10.1097/MD.0000000000018794.
Spinal involvement in adult Langerhans cell histiocytosis (LCH) is rare, and epidural involvement is unusual. LCH is mostly indistinguishable from other spinal lesions such as infection, lymphoma, and metastasis. So, it could be easily misdiagnosed without suspicion.
We report a case of a 33-year-old man who complained of gait disturbance with weakness in both legs and severe back pain.
A continuous enhancing epidural lesion with cord compression from the T7 to L1 level was detected in magnetic resonance imaging. Laboratory analysis indicated the possibility of spinal infectious disease. We assumed that the lesion could be tuberculous spondylitis.
The patient underwent posterior laminectomy with marginal excision of the epidural mass to relieve cord compression. Pathological examination confirmed the diagnosis of LCH. The 12-month follow-up evaluation revealed that the patient was neurologically intact and had no gait disturbance.
This case report presents a patient with epidural LCH of the thoracic spinal cord, which can mimic spinal infections such as tuberculous spondylitis with abscess formation. Therefore, LCH could be considered as a possible diagnosis when a patient presents with features of infectious spondylitis with vertebral involvement.
成人朗格汉斯细胞组织细胞增多症（LCH）累及脊柱罕见，硬膜外受累不常见。LCH大多与其他脊柱病变难以区分，如感染、淋巴瘤和转移瘤。因此，若无怀疑，很容易误诊。
我们报告一例33岁男性患者，主诉步态障碍、双腿无力及严重背痛。
磁共振成像检测到一个从T7至L1水平的连续强化硬膜外病变并伴有脊髓受压。实验室分析提示脊柱感染性疾病的可能性。我们推测该病变可能是结核性脊柱炎。
患者接受了后路椎板切除术及硬膜外肿块边缘切除术以缓解脊髓受压。病理检查确诊为LCH。12个月的随访评估显示患者神经功能完好，无步态障碍。
本病例报告了一名胸段脊髓硬膜外LCH患者，该病可模仿结核性脊柱炎伴脓肿形成等脊柱感染。因此，当患者出现感染性脊柱炎累及椎体的特征时，LCH可被视为一种可能的诊断。
