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Multicentric Reticulohistiocytosis Clinical Presentation

  • Author: Alisa N Femia, MD; Chief Editor: Herbert S Diamond, MD  more...
 
Updated: Dec 29, 2015
 

History

The primary manifestations of multicentric reticulohistiocytosis (MRH) are joint and skin involvement. Inflammatory joint disease is a presenting symptom in approximately 40% of cases and is the sole symptom in 45% of patients. Although the arthritis may wax and wane, it can rapidly become severe.

Approximately 30% of patients first develop skin papules and nodules, while another 25% of patients develop skin and joint manifestations at the same time. One tenth to one third of patients report pruritus.

Nonspecific pulmonary findings, such as pleural effusions and infiltrates, have been reported in association with MRH. Direct pulmonary involvement by MRH is extraordinarily rare but has been reported in 5 cases to date.[42]

Cardiac involvement is also extremely rare, but it has been reported in isolated cases and can manifest with myocardial involvement or pericardial disease.[43, 44, 45, 46]

There is one reported case of hepatic involvement in a patient with MRH and lung involvement.[47]

About one third of patients have constitutional symptoms, such as weakness, weight loss, and fever.

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Physical Examination

Arthritis

MRH is a polyarthritis with a predilection for the distal interphalangeal joints but capable of affecting several others (see the image below). The rates of distribution are as follows:

  • Hands (76%)
  • Knees (73%)
  • Shoulders (64%)
  • Wrists (64%)
  • Hips (61%)
  • Ankles (58%)
  • Elbows (58%)
  • Feet (58%)
  • Spine (52%)
    Nodules on a hand with deformed joints from arthri Nodules on a hand with deformed joints from arthritis due to multicentric reticulohistiocytosis.

Cutaneous lesions

Lesions vary from papules that are 1-2 mm in diameter to nodules that are 1 cm in diameter or larger. Papules and lesions may be isolated from one another, or they may be clustered, sometimes giving them a cobblestone appearance (see the image below). Clustering of papulonodules overlying the periungual areas may result in a characteristic “coral-bead” appearance. Nodules overlying extensor joints may resemble rheumatoid nodules.

Cobblestone papules on the eyelid and papules on t Cobblestone papules on the eyelid and papules on the forehead.

The lesions are usually nontender and may be skin colored, red, or yellowish. The nodules grow slowly and rarely ulcerate. Infiltrated plaques may resemble mucinosis.

The Koebner phenomenon has been reported, wherein trauma to the skin, including from ultraviolet (UV) radiation,[48] gives rise to new lesions.

Although MRH lesions have a predilection for the hands and face, they may occur on any surface of the body. Distribution rates are as follows:

  • Face (ears, nose, paranasal areas) and hands (90%): Several miscellaneous nail changes have also been described, but most are due to adjacent arthritis
  • Ears (76%)
  • Forearms (55%), as shown below
    Swollen elbow and nodules on the forearm. Swollen elbow and nodules on the forearm.
  • Elbows (40%)
  • Scalp (40%)
  • Mucosal surfaces (50%): Such as the lips, tongue, gingiva, and nasal septum

In rare cases (9 reported to date), patients have a photodistribution of lesions simulating dermatomyositis, although it is possible that this manifestation is underrecognized. (See the images below.)[49, 50, 51]

Erythematous to brown papules overlying the right Erythematous to brown papules overlying the right dorsal hand and wrist and erythematous to violaceous patches over the right dorsal hand and fingers. The cutaneous changes are in a photodistributed pattern and mimic the changes of dermatomyositis.
Erythematous to brown papules and erythematous to Erythematous to brown papules and erythematous to violaceous patches overlying the right dorsal hand and fingers, with a crusted erosion overlying the fourth metacarpophalangeal joint. These cutaneous changes can be easily confused with dermatomyositis.

Malignancy is associated with MRH in approximately 25% of cases, similar to the observed frequency in dermatomyositis. Features mimicking dermatomyositis in a patient with MRH, however, do not appear to increase the risk of malignancy.

About one third of patients have been reported to have xanthelasma, but whether this is related to MRH is unclear.[49]

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Contributor Information and Disclosures
Author

Alisa N Femia, MD Assistant Professor, Ronald O Perelman Department of Dermatology, New York University Medical Center

Alisa N Femia, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Medical Dermatology Society, Rheumatologic Dermatology Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, Texas Medical Association

Disclosure: Received royalty from Elsevier publishers for independent contractor; May receive consulting fee from FDA panel for consulting in future, since I am on one of their committees, but at this time so far have received zero from FDA.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Ruth Ann Vleugels, MD, MPH Assistant Professor of Dermatology, Harvard Medical School; Associate Physician, Department of Dermatology, Brigham and Women's Hospital; Associate Physician, Department of Immunology and Allergy, Children's Hospital Boston

Ruth Ann Vleugels, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Rheumatology, American Medical Association, Society for Investigative Dermatology, Medical Dermatology Society, Dermatology Foundation

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Marcel E Conrad, MD Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine

Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, and Southwest Oncology Group

Disclosure: No financial interests None None

Rosalie Elenitsas, MD Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Bryan L Martin, DO Associate Dean for Graduate Medical Education, Designated Institutional Official, Associate Medical Director, Director, Allergy Immunology Program, Professor of Medicine and Pediatrics, Ohio State University College of Medicine

Bryan L Martin, DO is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Osteopathic Internists, American College of Physicians, American Medical Association, and American Osteopathic Association

Disclosure: Nothing to disclose.

Lindsay T (Morgan) Bicknell, MD University of Texas Medical School at Houston

Lindsay T Morgan is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Takeji Nishikawa, MD Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

References
  1. Sroa N, Zirwas MJ, Bechtel M. Multicentric reticulohistiocytosis: A case report and review of the literature. Cutis. 2010 Mar. 85(3):153-5. [Medline].

  2. Luz FB, Gaspar AP, Ramos-e-Silva M, et al. Immunohistochemical profile of multicentric reticulohistiocytosis. Skinmed. 2005 Mar-Apr. 4(2):71-7. [Medline].

  3. Tashiro A, Takeuchi S, Nakahara T, Oba J, Tsujita J, Fukushi J, et al. Aberrant expression of CD10 in ground-glass-like multinucleated giant cells of multicentric reticulohistiocytosis. J Dermatol. 2010 Nov. 37(11):995-7. [Medline].

  4. Kroot EJ, Weel AE, Hazes JM, Zondervan PE, Heijboer MP, van Daele PL, et al. Diagnostic value of blind synovial biopsy in clinical practice. Rheumatology (Oxford). 2006 Feb. 45(2):192-5. [Medline].

  5. Ginsburg WW, O'Duffy JD, Morris JL, Huston KA. Multicentric reticulohistiocytosis: response to alkylating agents in six patients. Ann Intern Med. 1989 Sep 1. 111(5):384-8. [Medline].

  6. Liang GC, Granston AS. Complete remission of multicentric reticulohistiocytosis with combination therapy of steroid, cyclophosphamide, and low-dose pulse methotrexate. Case report, review of the literature, and proposal for treatment. Arthritis Rheum. 1996 Jan. 39(1):171-4. [Medline].

  7. Franck N, Amor B, Ayral X, et al. Multicentric reticulohistiocytosis and methotrexate. J Am Acad Dermatol. 1995 Sep. 33(3):524-5. [Medline].

  8. Gourmelen O, Le Loet X, Fortier-Beaulieu M, et al. Methotrexate treatment of multicentric reticulohistiocytosis. J Rheumatol. 1991 Apr. 18(4):627-8. [Medline].

  9. Rentsch JL, Martin EM, Harrison LC, Wicks IP. Prolonged response of multicentric reticulohistiocytosis to low dose methotrexate. J Rheumatol. 1998 May. 25(5):1012-5. [Medline].

  10. Kovach BT, Calamia KT, Walsh JS, Ginsburg WW. Treatment of multicentric reticulohistiocytosis with etanercept. Arch Dermatol. 2004 Aug. 140(8):919-21. [Medline].

  11. Lovelace K, Loyd A, Adelson D, Crowson N, Taylor JR, Cornelison R. Etanercept and the treatment of multicentric reticulohistiocytosis. Arch Dermatol. 2005 Sep. 141(9):1167-8. [Medline].

  12. Rudd A, Dolianitis C, Varigos G, Howard A. A case of multicentric reticulohistiocytosis responsive to azathioprine in a patient with no underlying malignancy. Australas J Dermatol. 2011 Nov. 52(4):292-4. [Medline].

  13. Hiramanek N, Kossard S, Barnetson RS. Multicentric reticulohistiocytosis presenting with a rash and arthralgia. Australas J Dermatol. 2002 May. 43(2):136-9. [Medline].

  14. Saito K, Fujii K, Awazu Y, et al. A case of systemic lupus erythematosus complicated with multicentric reticulohistiocytosis (MRH): successful treatment of MRH and lupus nephritis with cyclosporin A. Lupus. 2001. 10(2):129-32. [Medline].

  15. Goto H, Inaba M, Kobayashi K, et al. Successful treatment of multicentric reticulohistiocytosis with alendronate: evidence for a direct effect of bisphosphonate on histiocytes. Arthritis Rheum. 2003 Dec. 48(12):3538-41. [Medline].

  16. Satoh M, Oyama N, Yamada H, Nakamura K, Kaneko F. Treatment trial of multicentric reticulohistiocytosis with a combination of predonisolone, methotrexate and alendronate. J Dermatol. 2008 Mar. 35(3):168-71. [Medline].

  17. Sellam J, Deslandre CJ, Dubreuil F, Arfi S, Kahan A. Refractory multicentric reticulohistiocytosis treated by infliximab: two cases. Clin Exp Rheumatol. 2005 Jan-Feb. 23(1):97-9. [Medline].

  18. Kalajian AH, Callen JP. Multicentric reticulohistiocytosis successfully treated with infliximab: an illustrative case and evaluation of cytokine expression supporting anti-tumor necrosis factor therapy. Arch Dermatol. 2008 Oct. 144(10):1360-6. [Medline].

  19. Yeter KC, Arkfeld DG. Treatment of multicentric reticulohistiocytosis with adalimumab, minocycline, methotrexate. Int J Rheum Dis. 2013 Feb. 16(1):105-6. [Medline].

  20. De Knop KJ, Aerts NE, Ebo DG, Van Offel JF, Stevens WJ, De Clerck LS. Multicentric reticulohistiocytosis associated arthritis responding to anti-TNF and methotrexate. Acta Clin Belg. 2011 Jan-Feb. 66(1):66-9. [Medline].

  21. Cash JM, Tyree J, Recht M. Severe multicentric reticulohistiocytosis: disease stabilization achieved with methotrexate and hydroxychloroquine. J Rheumatol. 1997 Nov. 24(11):2250-3. [Medline].

  22. Lonsdale-Eccles AA, Haworth AE, McCrae FC, Young-Min SA. Successful treatment of multicentric reticulohistiocytosis with leflunomide. Br J Dermatol. 2009 Aug. 161(2):470-2. [Medline].

  23. Shannon SE, Schumacher HR, Self S, Brown AN. Multicentric reticulohistiocytosis responding to tumor necrosis factor-alpha inhibition in a renal transplant patient. J Rheumatol. 2005 Mar. 32(3):565-7. [Medline].

  24. Broadwell AW, Calamia KT, Kransdorf MJ, Ginsburg WW. Healing of erosive disease in multicentric reticulohistiocytosis. J Rheumatol. 2010 Jun. 37(6):1366-7. [Medline].

  25. Mavragani CP, Batziou K, Aroni K, Pikazis D, Manoussakis MN. Alleviation of polyarticular syndrome in multicentric reticulohistiocytosis with intravenous zoledronate. Ann Rheum Dis. 2005 Oct. 64(10):1521-2. [Medline]. [Full Text].

  26. Pacheco-Tena C, Reyes-Cordero G, Ochoa-Albíztegui R, Ríos-Barrera V, González-Chávez SA. Treatment of multicentric reticulohistiocytosis with tocilizumab. J Clin Rheumatol. 2013 Aug. 19(5):272-6. [Medline].

  27. Mahajan RS, Shah AC, Nagar A, Freny BE. Treatment of facial lesions of multicentric reticulohistiocytosis by carbon dioxide laser. J Cutan Aesthet Surg. 2013 Jul. 6(3):161-3. [Medline]. [Full Text].

  28. Selmi C, Greenspan A, Huntley A, Gershwin ME. Multicentric reticulohistiocytosis: a critical review. Curr Rheumatol Rep. 2015 Jun. 17 (6):511. [Medline].

  29. Lotti T, Santucci M, Casigliani R, Fabbri P, Bondi R, Panconesi E. Multicentric reticulohistiocytosis. Report of three cases with the evaluation of tissue proteinase activity. Am J Dermatopathol. 1988 Dec. 10(6):497-504. [Medline].

  30. Gorman JD, Danning C, Schumacher HR, Klippel JH, Davis JC Jr. Multicentric reticulohistiocytosis: case report with immunohistochemical analysis and literature review. Arthritis Rheum. 2000 Apr. 43(4):930-8. [Medline].

  31. Nakamura H, Yoshino S, Shiga H, Tanaka H, Katsumata S. A case of spontaneous femoral neck fracture associated with multicentric reticulohistiocytosis: oversecretion of interleukin-1beta, interleukin-6, and tumor necrosis factor alpha by affected synovial cells. Arthritis Rheum. 1997 Dec. 40(12):2266-70. [Medline].

  32. Iwata H, Okumura Y, Seishima M, Aoyama Y. Overexpression of monocyte chemoattractant protein-1 in the overlying epidermis of multicentric reticulohistiocytosis lesions: a case report. Int J Dermatol. 2012 Apr. 51(4):492-4. [Medline].

  33. Adamopoulos IE, Wordsworth PB, Edwards JR, Ferguson DJ, Athanasou NA. Osteoclast differentiation and bone resorption in multicentric reticulohistiocytosis. Hum Pathol. 2006. 37(9):1176–85.

  34. Islam AD, Naguwa SM, Cheema GS, Hunter JC, Gershwin ME. Multicentric reticulohistiocytosis: A rare yet challenging disease. Clin Rev Allergy Immunol. 2013 Feb 17.

  35. Valencia IC, Colsky A, Berman B. Multicentric reticulohistiocytosis associated with recurrent breast carcinoma. J Am Acad Dermatol. 1998 Nov. 39(5 Pt 2):864-6. [Medline].

  36. Tan BH, Barry CI, Wick MR, et al. Multicentric reticulohistiocytosis and urologic carcinomas: a possible paraneoplastic association. J Cutan Pathol. 2011 Jan. 38(1):43-8. [Medline].

  37. Han L, Huang Q, Liao KH, et al. Multicentric reticulohistiocytosis associated with liver carcinoma: report of a case. Case Rep Dermatol. 2012 May. 4(2):163-9. [Medline]. [Full Text].

  38. El-Haddad B, Hammoud D, Shaver T, Shahouri S. Malignancy-associated multicentric reticulohistiocytosis. Rheumatol Int. 2011 Sep. 31(9):1235-8. [Medline].

  39. Kishikawa T, Miyashita T, Fujiwara E, Shimomura O, Yasuhi I, Niino D, et al. Multicentric reticulohistiocytosis associated with ovarian cancer. Mod Rheumatol. 2007. 17(5):422-5. [Medline].

  40. Huang X, Zhang L, Zhang S. Multicentric reticulohistiocytosis with extra-mammillary Paget's disease: a case report. Eur J Med Res. 2013 Oct 29. 18(1):38. [Medline].

  41. Takahashi M, Mizutani H, Nakamura Y, Shimizu M. A case of multicentric reticulohistiocytosis, systemic sclerosis and Sjögren syndrome. J Dermatol. 1997 Aug. 24(8):530-4. [Medline].

  42. West KL, Sporn T, Puri PK. Multicentric reticulohistiocytosis: a unique case with pulmonary fibrosis. Arch Dermatol. 2012 Feb. 148(2):228-32. [Medline].

  43. Webb-Detiege T, Sasken H, Kaur P. Infiltration of histiocytes and multinucleated giant cells in the myocardium of a patient with multicentric reticulohistiocytosis. J Clin Rheumatol. 2009 Feb. 15(1):25-6. [Medline].

  44. Benucci M, Sulla A, Manfredi M. Cardiac engagement in multicentric reticulohistiocytosis: report of a case with fatal outcome and literature review. Intern Emerg Med. 2008 Jun. 3(2):165-8. [Medline].

  45. Lambert CM, Nuki G. Multicentric reticulohistiocytosis with arthritis and cardiac infiltration: regression following treatment for underlying malignancy. Ann Rheum Dis. 1992 Jun. 51(6):815-7. [Medline]. [Full Text].

  46. Fast A. Cardiopulmonary complications in multicentric reticulohistiocytosis. Report of a case. Arch Dermatol. 1976 Aug. 112(8):1139-41. [Medline].

  47. Yang HJ, Ding YQ, Deng YJ. Multicentric reticulohistiocytosis with lungs and liver involved. Clin Exp Dermatol. 2009 Mar. 34(2):183-5. [Medline].

  48. Taniguchi T, Asano Y, Okada A, Sugaya M, Sato S. Ultraviolet light-induced Köbner phenomenon contributes to the development of skin eruptions in multicentric reticulohistiocytosis. Acta Derm Venereol. 2011 Mar. 91(2):160-3. [Medline].

  49. Fett N, Liu RH. Multicentric reticulohistiocytosis with dermatomyositis-like features: a more common disease presentation than previously thought. Dermatology. 2011. 222(2):102-8. [Medline].

  50. Mun JH, Ko HC, Kim MB. Multicentric reticulohistiocytosis masquerading as dermatomyositis: similar and different features. J Dermatol. 2012 Jan. 39(1):104-7. [Medline].

  51. Bennassar A, Mas A, Guilabert A, Julia M, Mascaro-Galy JM, Herrero C. Multicentric reticulohistiocytosis with elevated cytokine serum levels. J Dermatol. 2011 Sep. 38(9):905-10. [Medline].

  52. Wat M, Sun GS, Rodriguez-Waitkus PM, Hsu S. Granuloma annulare mimicking multicentric reticulohistiocytosis. Dermatol Online J. 2013 Nov 15. 19(11):20400. [Medline].

  53. Yamada T, Kurohori YN, Kashiwazaki S, Fujibayashi M, Ohkawa T. MRI of multicentric reticulohistiocytosis. J Comput Assist Tomogr. 1996 Sep-Oct. 20(5):838-40. [Medline].

  54. Kamel H, Gibson G, Cassidy M. Case report: the CT demonstration of soft tissue involvement in multicentric reticulohistiocytosis. Clin Radiol. 1996 Jun. 51(6):440-1. [Medline].

  55. Zhang B, Zhou H, Han J, Shi X, Zhang X. 18F-FDG PET/CT Findings in Multicentric Reticulohistiocytosis. Clin Nucl Med. 2015 Nov 13. [Medline].

  56. Wade RG, Daivajna S, Chapman P, Murphy JG, Makkuni D. Hand surgery for Multicentric Reticulohistiocytosis: A new avenue of treatment and review of the literature. Int J Surg Case Rep. 2013. 4(8):744-7. [Medline]. [Full Text].

  57. Motegi SI, Yonemoto Y, Yanagisawa S, Toki S, Uchiyama A, Yamada K, et al. Successful Treatment of Multicentric Reticulohistiocytosis with Adalimumab, Prednisolone and Methotrexate. Acta Derm Venereol. 2015 Jun 15. [Medline].

 
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Multiple erythematous nodules are present on the dorsal hands of this adolescent with an inflammatory arthropathy.
Multiple erythematous to brown nodules on the fingers.
Erythematous, poikilodermatous, mamillated plaque on the anterior chest.
Histopathology of multicentric reticulohistiocytosis (MRH) skin lesions.
Histopathology of multicentric reticulohistiocytosis (MRH) skin lesions. Higher power demonstrating multinucleated giant cells with eosinophilic ground-glass cytoplasm.
Erythematous to brown papules overlying the right dorsal hand and wrist and erythematous to violaceous patches over the right dorsal hand and fingers. The cutaneous changes are in a photodistributed pattern and mimic the changes of dermatomyositis.
Erythematous to brown papules and erythematous to violaceous patches overlying the right dorsal hand and fingers, with a crusted erosion overlying the fourth metacarpophalangeal joint. These cutaneous changes can be easily confused with dermatomyositis.
Nodules on a hand with deformed joints from arthritis due to multicentric reticulohistiocytosis.
Swollen elbow and nodules on the forearm.
Cobblestone papules on the eyelid and papules on the forehead.
Low-power view of a biopsy sample of large histiocytes and multinucleated giant cells in the dermis.
High-power view of large histiocytes in the dermis.
Brown immunoperoxidase staining for lysozyme in histiocytes.
 
 
 
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