Multicentric Reticulohistiocytosis Workup

  • Author: Jeffrey P Callen, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Aug 16, 2011
 

Laboratory Studies

  • No specific laboratory studies are specific for multicentric reticulohistiocytosis (MRH). Rheumatoid factor findings are usually negative.
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Imaging Studies

  • Radiography of the affected joints reveals destruction of bone disproportionate to loss of cartilage. Lesions may resemble gouty erosions.
    • Mild osteopenia is noted.
    • Marked resorption of subchondral bone is common.
    • The findings may develop rapidly and can resemble arthritis mutilans.
  • The cutaneous nodules may be seen as soft tissue swellings.
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Other Tests

  • Findings on joint fluid analysis vary. The effusions may demonstrate polymorphonuclear leukocytes or mononuclear cells.
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Histologic Findings

Early skin lesions demonstrate a lymphohistiocytic infiltrate. Mature lesions demonstrate a dermis filled by giant multinucleated cells with a pale, fine, granular (ie, ground glass) eosinophilic cytoplasm. Periodic acid-Schiff stain results are positive and are diastase-resistant. Lipid stain results may be positive. Results of acid phosphatase, nonspecific esterase, and lysozyme stains are usually positive. Results of S100 protein and alpha-1-antitrypsin are negative. Langerhans granules are absent on electron microscopy. In synovial biopsy, lipid-laden giant cells and histiocytes are similar to those seen on skin biopsy.

Histopathology of multicentric reticulohistiocytosHistopathology of multicentric reticulohistiocytosis (MRH) skin lesions. Histopathology of multicentric reticulohistiocytosHistopathology of multicentric reticulohistiocytosis (MRH) skin lesions. Higher power demonstrating the ground glass cytoplasm and multinucleated giant cells.
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Contributor Information and Disclosures
Author

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, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Specialty Editor Board

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.

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

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

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; 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, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

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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 the ground glass cytoplasm and multinucleated giant cells.
 
 
 
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