A case of cutaneous rosai-dorfman disease treated by intrale
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The purely cutaneous form of the disease, namely cutaneous RDD (CRDD), is a rare benign non-Langerhans histiocytosis of unknown cause. The phenomenon of emperipolesis is suggestive but not totally specific. Various kinds of treatment have been applied with different outcomes. Here, authors report a case of CRDD cured by intralesional injections of glucocorticoid.

A 45-year-old Chinese male with no identifiable past medical history consulted us for cutaneous lesions located on his shoulder and back. A red nodule had appeared 3 months earlier and grew progressively in size with no pain or pruritus. Subsequently, several papules and nodules appeared nearby and merged to form a dusky-red infiltrated plaque. A month later, similar red nodules appeared on his shoulder and waist and gradually enlarged. The patient denied any local trauma or infection. He had no symptoms of fever, malaise, or weight loss and had no history of hypertension, diabetes, food, and/or drug allergies. There were no similar patients in his family.

Physical examination revealed two dark red plaques that infiltrated his back and a peanut-size red nodule with a smooth surface on his right shoulder. The boundaries of the two plaques were clear and irregular. There was no enlargement of lymph nodes palpated in his neck, axillary fossa, or groin.

Laboratory investigations indicated normal results for routine tests of blood and urine, liver, and kidney functions, and hematological examination of sexually transmitted diseases was normal. A skin biopsy specimen showed an intradermal infiltration of lymphocytes, histiocytes, multinucleated giant cells, and a few plasma cells. A high-power view showed emperipolesis.

From those clinical manifestations and histological features, the diagnosis of cutaneous Rosai-Dorfman disease (CRDD) was made. Treatment with acitretin at 20 mg daily for 3 weeks did not show significant improvement and was terminated because of the obvious dryness of his lips. An intralesional injection of betamethasone was then prescribed, once every 3 weeks, three times in total. After 3 weeks of the first treatment, the lesions had a shrunken surface and were dim in color. At the 9-week visit, the patient was satisfied with the improvement of his skin lesions, which further improved during the next 6 months of follow-up. During that period, the patient did not complain of any discomfort.

Source: https://www.e-ijd.org/article.asp?issn=0019-5154;year=2021;volume=66;issue=2;spage=223;epage=223;aulast=Yuan