In March 2005, a 41-year-old Japanese woman was referred to our department with asymptomatic skin lesions on her face (Figure 1A-C). Since she had right lower leg pain for 6 months, evaluations included radiography, technetium Tc 99m bone scintigraphy, magnetic resonance imaging, and a bone biopsy of the tibia. By radiography and bone scintigraphy, multiple lesions on both femur and tibia bones were detected (Figure 2A and B). A bone biopsy specimen from the right tibia showed a mixed infiltrate of histiocytic foamy cells, lymphocytes, and multinuclear giant cells. Most of the infiltrating histiocytic foamy cells were CD68 positive but negative for S100 stain and CD1a (Figure 2C). From these examination results, her bone lesions were diagnosed as indicating Erdheim-Chester disease 1 month before her visit to the dermatology clinic.
Yanagi T, Kato N, Yamane N, Osawa R, Hiraga H. Verruca Plana–Like Papules as a New Manifestation of Erdheim-Chester Disease. Arch Dermatol. 2007;143(7):945-955. doi:10.1001/archderm.143.7.952