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December 1993

Multiple Cutaneous Ulcerations

Arch Dermatol. 1993;129(12):1607-1612. doi:10.1001/archderm.1993.04540010087013

DIAGNOSIS:  Langerhans' cell histiocytosis (LCH) (histiocytosis X).

[ill] AND CLINICAL COURSE  The hematoxylin-eosin-stained sections under low-power view showed granulomatous inflammation in the upper and middle dermis, while the high-power view showed an aggregation of pale-staining epithelioid cells surrounded by darker-staining mononuclear cells.Examination using flexible sigmoidoscopy (to 45 cm) revealed loss of vascularity with friability in the rectum and deep linear ulcerations in the sigmoid colon. Sigmoid biopsy specimens revealed nonspecific acute and chronic inflammation of the colonic mucosa and submucosa consistent with Crohn's disease.The patient was treated with a combination of oral prednisone and sulfasalazine, resulting in complete healing of the skin lesions and resolution of the bloody stools over a 2-week period. However, 3 months

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