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Thoracic spine Langerhans cell histiocytosis in a child with achondroplasia
  1. Zoe Chan1,
  2. Lesley Simpson2 and
  3. Pasquale Gallo3
  1. 1 Neurosurgery, NHS Lothian, Edinburgh, UK
  2. 2 Oncology, Royal Hospital for Sick Children, Edinburgh, UK
  3. 3 Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, UK
  1. Correspondence to Dr Zoe Chan, zoe17chan{at}


Multifocal bone Langerhans cell histiocytosis (LCH) is usually treated with prednisolone and vinblastine. We present a case conservatively treated with indomethacin with good clinical and radiological response. A 7-year-old achondroplastic boy presented with worsening thoracic back pain and leg weakness. An admission MRI spine showed a pathological T1 vertebrae fracture with posterior soft tissue extension compressing and distorting the spinal cord. A CT guided biopsy revealed an LCH. Steroids were avoided to reduce osteopenia risk and further vertebral fragility. Considering the risk of a thoracic surgical approach in a child with this background, he was managed conservatively with indomethacin and a Sternal Occipital Mandibular Immobilizer (SOMI) Brace. Pain resolved completely within 6 months and the brace was discontinued. Serial follow-up scans showed progressive resolution of the pathological T1 fracture and complete resolution of the spinal cord compression.

  • paediatric oncology
  • neurosurgery
  • paediatrics (drugs and medicines)
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  • Contributors PG and LS were involved in the conception and design of the case report. ZC drafted and revised the case report. PG obtained the consent from the patient and did the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.

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