[Use of targeting therapy in Erdheim-Chester disease: A case report with neurologic involvement]

Rev Med Interne. 2020 Jun;41(6):413-417. doi: 10.1016/j.revmed.2020.02.008. Epub 2020 Feb 27.
[Article in French]

Abstract

Introduction: Erdheim-Chester disease (ECD) is a rare multisystemic disease characterised by an infiltration of various organs by CD68+ CD1a- histiocytes. The clinical and radiological presentation is very variable.

Case report: We report the case of a 71-year-old woman with ECD which was revealed by neurological and cutaneous manifestations. The diagnosis was confirmed by skin biopsy and the BRAFV600E mutation was identified in skin tissue, leading to the use of combined therapy targeting the RAS-RAF-ERK-MEK pathway. This therapy allowed an improvement of cutaneous manifestations but neurological manifestations lead to death, underlying their notable severity.

Conclusion: Our case report shows the persistent diagnostic difficulty of the ECD and the particular gravity of neurologic involvement.

Keywords: Atteinte cutanée; Atteinte neurologique; BRAF; Erdheim-Chester disease; Histiocytose; Histiocytosis; Maladie d’Erdheim-Chester; Neurologic manifestations; Skin manifestations.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Azetidines / administration & dosage
  • Drug Therapy, Combination
  • Erdheim-Chester Disease / complications*
  • Erdheim-Chester Disease / diagnosis
  • Erdheim-Chester Disease / drug therapy*
  • Female
  • Humans
  • Mitogen-Activated Protein Kinase Kinases / antagonists & inhibitors
  • Molecular Targeted Therapy* / methods
  • Nervous System Diseases / diagnosis
  • Nervous System Diseases / drug therapy*
  • Nervous System Diseases / etiology*
  • Piperidines / administration & dosage
  • Protein Kinase Inhibitors / administration & dosage*
  • Proto-Oncogene Proteins B-raf / antagonists & inhibitors
  • Proto-Oncogene Proteins B-raf / genetics
  • Rare Diseases
  • Skin Diseases / diagnosis
  • Skin Diseases / etiology
  • Skin Diseases / pathology
  • Skin Diseases / therapy
  • Vemurafenib / administration & dosage

Substances

  • Azetidines
  • Piperidines
  • Protein Kinase Inhibitors
  • Vemurafenib
  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf
  • Mitogen-Activated Protein Kinase Kinases
  • cobimetinib