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Rosai-Dorfman disease (RDD) is a rare, benign histiocytic proliferative disorder primarily occurring in the lymph nodes. Extranodal disease can occur in skin and soft tissue, central nervous system, gastrointestinal tract, and breast. Here we present a case of a 55-year-old female with a history of hypertension, hyperlipidemia, and diabetes mellitus who presented with a fixed solid mass localized to the right medial thigh. Excision revealed S100 and CD 68 positive scattered lymphoid aggregates and emperipolesis, hallmark molecular and cytopathologic features of RDD. RDD is a nonmalignant, classically sporadic histiocytosis. Clinical outcome in terms of mortality seems to be favorable in most cases, however given the benign and slowly progressive nature of the disease, conservative management with observation is typical, with surgical excision recommended for larger lesions. Currently, therapy revolves around surgical and immunosuppressive treatments, but the optimal diagnostic and therapeutic management of RDD remains to be defined.

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Heparin Induced Thrombocytopenia (HIT) is a life threatening condition which is caused due to antibody formation following exposure to heparin or heparin products. It occurs due to the formation of Platelet Factor 4 antibodies (PF4). HIT is classified into 3 categories based on the duration between heparin exposure and onset of drop in platelet counts. A less common form of HIT is delayed onset HIT which occurs more than 9 days after exposure to heparin or heparin products. In this report we would like to present a rare case of delayed onset HIT which occurred in our patient who presented with rhabdomyolysis and Non ST elevation myocardial infraction (NSTEMI); which resulted in limb ischemia which needed to be treated by amputation of the affected area. We also highlight further management of patients who have thrombotic disease in the setting of HIT and review literature of how heparin or heparin products can be reintroduced in such patient who cannot be managed by other anticoagulation.

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