In LCH, involvement of the calvaria, skull base, maxillofacial bones, and hypothalamic-pituitary axis is fairly common. The precise location of these lesions contributes to the variety of clinical manifestations of LCH, which includes scalp and/or facial swelling, seizures, hearing loss, recurrent otitis media, gingival bleeding, proptosis, diabetes insipidus, and cranial nerve palsies.

15-YEAR-OLD male had a 4-month history of cough productive of blood-tinged sputum, low-grade fevers, night sweats, progressive left wrist pain, and a 40-lb weight loss. 1 Symptoms and radiographic findings of a right middle lobe pneumonia persisted despite multiple courses of antibiotics, including erythromycin, bactrim, and ciprofloxacin over the next 4 months. He was thought to have an asthmatic component to his respiratory symptoms and was prescribed a course of prednisone and albuterol without improvement. He developed worsening left wrist pain, stiffness, swelling, and dysfunction. Social and travel history was notable only for a brief visit to central Wisconsin 14

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