Pressure Bandage as an Effective Treatment for Intralymphatic Histiocytosis Associated with Rheumatoid Arthritis

Abstract

The patient is a 71-year-old male who has been suffering from rheumatoid arthritis for over 20 years. He first noticed the erythema on his right forearm in 2008, which got worse in 2009. Topical corticosteroids were not effective, and a skin biopsy was performed. Histopathologic examination showed aggregation of the inflammatory cells in the dermal vessels. Those cells were positive for CD68 and CD31 and all the surrounding vessels expressed D2–40 and CD31. We diagnosed him with intralymphatic histiocytosis. One week after the skin was biopsied, only the part of the erythematous lesion covered by skin tape had improved, suggesting that pressure on the lesion might improve the erythematous eruption. We therefore used a pressure bandage elbow supporter in addition to topical treatment. The lesion improved 3 months later and was totally diminished after 9 months. Combined with previously reported cases, our case suggested that intralymphatic histiocytosis is closely related to lymphostasis.

Indication for Random Skin Biopsy for the Diagnosis of Intravascular Large B Cell Lymphoma

“…Another disorder that should be ruled out is intralymphatic histiocytosis, known as a rare complication of long-lasting rheumatoid arthritis [15]. The dilated lymphatic vessels contain agglomerations of histiocytes within their lumina.…”

Intralymphatic Histiocytosis: A case report and review of literature

“…Similarly, intralymphatic histiocytosis associated with breast cancer occurred over mastectomy scar . These findings suggest that lymphatic vessel engorgement by histiocytes migrating from neighboring inflammatory reactions may play a key pathogenic role . Lymphostasis may lead to poor clearance of antigen, localized immune dysfunction, and persistent inflammation which may contribute to stimulation of histiocytes to proliferate and aggregate in the lymphatic vessels .…”

“…In patients with RA, osteoarthritis or metal implantation, cutaneous lesions were located on the skin adjacent or overlying the affected joints . Similarly, intralymphatic histiocytosis associated with breast cancer occurred over mastectomy scar .…”

Cutaneous Reactive Angiomatosis with Combined Histological Pattern Mimicking a Cellulitis

“…CRA has often been described in association with many different systemic or local diseases such as rheumatoid arthritis, bacterial endocarditis, cryoproteinemia, lymphoproliferative disorders, peripheral atherosclerosis, or an arteriovenous shunt [10,11] (table 1). …”