Rheumatology · Pediatrics · 3 h ago
Two pediatric cases highlight diagnostic challenges in multicentric reticulohistiocytosis
A report in *Clinical Rheumatology* describes two boys with multicentric reticulohistiocytosis (MRH), a rare disorder that can resemble juvenile idiopathic arthritis. Skin biopsies confirmed the diagnoses; both patients’ symptoms improved with tofacitinib, according to the authors.
- Two boys had biopsy-confirmed multicentric reticulohistiocytosis.
- Both had arthritis and atypical skin manifestations.
- Authors reported symptom improvement with tofacitinib.
- Treatment evidence is limited to two cases.
Multicentric reticulohistiocytosis (MRH) is a rare histiocytic disorder that usually affects middle-aged and older adults. In this two-case report and literature review, clinicians describe a 10.8-year-old boy with polyarthritis, coral-bead-like papules and subcutaneous nodules, and a 14-year-old boy previously diagnosed with systemic-onset juvenile idiopathic arthritis (JIA) and macrophage activation syndrome. The older boy had persistent atypical, pruritic rashes despite conventional and biologic therapies.
Skin biopsies confirmed MRH in both cases. The authors report that tofacitinib was effective in alleviating symptoms, but provide no quantitative outcome measures in the supplied text. They emphasize that MRH may be mistaken for JIA and that histopathology can help distinguish it from other conditions.
The cases suggest considering MRH when children have arthritis alongside unusual skin lesions, including when inflammatory markers are normal, and support biopsy to investigate atypical presentations. However, evidence for treatment is limited here to two cases; the report does not establish comparative efficacy or support broader conclusions about tofacitinib. Treatment decisions cannot be based on these observations alone.
In practice
In children with arthritis and atypical skin lesions, including coral-bead-like papules or persistent unusual rashes, MRH is a possible alternative to JIA; the authors recommend skin biopsy to investigate such presentations. Biopsy confirmed MRH in both reported boys, and the authors describe symptom improvement with tofacitinib. These observations come from only two cases, with no quantitative outcomes or comparative treatment data, and do not establish efficacy or justify changing treatment practice.
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Clinical Rheumatology: Multicentric reticulohistiocytosis in children: two case reports and a literature review ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.