Management of polyostotic eosinophilic granuloma

Abstract

Eosinophilic granuloma is a rare disease which is difficult to diagnose clinically and radiographically. Localized Langerhans' cell histiocytosis, previously known as eosinophilic granuloma, mainly affects the skull, mandible, vertebrae, pelvis and ribs in children and the long bones of adults. We present a case report of a female who developed pain and swelling over the left mandibular region, and was later diagnosed as eosinophilic granuloma, which after administration of intralesional corticosteroid with surgical enucleation showed positive response. This disease is of importance to dental professionals because early clinical signs can occur in the jaw and can cause extensive destruction of the periodontal tissues and bone. The purpose of this case report is to describe a case of eosinophilic granuloma with emphasis on conservative approach for the treatment and the radiographic changes observed during and after the treatment.

Keywords: Adrenal cortex hormones; Langerhans’ cell histiocytosis; eosinophilic granuloma.

Figure 1

Old orthopantomogram depicting osteolytic lesions in the left mandibular posterior and anterior part in the year 2007

Figure 2

Orthopantomogram showing increase in the radiolucency and the size of the lesions after two years (2009)

Figure 3

Histopathological picture showing predominantly mononuclear cells with clefted nuclei and granular cytoplasm admixed with eosinophils, neutrophils and lymphocytes

Figure 4

Immunohistochemistry showing that histiocytic cells were positive for the CD 68

Figure 5

Immunohistochemistry showing that histiocytic cells were positive for the CD 1A

Figure 6

Immunohistochemistry showing that histiocytic cells were positive for the S-100 protein

Figure 7

Computed tomography scan

Figure 8

A separate well-defined new radiolucent lesion observed distal to the left mandibular first molar

Figure 9

Post-treatment orthopantomogram showing complete bone formation distal to the left mandibular first molar