Granuloma eosinófilo costal solitario en edad excepcional. Reporte de un caso y revisión de la literatura

Resumo

The eosinophilic granuloma (EG) is a non- neoplasic solitary proliferation, is part of a spectrum of Langerhans histiocytosis, formerly known as histiocytosis X. It is a rare disease with predominant involvement in males during childhood and adolescence, It can affect one or multiple bones, skull, long bones , ribs, vertebrae and jaw. We present the case of a 30 year old patient, with no relevant history of previous disease. The patient reffered intense pleuritic pain in the left hemithorax during the last three months, refractory to analgesic treatment. Physical examination of the chest, showed increased volume at the left posterior sixth costal arch. Laboratory tests in the normal range. A chest x-ray image showed a defect in the outer corner of the sixth (6th) left costal arch, of lytic appearance with apparent tenting of the periosteum and loss of bone substance. A study was performed with a chest tomograph multidectector, which showed a space-occupying lesion affecting the sixth (6th) left costal arch, with a hypodense central portion of osteolytic appearence. A Full Survey bony chest and static body scan showed a focus of abnormal radiotracer accumulation with discrete expansive and deforming behavior in the sixth (6th) left posterior costal arch, no significant changes in the rest of the skeleton. An excisional biopsy was performed by means of a thoracostomy. Immunohistological analysis showed the presence of an Eosinophilic Granuloma Langerhans Cell Histiocytosis.