'Beneath the Surface': When a Child's Head Swelling Reveals More

Abstract

Presentation
A 6.5-month-old male infant presented with a progressively enlarging, firm, non-mobile left parietotemporal swelling. Parents reported a minor head impact a week prior. He also had recurrent eczematous dermatitis resistant to treatment. Examination revealed a hemodynamically stable infant with normal neurological findings.

Diagnosis
Laboratory tests showed bicytopenia and elevated CRP. Neuroimaging detected multifocal lytic skull lesions, and abdominal ultrasound revealed hepatic nodules, suggesting systemic involvement. Histopathology confirmed Langerhans Cell Histiocytosis (LCH), a rare histiocytic disorder.

Treatment
Given multisystem involvement, chemotherapy was initiated with two drugs. The patient is under oncology follow-up for further management.

Discussion
LCH results from abnormal Langerhans cell proliferation and affects multiple organs. Diagnosis requires histopathology and immunophenotyping. Treatment varies based on severity, with systemic therapy for multisystem cases. Prognosis depends on age and organ involvement, with younger patients and high-risk organ disease having poorer outcomes.