Eosinophilic granuloma: a case report

Abstract

Eosinophilic granuloma, a benign bone lesion, is usually seen in young adults under 22 years of age and children and is often confused with osteomyelitis, Ewing's tumor, tuberculosis of the bone, etc. The lesions may occur in any bone, but they are most frequently seen in the skull, ribs, vertebrae and long bones. Distribution, therefore, resembles that of multiple myeloma and secondary carcinoma. Since the roentgenogram may also be similar, mistakes in diagnosis may occur. The age incidence, on the other hand, is quite different from frequently confused conditions. The essential element in the lesion appears to be a sheet like collection of histiocytes, so that the disease can be regarded as a skeletal histiocytosis in nature similar to Schuller Christian and Letterer Siwe diseases, in spite of its benign course. In the event that the process remains localized, prognosis is excellent. Bone or subcutaneous lesions of eosinophilic granuloma may heal spontaneously or be cured either by surgical curetting or radiation. This patient, 22 years old, was brought to our attention because of fairly severe, persistent pain in the right upper arm. During clinical studies an area of bone destruction 2 to 3 cm in diameter was found in the right scapula. The lesion was interpreted as either a bone cyst or eosinophilic granuloma from the X ray. Upon surgical exposure, the soft, gray red tissue that filled the focus was biopsied and a pathological diagnosis of eosinophilic granuloma was made. The patient refused both further surgery and radiation therapy.