Langerhans cell histiocytosis physical examination

Physical Findings
Organs involved:
 * Bone: Most frequent in both unifocal and disseminated disease presenting as painful swelling. Skull, long bone of upper extremity, flat bones are affected in descending order. Infiltration in hands and feet is unusual. Osteolytic lesions can lead to pathological fractures.
 * Skin: Commonly present as rash which varies between scaly erythematous lesions to red papules pronounced in intertriginous areas. Up to 80% of LS would have extensive eruptions on the scalp.
 * Bone marrow : Pancytopenia with super added infection usually implies poor prognosis. Anemia can be due to number of factors and not necessarily implies bone marrow infiltration.
 * Lymph node: cervical commonest. enlargement of the liver in 20%, spleen in 30% and lymph nodes in 50% of HSC.
 * Endocrine glands:Hypothalamic pituitary axis commonly involved. Diabetes insipidus most common. Anterior pituitary hormone deficiency is usually permanent.
 * Lungs:
 * Less frequently GIT, CNS.