Langerhans cell histiocytosis in children with refractory diarrhoea and hypoalbuminaemia as the initial presentation: two case reports and a literature review

Table 1 The investigations conducted in both patients

		Patient 1	Patient 2
Characteristics	Age, m	18	14
Characteristics	Gender	Female	Female
Main syndromes		Diarrhoea; intermittent fever	Diarrhoea; intermittent fever
Physical examination		A few erythaematous lesions on abdomen	Many erythaematous lesions on abdomen
Laboratory indices	Main abnormal index	Haemoglobin: 87 g/L Albumin: 15.7 g/L	Haemoglobin: 92 g/L Albumin: 22 g/L
	Stool tests	Occult blood +, WBC 0–2/HP	Occult blood +, WBC 0–1/HP
	Routine urinalysis	Negative	Negative
	Serum infection indicators	Negative	WBC count 19.84 × 10⁹/L, Neutrophils 6.5 × 10⁹/L Procalcitonin 1.77 ng/mL,
	Pathogen (T-SPOT, EBV, CMV, HIV, C. difficile)	Negative	Negative
	liver enzymes	Negative	Negative
	renal function	Negative	Negative
Pituitary MRI		Negative	Negative
Bone marrow examination		Negative	S100 and CyclinD1 histiocytes infiltrated
Endoscopy	Gastroenteroscopy	Erosion and narrowing of the duodenum, with white-tipped villi resembling snowflakes in small intestinal mucosa	Rough musosa in small intestine and atrophied villi
Endoscopy	Colonoscopy	Multiple haemorrhagic spots and oedema in the colonic mucosa	Oedema in the colonic mucosa
Biopsy		Langerhans cells, and immunohistochemical assessment revealed CD1a and Langerin	Langerhans cells, and immunohistochemical assessment revealed S100, Vim, CD1a, CyclinD1 and Langerin
Positron emission tomography -CT		Bone and pneumonia were involved	Liver and bone marrow were involved

CRP C-reactive protein, WBC white blood cell, EBV Epstein–Barr virus, CMV cytomegalovirus, HIV human immunodeficiency virus, C. difficile Clostridium difficile, MRI magnetic resonance imaging

ISSN: 1471-2431