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Cutaneous Hemophagocytic Lymphohistiocytosis Bean Bags From the Bone

Jillian W. Millsop, MD, MS1; Baran Ho, MD1; Maija Kiuru, MD, PhD1,2; Maxwell A. Fung, MD1,2; Victoria R. Sharon, MD, DTMH1
[+] Author Affiliations
1Department of Dermatology, University of California–Davis, Sacramento
2Department of Pathology, University of California–Davis, Sacramento
JAMA Dermatol. 2016;152(8):950-952. doi:10.1001/jamadermatol.2016.0978.
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This case report describes the role of histologic “bean bag cells” in the diagnosis of hemophagocytic lymphohistiocytosis.

We report a case of hemophagocytic lymphohistiocytosis (HLH) in which the histologic features of “bean bag cells” found in the skin biopsy specimen facilitated the diagnosis of this rare disorder.

Article InformationCorresponding Author: Victoria R. Sharon, MD, DTMH, Department of Dermatology, University of California–Davis, 3301 C St, Ste 1400, Sacramento, CA 95816 (vsharon@ucdavis.edu).

Published Online: May 18, 2016. doi:10.1001/jamadermatol.2016.0978.

Conflict of Interest Disclosures: None reported.

Previous Presentation: This case was presented at the 52nd Annual Meeting of the American Society of Dermatopathology; October 8, 2015; San Francisco, California.

Additional Contributions: We thank the patient and his parents for granting permission to publish this information.

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Figure 1.
Whole-Body Positron Emission Tomography–Computed Tomography (PET-CT) Scans

A, The initial PET-CT scan reveals abnormal foci of increased uptake in the bone marrow, mandible, scapulae, ribs, and pelvis, and diffuse uptake in the liver, lung, and kidneys. B, The PET-CT scan 3 months after admission reveals resolution of pulmonary, bone, and hepatic lesions.

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Figure 2.
Clinical Images

A, Right upper back with a pink plaque with overlying subtle scale. B, Left upper cutaneous lip with a pink papule and plaque without scale.

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Figure 3.
Hematoxylin-Eosin–Stained Biopsy Specimens From Left Upper Chest Lesion

A and B, Superficial and deep perivascular and perineural infiltrate of histiocytes and lymphocytes extending to the subcutis and vacuolar interface dermatitis without substantial epidermal alteration. B, At higher magnification, the “bean bag cells” characteristic of hemophagocytosis are apparent.

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