title: Treatment of recurrent eosinophilic granuloma with systemic therapy.
abstract: OBJECTIVE
  To describe the systemic treatment of recurrent eosinophilic granuloma.
  
  
  METHODS
  Case report and review of Langerhans cell histiocytosis.
  
  
  RESULTS
  A 9-year-old boy had painful, right upper eyelid swelling. A computed tomography scan showed a right superolateral orbital mass with evidence of bony erosion. Frozen section evaluation was consistent with eosinophilic granuloma. Biopsy and curettage were performed. Systemic work-up was negative for extraorbital disease. Recurrence of the orbital mass 6 weeks after surgery was confirmed by magnetic resonance imaging (MRI). Four weeks after treatment with prednisone and vinblastine, MRI showed a marked decrease in the size of the orbital lesion. Additional treatment with 6-mercaptopurine and methotrexate was initiated, and MRI 6 months later showed complete resolution of the lesion.
  
  
  CONCLUSIONS
  The treatment of recurrent eosinophilic granuloma is challenging. The goal is to effectively cure the lesion with minimal short-term and long-term side effects. Systemic steroids, vinca alkaloids, antimetabolites, and antifols are preferred because they have less toxicity and mutagenicity. Combination chemotherapy used in conjunction with treatment by a pediatric hematologist/oncologist appears to be an effective method of treating recurrent disease.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, U.S.A. alice-song@uiowa.edu
authors.forename: Alice
authors.initials: A
authors.lastname: Song
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Johnson
authors.forename: Sander R
authors.initials: SR
authors.lastname: Dubovy
authors.forename: Stuart
authors.initials: S
authors.lastname: Toledano
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D004359:Drug Therapy, Combination; D004803:Eosinophilic Granuloma / Q000175:diagnosis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use*; D012008:Recurrence; D014747:Vinblastine / Q000627:therapeutic use*; D014965:X-Rays
chemical_list: D005938:Glucocorticoids; D014747:Vinblastine; D015122:Mercaptopurine; D011241:Prednisone