title: Necrobiotic xanthogranuloma treated with chlorambucil.
abstract: We report a case of necrobiotic xanthogranuloma that responded to treatment with chlorambucil. A 56-year-old man presented with a 5-year history of multiple, mildly pruritic, brown-to-violaceous plaques with central ulceration and atrophy involving the periorbital area, extremities, and trunk. Laboratory studies showed mild leukopenia and a monoclonal gammopathy of the IgG lambda type on serum protein immunoelectrophoresis. Histopathological evaluation revealed a dense histiocytic infiltrate with hyaline necrobiosis involving the dermis with extension to the subcutis. Multiple large multinucleated giant cells and scattered lymphocytes were seen. A diagnosis of necrobiotic xanthogranuloma was established. The patient was started on chlorambucil initially at 2 mg per day. The dose was later increased to 4 mg per day, which resulted in flattening and complete resolution of his skin lesions.
authors.affiliation: University of California Davis, Department of Dermatology, USA. sima.torabian@ucdmc.ucdavis.edu
authors.forename: Sima Z
authors.initials: SZ
authors.lastname: Torabian
authors.forename: Nasim
authors.initials: N
authors.lastname: Fazel
authors.forename: Robin
authors.initials: R
authors.lastname: Knuttle
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D002699:Chlorambucil / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006099:Granuloma / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014973:Xanthomatosis / Q000188:drug therapy / Q000473:pathology*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002699:Chlorambucil