title: Successful multimodality treatment of recalcitrant necrobiotic xanthogranuloma using electron beam radiation and intravenous immunoglobulin.
abstract: Necrobiotic xanthogranuloma (NXG) is a rare dermatosis with a poorly understood pathophysiology. Studies comparing treatments for such lesions are limited. We present the case of a patient with a 30-year history of NXG refractory to several individual therapeutic interventions [excision, intravenous immunoglobulin (IVIg), systemic chemotherapies and immunosuppressants, cryotherapy and laser therapy], who ultimately responded to a combination of treatment with electron beam radiation therapy (EBRT) in conjunction with IVIg. This combined treatment resulted in flattening of the NXG lesions and a reduction of symptomatic pruritus within the treatment zone. EBRT may represent a potent treatment for NXG, and formal trials evaluating its effectiveness may yield insights into the management of NXG.
authors.affiliation: Department of Dermatology, Lahey Hospital and Medical Center, Burlington, MA, USA.|Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: V E
authors.initials: VE
authors.lastname: Nambudiri
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA.
authors.forename: C
authors.initials: C
authors.lastname: McLaughlin
authors.affiliation: Department of Radiation Oncology, Lahey Hospital and Medical Center, Burlington, MA, USA.
authors.forename: T C M
authors.initials: TC
authors.lastname: Lo
authors.affiliation: Department of Pathology, Lahey Hospital and Medical Center, Burlington, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Zembowicz
authors.affiliation: Department of Dermatology, Lahey Hospital and Medical Center, Burlington, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Moschella
mesh_terms: D003131:Combined Modality Therapy; D004583:Electrons / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D058252:Necrobiotic Xanthogranuloma / Q000628:therapy*; D011878:Radiotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors