• Tomoyuki Asano, Ken Suzutani, Aya Watanabe, Aki Honda, Natsumi Mori, Makiko Yashiro, Shuzo Sato, Hiroko Kobayashi, Hiroshi Watanabe, Momoko Hazama, Takashi Kanno, Eiji Suzuki, Shiro Ishii, and Kiyoshi Migita.
• Department of Rheumatology Department of Dermatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation, Nishinouchi, Koriyama Department of Radiology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan.
• Medicine (Baltimore). 2018 Aug 1; 97 (33): e11449e11449.

IntroductionMulticentric reticulohistiocytosis (MRH) is a rare histiocytic disorder that involves the skin, joints, and visceral organs.Case PresentationWe report a 67-year-old woman with MRH who presented with a 2-years history of polyarthralgia and skin nodules. Her symptoms were an inflammatory polyarthropathy with punched-out lesions of the distal interphalangeal (DIP) joints of both hands. Doppler ultrasonography of the hands showed large bone erosions with power Doppler signals in the DIP joints. F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) demonstrated increased FDG uptake in cutaneous papules surrounding the affected joints, suggesting an inflammatory process. There was no evidence of malignancy. Biopsy samples of skin nodules exhibited dermal infiltration with CD68-positive histiocytes and multinucleated giant cells. The patient was diagnosed with MRH and treated with combination therapy comprising a steroid (prednisolone), tacrolimus, methotrexate, and infliximab, which resulted in clinical improvement. Following infliximab treatment, there was a significant decrease in a bone resorption marker (tartrate-resistant acid phosphatase 5b: TRACP-5b), suggesting that tumor necrosis factor-α targeting therapy may inhibit osteoclast formation and resorption activity in patients with MRH.ConclusionMRH is a progressive destructive arthritic condition, and early diagnostic and therapeutic strategies are necessary to improve the outcome. FDG-PET/CT and joint ultrasonography might be noninvasive imaging modalities that could help diagnose MRH.

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