Langerhans Cell Histiocytosis Presented as Generalized Vesiculo-Pustules in a Neonate

A one-month-old female baby had been noted to have multiple vesicles and pustules over the head, face, trunk and four extremities since she was one-week-old. Under the impression of disseminated herpes virus infection, intravenous acyclovir was given after admission. Serum herpes simplex virus and varicella zoster virus enzyme-linked immunosorbent assay test and virus culture were all fruitless, although herpes simplex virus-1 was vaguely identifi ed in direct fl uorescent staining of lesion scrapings. Unfortunately, new lesions still continued popping out despite treatment. Dermatologist was then consulted, and Tzanck smear as well as skin biopsy were performed. The histopathological exam showed Langerhans cell histiocytosis. Skull x-ray fi lm showed expansile osteolytic lesion over the left parietal area and the chest x-ray increased reticulonodular infi ltration in both lung fi elds. There was no abnormal fi nding in the long bone survey or abdominal sonography. In summary, we report a case of neonatal Langerhans cell histiocytosis presenting as generalized vesiculo-pustules. It should be differentiated from herpes virus infection in the clinical setting. (Dermatol Sinica 27: 176-180, 2009)