Multiple adult-onset xanthogranuloma, an uncommon diagnosis*

©2017 by Anais Brasileiros de Dermatologia Dear Editor, A 77-year-old Caucasian male patient was referred to our Service for presenting brownish and erythematous-violet papules (4 to 8 mm), located bilaterally in arms, armpits, lower abdominal quadrants and thighs (Figure 1). There was no involvement of the face, dorsal surface of the joints or mucous membranes. The lesions, which were always asymptomatic, had evolved progressively for ten months. At the general objective examination, there were no significant alterations, namely ophthalmologic, cardiopulmonary and neurological. No systemic semiology or relevant family history coexisted. Among the patient’s personal antecedents were major depression and anxiety disorder. Diagnoses of histiocytosis, particularly generalized eruptive histiocytoma, multiple adult xanthogranuloma (XGA), Erdheim-Chester disease and cutaneous metastases, were considered. The histopathological study of a lesion showed infiltration of the dermis and, in particular, of the hypodermis by histiocytes with foamy cytoplasm, accompanied by Touton cells, occasional lymphocytes and rare eosinophils (Figure 2). Infiltrate cells were CD68 positive and protein S100 and CD1a negative (Figure 3). No alterations were observed in the complementary evaluation, which included: hemogram with leukogram; blood biochemistry; electrophoretic proteinogram and serum immunofixation; urinalysis, diuresis monitoring and pituitary hormone study; skeletal radiography; electrocardiogram; respiratory function tests; cranioenchephalic and thoraco-abdominopelvic tomodensitometry studies.