Erdheim-Chester Disease ECD
Erdheim-Chester disease is a rare form of non-Langerhans-Cell Histiocytosis. It involves the excessive production of histiocytes, which are a type of white blood cell. These cells, which normally help fight infection and injury, then gather in different organs and tissues and can result in a variety of symptoms, including organ failure.

 

Erdheim-Chester is a disease that most often becomes apparent in middle age, with an average age at onset of 53 years. It can affect men and women. The rate of occurrence is not known, although it is believed to be under-diagnosed and/or misdiagnosed. At the present time, it is not categorized as a cancer, immune disorder, or infection. It is not believed to be contagious or hereditary. The cause is not known although some cases have the BRAF V600E mutation also found in LCH and cancers such as melanoma and thyroid cancer.

The first two cases of ECD were reported by scientists Jakob Erdheim and William Chester in 1930. In 1972, Dr. Ronald Jaffe reported a third case and coined the name Erdheim-Chester disease (ECD).

This disease mostly affects long bones (arms and legs), but it can occur in the tissues behind the eyeballs, kidney, skin, brain, lung, heart, pituitary gland, and a part of the posterior abdominal wall called the retro peritoneum. Erdheim-Chester is sometimes mistaken for Langerhans Cell Histiocytosis. However, a biopsy of the affected tissue differs in a number of ways from LCH and can establish a definite diagnosis. The cells in ECD stain for the same proteins as Juvenile Xanthogranuloma (JXG) but the clinical presentation and age is different. The symptoms and course of the disease depend on the location and extent of the involvement of the internal organs (i.e. the disease outside the bones).

Because this is a very rare disease, no large studies have been performed, and no treatment plan has been established that is widely accepted. However, various treatments have been used with limited success. These include steroids, immunotherapy (treatment to restore the ability of the immune system such as interferon), chemotherapy to control the over-production of cells, the use of high-energy rays (radiation therapy), and/or surgery. Some patients with the BRAF V600E have been treated with Vemurafenib, which targets this mutation. While these treatments may control the symptoms and growth of the disease, there is no known “cure.”

Erdheim Chester can be life-threatening with complications such as heart failure, severe damage to the lungs, and kidney failure. However, with treatment, there are patients who are able to live a near-normal life.

Please be advised that all the information you read here is not a replacement for the advice you will get from your consultant and their team.

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The questions below specifically relate to Erdheim-Chester Disease (ECD).
Erdheim-Chester Disease

1. What causes Erdheim-Chester Disease (ECD)?
Erdheim Chester disease involves the excessive production of histiocytes, which are a type of white blood cell. What causes over-production of these cells is not yet known, although some cases have the BRAF V600E mutation also found in LCH and cancers such as melanoma and thyroid cancer.

2. Is there a cure for Erdheim-Chester Disease?
The best treatments available today may control and sometimes shrink the tumors associated with the disease. However, we usually don’t use the term “cure” for this disease, since no specific amount of time without active disease has been established to determine that a patient is cured.

3. What are the different therapies/treatments commonly used to treat Erdheim-Chester Disease?
To date, there is no universally accepted treatment for Erdheim Chester. Various treatments, however, have been used with variable success. These include steroids, interferon, radiation, surgery, and chemotherapy such as vinblastine, vincristine, Cytoxan (cyclophosphamide), Adriamycin (doxorubicin), and 2CdA (cladribine). Other drugs have also been including Vemurafenib, which targets the BRAF V600E mutation.

4. Can an infant be tested at birth for ECD?
No, a biopsy of the affected tissue, rather than a blood test, is required for diagnosis and unless the patient has a lesion this could not be performed.

Please be advised that all the information you read here is not a replacement for the advice you will get from your consultant and their team.

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What are the possible side effects of interferon?

More common signs/symptoms include:
a. Flu-like symptoms (Fever, chills, headache, dizziness, fatigue, muscle aches, nausea, vomiting, diarrhea)
b. Irritability/depression Decreased appetite
c. Irregular heart rate
d. Decreased blood counts (red cells, white cells, and clotting cells)
e. Liver abnormalities

What are the possible side effects of 2-CdA (cladribine /leustatin)?

More common signs/symptoms include:
a. Flu-like symptoms (Fever, chills, headache, fatigue, nausea/vomiting)
b. Decreased appetite
c. Constipation
d. Low blood counts (red cells, white cells, and clotting cells)
e. Skin rash/redness/itching

Please be advised that all the information you read here is not a replacement for the advice you will get from your consultant and their team.

Help ensure that we can continue to bring you this vital informational material, make a donation today

Erdheim-Chester disease Newsfeed

pubmed: erdheim chester dise...

NCBI: db=pubmed; Term=erdheim chester disease

Related Articles

[Clinical and pathological characteristics of Erdheim-Chester disease involving the lungs].

Zhonghua Jie He He Hu Xi Za Zhi. 2017 Aug 12;40(8):604-610

Authors: Lu T, Wang S, Huang H, Wang T, Wang M, Zhong DR, Feng RE

Abstract
Objective: To explore the clinical manifestations, pathological features, differential diagnosis and gene mutation status in patients with pulmonary involvement of Erdheim-Chester disease (ECD). Methods: The clinical data of 4 cases of Erdheim-Chester disease admitted to Peking Union Medical College Hospital from October 2014 to August 2016 were examined for imaging, microscopic and immunohistochemitry findings, and BRAFV600E mutation. The related literatures were reviewed. Results: Among the 4 cases, there were 3 males and 1 female, aging from 7 to 47 years, and the average age was 34.5 years. They complained of chest tightness, shortness of breath and bone pain. They all had multiple bone lesions, involving the long bones, skulls and vertebrae, and imaging showed increased bone uptake and bone sclerosis. CT scan showed pleural thickening or pleural effusion(4/4), widened lobular septa(3/4), bronchial vascular bundle thickening(3/4), multiple patchy ground glass and solid shadows(4/4), and cystic shadows(1/4). Multiple bone lesions were the main extrapulmonary manifestations. All the cases had multiple bone lesions, involving the long bones, skulls and vertebrae, and showed increased bone uptake and bone sclerosis. Surgical biopsy of the thoracic tissue was performed in all 4 cases (pleural in 1 case, lung in 2, anterior mediastinal mass in 1). Microscopically, the lesion was composed of spindle-shaped fibroblasts and foamy histiocytes enmeshed in reactive fibrous tissue. Lymphocytes and plasma cells were also found. Immunohistochemically, all the histiocytes were positive for CD(68), and none of them expressed CD1a. All cases were detected by real-time quantitative PCR for BRAFV600E gene mutation. Conclusions: The pulmonary involvement of Erdheim-Chester disease is rare, with clinical manifestations of chest tightness, shortness of breath, and some have no obvious respiratory symptoms. Pulmonary involvement in Erdheim-Chester disease has important manifestations, in which foam-like tissue cells with diffuse distribution along the lymphatic enmeshed in reactive fibrous tissue. It should be differentiated from diffuse interstitial lung diseases and metastatic tumors. The clinical features are often manifested as pleural thickening and pleural effusion, with multiple bone sclerosis lesions.BRAFV600E mutation detection is helpful for the diagnosis.

PMID: 28810314 [PubMed - in process]

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