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Pediatric Oncall Journal

A 14 month old with seborrheic dermatitis and interstitial pneumonia.

A 14 month old with seborrheic dermatitis and interstitial pneumonia.

Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai.

Medical Sciences Department, Pediatric Oncall, Mumbai
Clinical Problem
Case Report:- A 14 month old boy born of non consanguineous marriage presented with cough and difficulty in breathing since 4 months, seborrheic dermatitis over scalp since 1½ month. He had multiple hospitalizations in past for recurrent respiratory tract infections and had received multiple antibiotics and antituberculous therapy (ATT). There was no history of contact with TB and birth history was uneventful. His milestones and immunization were upto date. On examination, he had weight of 7.5 kg and height of 75 cm. He had seborrheic dermatitis and hepatomegaly. On respiratory system examination, he had bilateral fine crepitations. Other examination findings were normal.

Investigations showed:
 Hemoglobin = 9.3 gm%
 WBC count = 23,100/cumm [65% polymorphs, 30% lymphocytes, 5% eosinophils]
 Platelet count = 4,55,000/cumm
 SGOT = 61 IU/L, SGPT = 40 IU/L
 S. calcium, phosphorus, alkaline phosphatase = Normal
 S. LDH = 721 IU/L
 Chest X-Ray = Bilateral interstitial pneumonitis
 CT Chest = Ground glass opacities in both lung fields move in upper lobes
 ABG = No hypoxia
 Gastric lavage = No Acid fast bacillus, No fungus
 Bronchoalveolar lavage = No bacteria, Acid fast bacillus, PCP
 Blood culture = Staphylococcus albus coagulase negative.
 S. immunoglobulins = Normal

What is the diagnosis ? How to investigate further ?
Expert’s opinion :-Dr Ira Shah
This child has interstitial pneumonia with hepatomegaly. Cultures are negative (Staphylococcus albus coagulase negative may be a contaminant). Thus infection does not seem to be the cause of the problems in this child. The clue to the diagnosis is the seborrheic dermatitis. This is commonly seen with Langerhans histiocytosis (LCH). Patients with acute disseminated LCH (multiorgan involvement) present with fever; anemia; thrombocytopenia; pulmonary infiltrates; skin lesions; and enlargement of the lymph nodes, the spleen, and the liver. Cutaneous abnormalities are present in almost 80% of patients. The eruption may be extensive, involving the scalp, the face, the trunk, and the buttocks as well as the intertriginous areas. Lesions consist of closely set petechiae and yellow-brown papules topped with scale and crust. The papules may coalesce to form an erythematous, weeping eruption mimicking seborrheic dermatitis. Thus in this child a skin biopsy will be required to look for Langerhans cells. In this child, skin biopsy proved the diagnosis of Langerhans cell histiocytosis.
Compliance with ethical standards
Funding:  None  
Conflict of Interest:  None
Cite this article as:
Shah I. A 14 month old with seborrheic dermatitis and interstitial pneumonia. Pediatr Oncall J. 2007;4: 25.
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