A 50-year-old army man had a six-month history of severe debilitating pain in multiple joints. He also had nodular, itchy skin rashes for four months. These features were associated with loss of appetite, ulcers in the mouth, and significant weight loss. Various joints - including small hand joints, wrists, elbows, shoulders, knees, and ankles - were swollen, tender, restricted, and deformed. There were multiple discrete but grouped reddish-brown nodules of varying sizes (2mm-2cm) over the lower abdomen, face, forearms, back, buttocks, knees, and ankles. Biopsy of skin lesions confirmed clinical diagnosis of multicentric reticulohistiocytosis. Aggressive therapy with zoledronate and methotrexate was instituted. Pain reduced after three months and skin lesions, too, started settling down. At the end of One year, deformities persist and skin lesions, though milder, keep on cropping up intermittently.
Multicentric reticulohistiocytosis is a rare disease with destructive arthritis and skin lesions. The condition can involve other organs and may be associated with underlying malignancy. The exact cause of the disease remains unknown, and various drugs seem to offer very limited benefits. The disease can remain active for a prolonged period. (8 or more years) often leaving the patient with crippling and deformed joints.
