Modern Pediatrics. Ukraine. (2023). 1(129): 72-86. doi 10.15574/SP.2023.129.72
Дорош О. И.^1,2, Петрончак О. А.³, Масинник Ю. С.⁴, Гулей Р. В.³, Дудаш А. П.³, Фэш Н. А.³, Тимчишин С. М.¹, Литвин Г. О.^2
1 КНП Львовского областного совета «Западноукраинский специализированный детский медицинский центр», Украина
² Львовский национальный медицинский университет имени Данилы Галицкого, Украина
³ ООО «Западноукраинская гистологическая лаборатория», г. Львов, Украина
⁴ Центр медицинских инноваций «NOVO», г. Львов, Украина

Для цитирования: Dorosh OI, Petronchak OA, Masynnyk YuS, Guley RV et al. (2023). Langerhans cell histiocytosis in a child with multisystemic lesions associated with infected poliomyelitis and SARS-CoV-2, features of diagnostics. Clinical case. Modern Pediatrics. Ukraine. 1(129): 72-86. doi 10.15574/SP.2023.129.72.
Статья поступила в редакцию 30.11.2022 г., принята в печать 07.02.2023 г.

Лангергансоклеточный гистиоцитоз (ЛКГ) — редкое заболевание, морфологической основой которого является клональная пролиферация патологических клеток Лангерганса. Клинические проявления ЛКГ колеблются от локализованных форм с доброкачественным течением и спонтанным выздоровлением до мультисистемного поражения с тяжелым течением и летальным исходом. В патологический процесс могут вовлекаться любые органы и системы в разном сочетании (моно- и мультисистемное поражение). Для пациентов с мультисистемной формой ЛКГ и привлечением органов риска (печени, селезенки, костного мозга) характерны отрицательный ответ на стандартную терапию и неблагоприятный прогноз. Поражение кожи является классическим признаком ЛКГ.
Цель — описать сложность и продолжительность диагностики ЛКГ с мультисистемным поражением у мальчика в возрасте 2 года 2 месяца, инфицированного полиомиелитом и коронавирусом.
Клинический случай. Первые клинические проявления ЛКГ у ребенка дебютировали экзематозно-себорейной сыпью волосистой части головы с распространением на конечности, туловище. Ребёнка лечили по месту жительства от токсикодермии, геморрагического васкулита в течение 6 мес. Мальчик потерял 1,5 кг в массе тела за 1 мес. На момент госпитализации наблюдались себорейно-экзематозные высыпания на коже с геморрагическим компонентом, трофически-воспалительные изменения ногтей рук, признаки белково-энергетической недостаточности, стоматит, гингивит, гепатоспленомегалия, полисерозит, несахарный диабет. По результатам анализов: анемия, тромбоцитопения, гипопротеин- и гипоальбуминемия, коагулогические расстройства. У пациента наблюдалось появление нижнего вялого парапареза, мышечная гипотония, ребенок перестал удерживать голову, не мог сидеть. У мальчика диагностирован ряд инфекционных осложнений, в т.ч. полиомиелит (дериват вакцинного полиовируса типа 2 (VDPV2)), коронавирусная болезнь 19 (COVID-19). Ребенок получил цитостатическую терапию LCH III с положительным эффектом.
Ввиду низкого охвата детского населения в Украине прививками при наличии параличей или парезов у детей следует обязательно проводить лабораторное обследование на наличие полиовирусов в фекалиях. Медицинскому сообществу следует пропагандировать необходимость проведения обязательных профилактических прививок детям.
Исследование выполнено в соответствии с принципами Хельсинкской декларации. На проведение исследований получено информированное согласие пациента.
Авторы заявляют об отсутствии конфликта интересов.
Ключевые слова: лангергансоклеточный гистиоцитоз, полиомиелит, коронавирусная инфекция (SARS-CoV-2/СOVID-19), цитостатическая терапия, дети.
ЛИТЕРАТУРА

1. Abdull Gaffar B, Awadhi F. (2020). Oral manifestations of Langerhans cell histiocytosis with unusual histomorphologic features. Ann Diagn Pathol. 47: 151536. https://doi.org/10.1016/j.anndiagpath.2020.151536; PMid:32454442

2. Ahuja A, Uppe A, Nair G. (2018). Multisystem Involvement of Langerhans Cell Histiocytosis. J Assoc Physicians India. 66 (4): 75-76.

3. Aricò M, Astigarraga I, Braier J, Donadieu J, Gadner H, Glogova E et al. (2015). Lack of bone lesions at diagnosis is associated with inferior outcome in multisystem langerhans cell histiocytosis of childhood. Br. J. Haematol. 169: 241-248. https://doi.org/10.1111/bjh.13271; PMid:25522229

4. Aydillo T, Gonzalez-Reiche AS, Aslam S, van de Guchte A, Khan Z, Obla A et al. (2020). Shedding of Viable SARS-CoV-2 after Immunosuppressive Therapy for Cancer. N Engl J Med. 383: 2586-2588. https://doi.org/10.1056/NEJMc2031670; PMid:33259154 PMCid:PMC7722690

5. Baillet A, Grange L, Lafaix PA, Gaudin P, Juvin R. (2007). Radiculopathy as a manifestation of Langerhans' cell histiocytosis. Joint Bone Spine. 74 (2): 190-193. https://doi.org/10.1016/j.jbspin.2006.05.013; PMid:17344085

6. Bano S, Chaudhary V, Narula MK, Anand R, Venkatesan B, Mandal S, Majumdar K. (2014). Pulmonary Langerhans cell histiocytosis in children: a spectrum of radiologic findings. Eur J Radiol. 83 (1): 47-56. https://doi.org/10.1016/j.ejrad.2013.04.044; PMid:23769766

7. Barbui T, Iurlo A, Masciulli A, Carobbio A, Ghirardi A, Rossi G et al. (2021). Long-term follow-up of recovered MPN patients with COVID-19. Blood Cancer J. 11: 115.

8. Barclay M, Devaney R, Bhatt JM. (2020). Paediatric pulmonary Langerhans cell histiocytosis. Breathe (Sheff). 16 (2): 200003. https://doi.org/10.1183/20734735.0003-2020; PMid:32684994 PMCid:PMC7341617

9. Center for Public Health of the Ministry of Health of Ukraine. (2022). In 2021 the level of vaccination coverage of children against poliomyelitis was 80%. URL: https://phc.org.ua/news/u-2021-roci-riven-okhoplennya-scheplennyami-ditey-proti-poliomielitu-buv-80.

10. Cesaro S, Ljungman P, Mikulska M, Hirsch HH, von Lilienfeld-Toal M, Cordonnier C et al. (2022). Recommendations for the management of COVID-19 in patients with haematological malignancies or haematopoietic cell transplantation, from the 2021 European Conference on Infections in Leukaemia (ECIL 9). Leukemia. 36: 1467-1480. https://doi.org/10.1038/s41375-022-01578-1; PMid:35488021 PMCid:PMC9053562

11. Coronavirus Pandemic (COVID-19). (2022). Coronavirus country by country. URL: https://ourworldindata.org/coronavirus#coronavirus-country-profiles.

12. Czyzewski K, Galazka P, Zalas-Wiecek P, Gryniewicz-Kwiatkowska O, Gietka A, Semczuk K et al. (2019). Infectious complications in children with malignant bone tumors: a multicenter nationwide study. Infect Drug Resist. 12: 1471-1480. https://doi.org/10.2147/IDR.S199657; PMid:31213862 PMCid:PMC6549759

13. Dhar S, Srinivas SM, Dhar S, Basu S, Banerjee R, Malakar R et al. (2020). Langerhans cell histiocytosis in children: A retrospective case series of 126 cases. Pediatr Dermatol. 37 (6): 1085-1089. https://doi.org/10.1111/pde.14389; PMid:32981115

14. Donadieu J, Héritier S. (2017). Child Langerhans cell histiocytosis. Presse Med. 46 (1): 85-95. https://doi.org/10.1016/j.lpm.2016.09.013; PMid:28087208

15. Dorosh O, Masynnyk J, Tsymbalyuk-Voloshyn I. (2021). Features of the Course of Herpes Encephalitisin a Child with Acute Lymphoblastic Leukemia in Remission. Abstract Number: 543. Conference: 53rd Congress of the International Society of Paediatric Oncology (SIOP 2021). Honolulu, Hawaii, USA. Pediatric Blood & Cancer Journal (PBC). 68 (S5): 452-453. https://doi.org/10.1002/pbc.29349; PMid:34662504

16. Dorosh OI, Tsymbaluk-Voloshyn IP, Polishchuk RS, Dubey LYa, Vorobel OI, Kozlova OI et al. (2014). Langerhans Cells Histiocytosis: Features of Clinical and Laboratory Manifestations and the Course of the Disease. Zdorov'e rebenka. 5 (56): 40-49. URL: https://doaj.org/article/000c9c2670064f36962ba9e0407b25d5. https://doi.org/10.22141/2224-0551.5.56.2014.76242

17. Efremova EV, Vasil'chev AV, Shutov AM, Podusov AS, Troshina IYu, Timofeev AA. (2019). Case of Gullian-Barre. Syndrome in a Pftient with Pulmonary Langerhans Cell Hystiocytosis. Аrkhiv vnutrennei meditsyny. 9 (5): 399-402. https://doi.org/10.20514/2226-6704-2019-9-5-399-402

18. Emile JF, Abla O, Fraitag S, Horne A, Haroche J, Donadieu J et al. (2016). Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages. Blood. 127: 2672-2681. https://doi.org/10.1182/blood-2016-01-690636; PMid:26966089 PMCid:PMC5161007

19. Gadner H, Minkov M, Grois N, Potschger U, Thiem E, Arico M et al. (2013). Therapy prolongation improves outcome in multisystem Langerhans cell histiocytosis. Blood. 121: 5006-5014. https://doi.org/10.1182/blood-2012-09-455774; PMid:23589673

20. Gargano F, Welch JJ, Klinge PM, Sullivan SR, Taylor HO. (2019). Langerhans Cell Histiocytosis in the Pediatric Population: Treatment of Isolated Craniofacial Lesions. J Craniofac Surg. 30 (4): 1191-1193. https://doi.org/10.1097/SCS.0000000000005249; PMid:31166264

21. Glenthøj A, Jakobsen LH, Sengeløv H, Ahmad SA, Qvist K, Rewes A et al. (2021). SARS-CoV-2 infection among patients with haematological disorders: severity and one-month outcome in 66 Danish patients in a nationwide cohort study. Eur J Haematol. 106: 72-81. https://doi.org/10.1111/ejh.13519; PMid:32939853

22. Gómez-De Lara JL, Rodríguez-Paz CA. (2021). Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960). Rev Med Inst Mex Seguro Soc. 59 (6): 585-590.

23. Grois N, Prayer D, Prosch H et al. (2005). Neuropathology of CNS disease in Langerhans cell histiocytosis. Brain. 128 (4): 829-838. https://doi.org/10.1093/brain/awh403; PMid:15705614

24. Guyot-Goubin A, Donadieu J, Barkaoui M, Bellec S, Thomas C, Clavel J. (2008). Descriptive epidemiology of childhood Langerhans cell histiocytosis in France, 2000-2004. Pediatr. Blood Cancer. 51: 71-75. https://doi.org/10.1002/pbc.21498; PMid:18260117

25. Han D, Li F, Yahya WH, Ge R, Zhao Y, Liu B, Zhou Y, Wen Z. (2022). Multisystem Langerhans Cell Histiocytosis in Younger Infants First Presenting in Skin. J Pers Med. 12 (7): 1024. https://doi.org/10.3390/jpm12071024; PMid:35887522 PMCid:PMC9315804

26. Haupt R, Minkov M, Astigarraga I, Schäfer E, Nanduri V, Jubran R et al. (2013). Langerhans cell histiocytosis (LCH): guidelines for diagnosis, clinical work-up, and treatment for patients till the age of 18 years. Euro Histio Network. Pediatr Blood Cancer. 60 (2): 175-184. https://doi.org/10.1002/pbc.24367; PMid:23109216 PMCid:PMC4557042

27. Jones KM, Balalla S, Theadom A, Jackman G, Feigin VL. (2017). A systematic review of the worldwide prevalence of survivors of poliomyelitis reported in 31 studies. BMJ Open. 7 (7): e015470. https://doi.org/10.1136/bmjopen-2016-015470; PMid:28694346 PMCid:PMC5734404

28. Kalra A, Kalra K, Agarwal MC, Bhatia R. (1986). Hand Schuller Christian disease with multiple pareses. Indian Pediatr. 23 (7): 566-567.

29. Krafchik B, Pope E, Walsh SRA. (2005). Histiocytosis of the skin in children and adults. In: Weitzman S, Egeler M, editors. Histiocytic disorders of children and adults. Cambridge: UK: Cambridge University Press: 130-153. https://doi.org/10.1017/CBO9780511545252.008

30. Krooks J, Minkov M, Weatherall A. (2018). Langerhans cell histiocytosis in children: Diagnosis, differential diagnosis, treatment, sequelae, and standardized follow-up. J. Am. Acad. Dermatol. 78: 1047-1056. https://doi.org/10.1016/j.jaad.2017.05.060; PMid:29754886

31. Krooks J, Minkov M, Weatherall AG. (2018). Langerhans cell histiocytosis in children: History, classification, pathobiology, clinical manifestations, and prognosis. J Am Acad Dermatol. 78 (6): 1035-1044. https://doi.org/10.1016/j.jaad.2017.05.059; PMid:29754885

32. Krüger L, Schmitt E. (1995). Solitary involvement of the fourth thoracic vertebral body with eosinophilic granuloma and development of incomplete paraparesis. Eur Spine J. 4 (5): 313-316. https://doi.org/10.1007/BF00301042; PMid:8581534

33. Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR et al. (2020). Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 395: 1907-1918.

34. Lee LYW, Cazier J-B, Starkey T, Briggs SEW, Arnold R, Bisht V et al. (2020). COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol. 21: 1309-1316.

35. Leonidas JC, Guelfguat M, Valderrama E. (2003). Langerhans' cell histiocytosis. Lancet. 361: 1293-1295. https://doi.org/10.1016/S0140-6736(03)12990-X; PMid:12699969

36. Liu W, Wang L, Liu M, Li G. (2016). Pituitary Morphology and Function in 43 Children with Central Diabetes Insipidus. Int J Endocrinol. 2016: 6365830. Epub 2016 Mar 29. https://doi.org/10.1155/2016/6365830; PMid:27118970 PMCid:PMC4828552

37. Ljungman P, de la Camara R, Mikulska M, Tridello G, Aguado B, Zahrani MA et al. (2021). COVID-19 and stem cell transplantation; results from an EBMT and GETH multicenter prospective survey. Leukemia. 35: 2885-2894. https://doi.org/10.1038/s41375-021-01302-5; PMid:34079042 PMCid:PMC8171362

38. Ljungman P, Mikulska M, de la Camara R, Basak GW, Chabannon C, Corbacioglu S et al. (2020). The challenge of COVID-19 and hematopoietic cell transplantation; EBMT recommendations for management of hematopoietic cell transplant recipients, their donors, and patients undergoing CAR T-cell therapy. Bone Marrow Transpl. 55: 2071-2076. https://doi.org/10.1038/s41409-020-0919-0; PMid:32404975 PMCid:PMC7220575

39. Lü GH, Li J, Wang XB, Wang B, Phan K. (2014). Surgical treatment based on pedicle screw instrumentation for thoracic or lumbar spinal Langerhans cell histiocytosis complicated with neurologic deficit in children. Spine J. 14 (5): 768-776. https://doi.org/10.1016/j.spinee.2013.06.104; PMid:24035731

40. Lytvyn H, Basa N, Stasiv M, Troyanovska O, Dorosh O. (2020). Difficulties in diagnosing of measles inclusion body encephalitis in a child with acute lymphoblastic leukemia. IDCases 21: e00877. https://doi.org/10.1016/j.idcr.2020.e00877; PMid:32637321 PMCid:PMC7327900

41. McClain KL, Picarsic J, Chakraborty R, Zinn D, Lin H, Abhyankar H et al. (2018). CNS Langerhans cell histiocytosis: Common hematopoietic origin for LCH-associated neurodegeneration and mass lesions. Cancer. 124 (12): 2607-2620. https://doi.org/10.1002/cncr.31348; PMid:29624648 PMCid:PMC6289302

42. McKenzie S, Vecerek N, Kang Y, Knowles B, Hogeling M. (2019). А neonatal pustule: Langerhans cell histiocytosis. Dermatol Online J. 25 (8): 13030/qt6hr0w31v. https://doi.org/10.5070/D3258045129; PMid:31553864

43. Minkov M, Pötschger U, Thacker N, Astigarraga I, Braier J, Donadieu J et al. (2021). Additive Prognostic Impact of Gastrointestinal Involvement in Severe Multisystem Langerhans Cell Histiocytosis. J Pediatr. 237: 65-70.e3. https://doi.org/10.1016/j.jpeds.2021.06.016; PMid:34146548

44. Möhn N, Skripuletz T, Stangel M. (2018). Neurological complications of infections with (novel) enteroviruses. Nervenarzt. 89 (12): 1320-1331. https://doi.org/10.1007/s00115-018-0619-9; PMid:30259057

45. Morimoto A, Shioda Y, Sakamoto K, Imamura T, Imashuku S. (2022). Bone lesions of Langerhans cell histiocytosis triggered by trauma in children. Japan LCH Study Group. Pediatr Int. 64 (1): e15199. https://doi.org/10.1111/ped.15199; PMCid:PMC9541900

46. Munn S, Chu AC. (1998). Langerhans cell histiocytosis of the skin. Hematol Oncol Clin North Am. 12: 269-286. https://doi.org/10.1016/S0889-8588(05)70510-4; PMid:9561900

47. Navaeian A, Mahmoudi S, Pourakbari B, Bakhtiari M, Khodabandeh M, Abdolsalehi MR, Sharari AS, Mamishi S. (2021). COVID-19 infection in children with underlying malignancies in Iran. J Basic Clin Physiol Pharmacol. 33 (1): 79-84. https://doi.org/10.1515/jbcpp-2021-0057; PMid:34192829

48. Nemet AY, Danks J, Grigg J. (2008). A 7th nerve palsy in a child with Langerhans histiocytosis. Orbit. 27 (2): 123-125. https://doi.org/10.1080/01676830701375785; PMid:18415873

49. Odoom JK, Obodai E, Boateng G, Diamenu S, Attiku K, Avevor P et al. (2021). Detection of vaccine-derived poliovirus circulation by environmental surveillance in the absence of clinical cases. Hum Vaccin Immunother. 17 (7): 2117-2124. https://doi.org/10.1080/21645515.2020.1852009; PMid:33517832 PMCid:PMC8189041

50. Padmanaban K, Kamalakaran A, Raghavan P, Palani T, Rajiah D. (2022). Langerhans Cell Histiocytosis of the Mandible. Cureus. 14 (8): e28222. https://doi.org/10.7759/cureus.28222; PMid:36158441 PMCid:PMC9486456

 51. Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F et al. (2020). COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 288: 192-206. https://doi.org/10.1111/joim.13091; PMid:32348588 PMCid:PMC7267177

52. Passamonti F, Cattaneo C, Arcaini L, Bruna R, Cavo M, Merli F et al. (2020). Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study. Lancet Haematol. 7: e737-745. https://doi.org/10.1016/S2352-3026(20)30251-9; PMid:32798473

53. Peng XS, Pan T, Chen LY, Huang G, Wang J. (2009). Langerhans' cell histiocytosis of the spine in children with soft tissue extension and chemotherapy. Int Orthop. 33 (3): 731-736. https://doi.org/10.1007/s00264-008-0529-8; PMid:18338168 PMCid:PMC2903089

54. Puri I, Garg D, Srivastava AK, Singh L, Shukla G, Goyal V. (2019). Langerhans Cell Histiocytosis Presenting With Late-Onset Sporadic Ataxia. Mov Disord Clin Pract. 6 (8): 716-718. https://doi.org/10.1002/mdc3.12830; PMid:31745485 PMCid:PMC6856461

55. Ren FL, Skipper DC, Elbendary A, Tan Q, Elston DM. (2020). Cutaneous manifestations of Langerhans cell histiocytosis in children: a retrospective cohort study of 43 patients. J Eur Acad Dermatol Venereol. 34 (10): e640-e642. https://doi.org/10.1111/jdv.16509

56. Sakamoto K, Morimoto A, Shioda Y, Imamura T, Imashuku S. (2019). Central diabetes insipidus in pediatric patients with Langerhans cell histiocytosis: Results from the JLSG-96/02 studies. Japan LCH Study Group (JLSG). Pediatr Blood Cancer. 66 (1): e27454. https://doi.org/10.1002/pbc.27454; PMid:30207064

57. Simko SJ, Garmezy B, Abhyankar H, Lupo PJ, Chakraborty R, Lim KP et al. (2014). Differentiating skin-limited and multisystem Langerhans cell histiocytosis. J Pediatr. 165 (5): 990-996. https://doi.org/10.1016/j.jpeds.2014.07.063; PMid:25441388 PMCid:PMC4254414

58. Spicer J, Chamberlain C, Papa S. (2020). Provision of cancer care during the COVID-19 pandemic. Nat Rev Clin Oncol. 17: 329-331. https://doi.org/10.1038/s41571-020-0370-6; PMid:32296166 PMCid:PMC7156894

59. Styczynski J, Cesaro S, von Lilienfeld-Toal M, Marchesi F, Gil L, Mikulska M et al. (2022). Current attitude to deferral of cellular therapy or nontransplant chemotherapy due to SARS-CoV-2 asymptomatic infection: Survey of Infectious Diseases Working Party EBMT. Transpl Infect Dis. 24: e13773. https://doi.org/10.1111/tid.13773; PMid:34918856

60. Styczynski J, Czyzewski K, Wysocki M et al. (2016). Increased risk of infections and infection-related mortality in children undergoing haematopoietic stem cell transplantation compared to conventional anticancer therapy: a multicentre nationwide study. Clin Microbiol Infect. 22 (2): 179 e171-179 e110. https://doi.org/10.1016/j.cmi.2015.10.017; PMid:26493843

61. Titgemeyer C, Grois N, Minkov M, Flucher-Wolfram B, Gatterer-Menz I, Gadner H. (2001). Pattern and course of single-system disease in Langerhans cell histiocytosis data from the DAL-HX 83- and 90-study. Med Pediatr Oncol. 37: 108-114. https://doi.org/10.1002/mpo.1178; PMid:11496348

62. Troyanovska O, Dorosh O, Lytvyn H, Tsymbalyuk I, Vorobel O, Stepanyuk O et al. (2022). Characteristics of COVID-19 in pediatric patients with hematological malignancies. Acta Haematologica Polonica. 53 (4): 273-276. https://doi.org/10.5603/AHP.a2022.0035

63. Vaiani E, Felizzia G, Lubieniecki F, Braier J, Belgorosky A. (2021). Paediatric Langerhans Cell Histiocytosis Disease: Long-Term Sequelae in the Hypothalamic Endocrine System. Horm Res Paediatr. 94 (1-2): 9-17. https://doi.org/10.1159/000517040; PMid:34167121

64.Wang J-G, Zhong Z-J, Mo Y-F, Wang L-C, Chen R. (2021). Epidemiological features of coronavirus disease 2019 in children: a meta-analysis. Eur Rev Med Pharm Sci. 25: 1146-1157.

65. Węcławek-Tompol J, Zakrzewska Z, Gryniewicz-Kwiatkowska O, Pierlejewski F, Bień E, Zaucha-Prażmo A et al. (2021). COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study. J Hematol Oncol. 14(1): 163. https://doi.org/10.1186/s13045-021-01181-4; PMid:34635137 PMCid:PMC8503711

66. WHO. (2022). WHO announces COVID-19 outbreak a pandemic. URL: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic.

67. Wood WA, Neuberg DS, Thompson JC, Tallman MS, Sekeres MA, Sehn LH et al. (2020). Outcomes of patients with hematologic malignancies and COVID-19: a report from the ASH Research Collaborative Data Hub. Blood Adv. 4: 5966-5975. https://doi.org/10.1182/bloodadvances.2020003170; PMid:33278301 PMCid:PMC7724912

68. Wu C, Li K, Hei Y, Lan P, Mu X. (2019). MR imaging features of orbital Langerhans cell Histiocytosis. BMC Ophthalmol. 19 (1): 263. https://doi.org/10.1186/s12886-019-1269-9; PMid:31856763 PMCid:PMC6923963

69. Zhang AW, Morjaria S, Kaltsas A, Hohl TM, Parameswaran R, Patel D et al. (2022). The effect of neutropenia and filgrastim (G-CSF) in cancer patients with COVID-19 infection. Clin Infect Dis. 74: 567-574. https://doi.org/10.1093/cid/ciab534; PMid:34111237 PMCid:PMC8406899

70. Zhang XH, Zhang J, Chen ZH, Sai K, Chen YS, Wang J, Ke C, Guo CC, Chen ZP, Mou YG. (2017). Langerhans cell histiocytosis of skull: a retrospective study of 18 cases. Ann Palliat Med. 6 (2): 159-164. https://doi.org/10.21037/apm.2016.11.04; PMid:28061539

71. Zhou W, Rao J, Li C. (2019). Isolated Langerhans cell histiocytosis in the hypothalamic-pituitary region: a case report. BMC Endocr Disord. 19 (1): 143. https://doi.org/10.1186/s12902-019-0474-0; PMid:31856773 PMCid:PMC6924050