Pulmonary langerhans cell histiocytosis: Can it originate from chest trauma?


1 Medical Student/ Intern Doctor, School of Medicine, Bahcesehir University, Istanbul, Turkey

2 Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine, Bahcesehir University, Istanbul; Department of Medical Oncology, VM Medical Park Samsun Hospital, Samsun, Turkey

3 Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey


Langerhans cell histiocytosis (LCH) is a rare medical condition which is defined by abnormal accumulation of a heterogeneous population of Langerhans cells that form nodules in certain tissues such as the skin, bone, and lungs. When the lungs are involved, the disease is called pulmonary LCH (PLCH). It is well established that PLCH is frequently observed in young adult smokers with equal gender distribution. Despite the clear role of smoking in PLCH pathogenesis, being a smoker rarely induces the disease, suggesting that host-related factors, inhaled antigens, or other stress-related factors may contribute to the pathogenesis. Here, we reported two cases of PLCH which both presented after chest trauma. Based on the findings from both the cases, it is concluded that the overstimulated inflammatory response in the posttraumatic lungs might be the responsible etiology resulting in the LCH if the lungs are already damaged and more sensitive due to smoking. We suggest that the differential diagnosis of PLCH should be especially considered in young adults with sudden or insidious onset of symptoms following chest trauma.


1. Castoldi MC, Verrioli A, De Juli E, Vanzulli A. Pulmonary Langerhans cell histiocytosis: The many faces of presentation at initial CT scan. Insights Imaging 2014;5:483‑92.
2. Vassallo R, Harari S, Tazi A. Current understanding and management of pulmonary Langerhans cell histiocytosis. Thorax 2017;72:937‑45.
3. Elia D, Torre O, Cassandro R, Caminati A, Harari S. Pulmonary Langerhans cell histiocytosis: A comprehensive analysis of 40 patients and literature review. Eur J Intern Med 2015;26:351‑6.
4. Suri HS, Eunhee SY, Nowakowski GS, Vassallo R. Pulmonary langerhans cell histiocytosis. Orphanet J Rare Dis 2012;7:16.
5. Pomeranz SJ, Proto AV. Histiocytosis X. Unusual‑confusing features of eosinophilic granuloma. Chest 1986;89:88‑92.
6. Saniee S, Afshari N, Kashefi S. Pulmonary Langerhans cell histiocytosis with Skin involvement; an amazing case report. J Res Clin Med 2019;7:32‑6.
7. Donohue P, Quill C. A single patient with pulmonary Langerhan’s cell histiocytosis followed by respiratory bronchiolitis interstitial lung disease. D33. ILD: CASE REPORTS III: American Thoracic Society; 2018:A6555‑A.
8. Perl M, Gebhard F, Braumüller S, Tauchmann B, Brückner UB, Kinzl L, et al. The pulmonary and hepatic immune microenvironment and its contribution to the early systemic inflammation following blunt chest trauma. Crit Care Med 2006;34:1152‑9.
9. Seitz DH, Niesler U, Palmer A, Sulger M, Braumüller ST, Perl M, et al. Blunt chest trauma induces mediator‑dependent monocyte migration to the lung. Crit Care Med 2010;38:1852‑9.
10. Ehrnthaller C, Flierl M, Perl M, Denk S, Unnewehr H, Ward PA, et al. The molecular fingerprint of lung inflammation after blunt chest trauma. Eur J Med Res 2015;20:70.
11. Venet F, Huang X, Chung CS, Chen Y, Ayala A. Plasmacytoid dendritic cells control lung inflammation and monocyte recruitment in indirect acute lung injury in mice. Am J Pathol 2010;176:764‑73.