Intralymphatic Histiocytosis and Hypertrichosis Occurring Over the Site of a Titanium Hip Implant in a Patch Test Negative Patient

Thomas N Helm, Paul J Wirth, Helen L Xu, Stefanos Haddad Haddad, Aries Y Liu-Helm


Intralymphatic histiocytosis typically presents as erythematous indurated plaques on the limbs of older individuals. Some affected individuals have underlying rheumatoid arthritis. When intralymphatic histiocytosis is associated with joint replacement surgery, plaques commonly occur near the skin incision.  Biopsy reveals dilated lymphatics filled with large numbers of histiocytes.  Although the etiology of this peculiar phenomenon is unknown, numerous cases have been associated with metal implants.  We report an additional patient with intravascular histiocytosis associated with a metal hip implant.  Patch testing to a special metal series which included the component of the implant was negative.  Our patient also developed hypertrichosis with silvery hairs overlying her plaque.  We review the literature on intralymphatic histiocytosis associated with metal implants, present the diagnostic histologic findings, and explore possible etiologies for this uncommon reactive phenomenon.


Intralymphatic histiocytosis, hip implant, metal, patch test

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