Indomethacin as a treatment for multifocal Eosinophilic granuloma

Eosinophilic granuloma of the bone is the most common variant of Langerhans cell histiocytosis. Most of the lesions occur in the skull, ribs, spine or long bones and may be single or multiple. Therapy is generally chosen based on the site involved and the number of lesions. Treatment options include single agent with prednisone, the combination of vinblastine and prednisone, curettage of bone lesions or intralesional steroids injection. Indomethacin seems to be effective in treating isolated Langerhans cell histiocytosis of the bone in children and is generally well-tolerated. We present the case of a 4-year-old boy with involvement of 2 bones, skull and vertebra, treated with curettage of the skull and indomethacin for 19 months. There was complete healing of the lesions at the end of the treatment and no evidence of recurrence 4 months post-treatment. We conclude that indomethacin seems to be effective in the treatment of Langerhans cell histiocytosis of the bone in children, avoiding more aggressive therapies.