A case of polyostotic eosinophilic granuloma of the lumbar spine in a seven year old male is reported. CT guided biopsy was not diagnostic on two occasions. Diagnosis was made clinically and radiographically with evidence of L3 vertebra plana and lytiylesion at L5. The patient was treated conservatively with aTLSO brace for spinal immobilization. Fifteen months after diagnosis, the patient is alive and well. Lesions at L3 and L5 persist with no progression of disease. The patient has resumed full physical activity and is being followed every six months with serial imagery. Eosinophilic granuloma is the most common and benign form of the three clinical entities comprising Langerhans cell histiocytosis: . It affects all ages but predominantly children and young adults. Back pain that persists after conservative therapy including anti-inflammatories and physical therapy warrants radiologic evaluation. Lesions found on plain films can be further evaluated with MR imaging. Bone scans are useful in finding additional bony or visceral lesions. A number of treatments have been suggested in the management of EG, however nearly all research suggests a conservative approach is most prudent for single system bony disease in patients free of neurologic deficit.
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