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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="other" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Pediatric Hematology/Oncology and Immunopathology</journal-id><journal-title-group><journal-title xml:lang="en">Pediatric Hematology/Oncology and Immunopathology</journal-title><trans-title-group xml:lang="ru"><trans-title>Вопросы гематологии/онкологии и иммунопатологии в педиатрии</trans-title></trans-title-group></journal-title-group><issn publication-format="print">1726-1708</issn><issn publication-format="electronic">2414-9314</issn><publisher><publisher-name xml:lang="en">Fund Doctors, Innovations, Science for Children</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">700</article-id><article-id pub-id-type="doi">10.24287/1726-1708-2023-22-1-110-121</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>CLINICAL OBSERVATIONS</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ</subject></subj-group><subj-group subj-group-type="article-type"><subject></subject></subj-group></article-categories><title-group><article-title xml:lang="en">Langerhans cell histiocytosis: a rare cause of exudative enteropathy in a young child</article-title><trans-title-group xml:lang="ru"><trans-title>Редкая причина экссудативной энтеропатии у ребенка раннего возраста – гистиоцитоз из клеток Лангерганса</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2881-4703</contrib-id><name-alternatives><name xml:lang="en"><surname>Movsisyan</surname><given-names>G. B.</given-names></name><name xml:lang="ru"><surname>Мовсисян</surname><given-names>Г. Б.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p><bold>Goar B. Movsisyan</bold>, Cand. Med. Sci., a senior researcher at the Laboratory of Rare Hereditary Diseases in Children, a pediatrician, a gastroenterologist of the Gastroenterology Department with Hepatology Group</p><p>2, building 1, Lomonosovskiy Avenue, 119991, Moscow </p></bio><bio xml:lang="ru"><p>Мовсисян Гоар Борисовна, канд. мед. наук, старший научный сотрудник лаборатории редких наследственных болезней у детей, врач-педиатр, врач-гастроэнтеролог гастроэнтерологического отделения с гепатологической группой </p><p>119991, Москва, Ломоносовский просп., 2, стр. 1</p></bio><email>Movsisyan@nczd.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9064-6443</contrib-id><name-alternatives><name xml:lang="en"><surname>Komarova</surname><given-names>A. D.</given-names></name><name xml:lang="ru"><surname>Комарова</surname><given-names>А. Д.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1107-8693</contrib-id><name-alternatives><name xml:lang="en"><surname>Kulikov</surname><given-names>K. A.</given-names></name><name xml:lang="ru"><surname>Куликов</surname><given-names>К. А.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0813-5626</contrib-id><name-alternatives><name xml:lang="en"><surname>Kalinina</surname><given-names>I. I.</given-names></name><name xml:lang="ru"><surname>Калинина</surname><given-names>И. И.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8305-7592</contrib-id><name-alternatives><name xml:lang="en"><surname>Lokhmatov</surname><given-names>M. M.</given-names></name><name xml:lang="ru"><surname>Лохматов</surname><given-names>М. М.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8805-8164</contrib-id><name-alternatives><name xml:lang="en"><surname>Oldakovskiy</surname><given-names>V. I.</given-names></name><name xml:lang="ru"><surname>Олдаковский</surname><given-names>В. И.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6667-9472</contrib-id><name-alternatives><name xml:lang="en"><surname>Tepaev</surname><given-names>R. F.</given-names></name><name xml:lang="ru"><surname>Тепаев</surname><given-names>Р. Ф.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3993-1246</contrib-id><name-alternatives><name xml:lang="en"><surname>Roslavtseva</surname><given-names>E. A.</given-names></name><name xml:lang="ru"><surname>Рославцева</surname><given-names>Е. А.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4905-2373</contrib-id><name-alternatives><name xml:lang="en"><surname>Potapov</surname><given-names>A. S.</given-names></name><name xml:lang="ru"><surname>Потапов</surname><given-names>А. С.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Shchigoleva</surname><given-names>N. E.</given-names></name><name xml:lang="ru"><surname>Щиголева</surname><given-names>Н. Е.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6034-8231</contrib-id><name-alternatives><name xml:lang="en"><surname>Materikin</surname><given-names>A. I.</given-names></name><name xml:lang="ru"><surname>Материкин</surname><given-names>А. И.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4885-4171</contrib-id><name-alternatives><name xml:lang="en"><surname>Savostyanov</surname><given-names>K. V.</given-names></name><name xml:lang="ru"><surname>Савостьянов</surname><given-names>К. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><xref ref-type="aff" rid="aff1"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">National Medical Research Center for Children’s Health of Ministry of Healthсare of the Russian Federation</institution></aff><aff><institution xml:lang="ru">ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России</institution></aff></aff-alternatives><aff-alternatives id="aff2"><aff><institution xml:lang="en">Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthсare of the Russian Federation</institution></aff><aff><institution xml:lang="ru">ФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава России</institution></aff></aff-alternatives><pub-date date-type="pub" iso-8601-date="2023-03-01" publication-format="electronic"><day>01</day><month>03</month><year>2023</year></pub-date><volume>22</volume><issue>1</issue><issue-title xml:lang="en"/><issue-title xml:lang="ru"/><fpage>110</fpage><lpage>121</lpage><history><date date-type="received" iso-8601-date="2022-09-12"><day>12</day><month>09</month><year>2022</year></date><date date-type="accepted" iso-8601-date="2023-02-28"><day>28</day><month>02</month><year>2023</year></date></history><permissions><copyright-statement xml:lang="en">Copyright ©; 2023, «D. Rogachev NMRCPHOI»</copyright-statement><copyright-statement xml:lang="ru">Copyright ©; 2023, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="en">«D. Rogachev NMRCPHOI»</copyright-holder><copyright-holder xml:lang="ru">ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России</copyright-holder><ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/"/><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by/4.0</ali:license_ref></license></permissions><self-uri xlink:href="https://hemoncim.com/jour/article/view/700">https://hemoncim.com/jour/article/view/700</self-uri><abstract xml:lang="en"><p>Exudative enteropathy is a clinical syndrome characterized by excessive loss of proteins through the gastrointestinal tract and is a rare complication of various gastrointestinal diseases. One of the rarest causes of protein malabsorption is Langerhans cell histiocytosis, which occurs as a result of inflammatory neoplasia of myeloid precursor cells caused by mutations in the mitogenactivated protein kinase pathway. Abnormal proliferation and accumulation of Langerhans cells in the intestinal wall leads to a violation of the outflow of lymph, and causes clinical manifestations characteristic of enteropathy. Given that the lesion of the gastrointestinal tract with histiocytosis from Langerhans cells occurs in 2–3% of cases, and the clinical signs are not highly specific, timely diagnosis is difficult. Delayed verification of the diagnosis and late initiation of adequate treatment are risk factors for multisystem lesions and lead to an unfavorable outcome. The literature describes a few observations of the onset or manifestation of the disease with symptoms of protein malabsorption. We present a rare clinical case of diagnosing histiocytosis from Langerhans cells in a young child with severe manifestations of exudative enteropathy at the onset. The patient's parents gave their consent to the use of their child's data, including photographs, for research purposes and in publications.Refractory gastrointestinal symptoms require mandatory endoscopic and histological examination to identify rare causes of malabsorption. Timely initiation of targeted therapy with vemurafenib in combination with subsequent chemotherapy provided the child with a favorable prognosis and stable remission of the disease.</p></abstract><trans-abstract xml:lang="ru"><p>Экссудативная энтеропатия – клинический синдром, который характеризуется чрезмерной потерей белков через желудочно-кишечный тракт и представляет собой редкое осложнение различных гастроинтестинальных заболеваний. Одной из самых редких причин развития мальабсорбции белка является гистиоцитоз из клеток Лангерганса, возникающий в исходе воспалительной неоплазии миелоидных клеток-предшественников, вызванной мутациями в митоген-активируемом протеинкиназном пути. Аномальная пролиферация и аккумуляция клеток Лангерганса в стенке кишки приводят к нарушению оттока лимфы и обусловливают характерные для энтеропатии клинические проявления. Учитывая, что поражение желудочно-кишечного тракта при гистиоцитозе из клеток Лангерганса встречается в 2–3% случаев, а клинические признаки не являются высокоспецифичными, своевременная диагностика затруднена. Отсроченная верификация диагноза и позднее начало адекватного лечения являются факторами риска мультисистемного поражения и обусловливают неблагоприятный исход. В литературе описаны немногочисленные наблюдения начала или проявления заболевания с симптомов мальабсорбции белка. Нами представлен редкий клинический случай диагностики гистиоцитоза из клеток Лангерганса у ребенка раннего возраста с тяжелыми проявлениями экссудативной энтеропатии в дебюте. Родители пациентки дали согласие на использование информации, в том числе фотографий ребенка, в научных исследованиях и публикациях. Рефрактерная гастроинтестинальная симптоматика требует обязательного эндоскопического и гистологического исследования для выявления редких причин мальабсорбции. Своевременная инициация таргетной терапии препаратом вемурафениб в сочетании с последующей химиотерапией позволила обеспечить ребенку благоприятный прогноз и стойкую ремиссию заболевания.</p></trans-abstract><kwd-group xml:lang="en"><kwd>clinical case</kwd><kwd>children</kwd><kwd>exudative enteropathy</kwd><kwd>Langerhans cell histiocytosis</kwd><kwd>targeted therapy</kwd><kwd>vemurafenib</kwd></kwd-group><kwd-group xml:lang="ru"><kwd>клинический случай</kwd><kwd>дети</kwd><kwd>экссудативная энтеропатия</kwd><kwd>гистиоцитоз из клеток Лангерганса</kwd><kwd>таргетная терапия</kwd><kwd>вемурафениб</kwd></kwd-group><funding-group/></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><citation-alternatives><mixed-citation xml:lang="en">1. Камалова А.А., Низамова Р.А., Хадиева Г.М., Зайнетдинова М.Ш. 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