{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T13:37:27Z","timestamp":1771508247513,"version":"3.50.1"},"reference-count":13,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,2,2]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>This case describes a man in his mid 60s from Mexico who presented with respiratory failure and elevated inflammatory biomarkers. Initial investigations revealed multiple opportunistic infections. A PET-CT scan showed variable uptake in bilateral intraconal masses, dural venous sinuses, paranasal sinuses, lungs, pericardium and both distal femurs. Bone biopsy confirmed clonal histiocytosis (CD68+, CD163+, Fascin+, BRAF-V600E+), leading to a diagnosis of Erdheim\u2013Chester disease (ECD), a rare non-Langerhans histiocytosis affecting multiple systems.<\/jats:p>\n                  <jats:p>As vemurafenib was unavailable in Mexico, pegylated interferon alpha (PEG-IFN-\u03b1) was initiated, producing significant clinical and biomarker improvement. The patient was discharged in stable condition and continues close multidisciplinary follow-up with infectious disease, cardiology, nephrology, pulmonology and haematology teams.<\/jats:p>\n                  <jats:p>This case highlights the importance of considering ECD in the differential diagnosis of multisystem diseases of unknown origin, especially with unusual manifestations such as multiple opportunistic infections, and reinforces the value of a coordinated, multidisciplinary approach in managing complex presentations.<\/jats:p>","DOI":"10.1136\/bcr-2025-269136","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T12:55:12Z","timestamp":1771505712000},"page":"e269136","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multiple opportunistic infections revealing Erdheim\u2013Chester disease: an atypical presentation"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8573-5189","authenticated-orcid":false,"given":"Brenda","family":"Gonzalez-Bedolla","sequence":"first","affiliation":[{"name":"Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9788-484X","authenticated-orcid":false,"given":"Francisco A","family":"Luna-Rangel","sequence":"additional","affiliation":[{"name":"Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xitlaly J","family":"Gonzalez-Leal","sequence":"additional","affiliation":[{"name":"Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel F","family":"Martinez-Resendez","sequence":"additional","affiliation":[{"name":"Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"2026021904550776000_19.2.e269136.1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2019003507"},{"key":"2026021904550776000_19.2.e269136.2","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1056\/NEJMicm2208776","article-title":"\u201cHairy Kidney\u201d in Erdheim-Chester Disease","volume":"388","author":"Srialluri","year":"2023","journal-title":"N Engl J Med"},{"key":"2026021904550776000_19.2.e269136.3","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2016001784"},{"key":"2026021904550776000_19.2.e269136.4","doi-asserted-by":"crossref","first-page":"118","DOI":"10.14740\/cr1025","article-title":"Erdheim-Chester Disease With Extensive Pericardial 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