27 August 2025
: Case report 
Extranodal Rosai-Dorfman Disease in a Pediatric Patient: A Case Report
Challenging differential diagnosis, Rare disease
Lili Miles ABCDEF 1*, Caroline Baughn
ABCDEF 2, Gleidson Messias Silva BD 3, Dorothea L. Douglas ABDE 4, Lei Shao BDEF 1
DOI: 10.12659/AJCR.948533
Am J Case Rep 2025; 26:e948533
Table 2 Comparison of clinical, diagnostic, treatment and outcome of the index case with 2 previous reports of adults with osseous Rosai-Dorfman Disease (RDD) who were misdiagnosed with osteomyelitis.
| Patient | Clinical presentation | Radiologic findings | Initial biopsy diagnosis | Post biopsy treatment | 2nd biopsy diagnosis | Treatment | Follow-up results |
|---|---|---|---|---|---|---|---|
| 16-month-old male (index case) | Pain and swelling after injury | X-ray: right distal radius lytic lesionMRI: destructive lesion with soft tissue component | Ultrasound guided needle biopsy: Osteomyelitis | Cephalexin for 5 daysFollowed by curettage | Osseous RDD negative cultures for bacteria, mycobacteria and fungiSubsequent imaging without other lesions | Observation due to no residual lesion on image | Disease free, 36 months |
| 19-year-old male []14 | Progressive pain without history of trauma | X-ray: normalMRI: marrow replacing lesion in distal femur without cortical or soft tissue involvement | CT-guided needle biopsy: chronic osteomyelitisNegative culture for bacteria and fungi | No treatment due to discordant with clinical status, open curettage biopsy | Osseous RDD Subsequent imaging without other lesions | Second curettage to remove the residual lesion, followed by observation | Disease free, 23 months |
| 42-year-old female []15 | Pain for 6 months with episodic soft tissue swelling | X-ray and CT: osteolytic lesion in the distal right tibia with cortical involvementMRI: soft-tissue involvement | Excisional biopsy: a chronic intraosseous inflammatory process | Transferred for a second opinion with a needle biopsy | Osseous RDD negative culture for bacteriaNo other lesions | Block resection of soft tissue component and curettage of bone lesion followed by observation | Disease free, 6 months |