Langerhans cell histiocytosis presenting as adult onset epilepsy

A 37-year-old man presented with recurrent secondary generalised seizures from right focal onset. An MRI scan of the brain revealed multiple contrast enhancing lesions mainly involving the frontal, parietal and temporal regions. The left frontotemporal lesion was biopsied and histopathology confirmed it to be a rare case of adult Langerhans cell histiocytosis. He was given a short course of oral corticosteroids. Two years later his clinical condition was much improved on antiepileptic therapy alone, and repeat MRI brain and MR spectroscopy showed significant resolution of the lesions.