Erdheim-Chester Disease

BACKGROUND: Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis that frequently involves the cardiovascular system. CASE SUMMARY: We report the case of a 40-year-old man who presented with concurrent atrial flutter and severe sinus node dysfunction and was subsequently diagnosed with ECD. His medical history was notable for nonischemic cardiomyopathy and central diabetes insipidus. Initial evaluation demonstrated chest pain, elevated C-reactive protein levels, and endocrine abnormalities. Imaging studies revealed a right atrial mass, a characteristic "hairy kidney" appearance, and circumferential aortic involvement. Histopathologic examination confirmed CD68+/CD163+ histiocytes harboring BRAF V600E/D and NRAS mutations. A leadless pacemaker was implanted, and targeted molecular therapy was initiated. DISCUSSION: This case illustrates that ECD may present with coexisting arrhythmias, underscoring the importance of comprehensive cardiac assessment. TAKE-HOME MESSAGE: Early multidisciplinary management, including advanced pacing strategies and targeted therapies, is essential to optimize outcomes in patients with extensive cardiac involvement.