PubMed1992
Two cases are reported of Vietnamese men who presented in young adult life with recurrent, painful, erythematous patches (which we have termed "erythralgia") over and adjacent to joints and accompanied by marked constitutional symptoms of malaise and lethargy, arthralgia and in one patient, fever. In the other, from the onset of the disease there were nodules over the bony prominences and in the interphalangeal regions of the fingers. The duration of the disease was over 12 years, the duration of each episode without therapy was one week and the interval between episodes was one to two weeks. In addition the patients showed a raised ESR and peripheral neutrophil leucocytosis of over 70%. There was a rapid response, within hours, to non-steroidal anti-inflammatory agents. Skin biopsies taken at varying stages of the disease episode failed to demonstrate neutrophils thereby failing to satisfy one major criterion of Sweet's Syndrome. Direct immunofluorescence studies were negative. Biopsy of the nodules did not show rheumatoid pathology. The serum rheumatoid factor was negative. Investigations failed to demonstrate any recognised pattern of cutaneous or rheumatologic disease; infections such as borreliosis were excluded. Both patients showed evidence of past hepatitis B infection. As recurrent painful cutaneous erythema is an uncommon phenomenon in dermatology except where the patient is suffering from recurrent cellulitis of the lower limbs, the patients reported here exhibit a pattern of disease not previously described.