[Erythema nodosum and Bazin's erythema induratum. Their relation to "inspecific" arteritis].
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Adolescent↗
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Erythema nodosum and Hodgkin's disease.
Erythema nodosum is an unusual manifestation of Hodgkin's lymphoma. One patient with long remission of Hodgkin's disease manifested persistent erythema nodosum beginning one and three months before relapse was clinically evident. So, the diagnosis of Hodgkin's disease should be considered in patients with unexplained recurrent erythema nodosum.
Adult↗
Recurrent erythema nodosum, arthritis and IgA nephropathy.
Erythema nodosum and IgA nephropathy are nosologic entities with an immunologic background. IgA nephropathy is a specific disease of the kidneys, while erythema nodosum may be associated with other illnesses. We report a unique case in which intermittent hematuria due to IgA nephropathy was superimposed on recurrent attacks of erythema nodosum and arthritis. A common pathophysiology is suggested.
Adult↗
[Erythema nodosum in sarcoidosis. 37 cases].
Erythema nodosum was seen in 37 out of 564 cases of sarcoidosis, i.e. 6.4. per cent. The female preponderance of the association was 56.8 per cent. It was accompanied by fever in 84 per cent of cases and with an increased sedimentation rate, greater than 50 mm in the first hour, in 44 per cent of cases. Articular manifestations (arthralgia or arthritis) were seen in 73 per cent of cases, with a predilection for the ankles. Progression by acute excerbations of the erythema nodosum and/or articular manifestations was rare. Mediastino-pulmonary involvement accompanying the erythema nodosum included mediastinal lymphadenopathy in all cases. Infiltration of the pulmonary parenchyma was seen in 27 per cent. Spontaneous resolution of the mediastino-pulmonary lesions occurred in 82 per cent of cases, regardless of the initial radiological appearance.
Adolescent↗
[Erythema nodosum association with malignant lymphoma].
Erythema nodosum is the most frequent clinicopathological variant of the panniculitides. The disorder is a cutaneous reaction consisting of inflammatory nodular lesions, usually located on the lower extremities. It may be associated with a wide variety of diseases, infections, sarcoidosis, rheumatologic diseases, inflammatory bowel diseases, medications and malignancies. Relationship between erythema nodosum and malignant lymphoma is described in the article. A review of the literature suggest that the diagnosis of Hodgkin's and non-Hodgkin's disease should be considered in patients with unexplained erythema nodosum.
Adult↗
[Erythema nodosum becoming a pheochromocytoma].
The erythema nodosum is a septal panniculitis of several etiologies: infectious, medicamentous, secondary to systemic disease or idiopathic cause. The patient is a 47 year-female with a hypertension history of several years of evolution, who shows the following set of symptoms: successive rashes of erythematous and pruriginous cutaneous lesions in inferior members, which are diagnosed by a cutaneous biopsy of erythema nodosum. In the etiology study, an abdominal echographia is made, finding a hypodense 7 x 5 cm solid mass placed in the left adrenal gland. Determinations of catecholamines and their metabolites are found to be increased in plasma and urine, with a final diagnosis of pheochromocytoma. The pheochromocytoma is an adrenal marrow tumour of chromaffin cells derived of the neural crest, which secrete catecholamines. It is an unusual tumour, with no gender differences and with a higher incidence between the third and fourth decade of life. Ninety per cent of the cases are rather sporadic. It causes arterial hypertension just in the 0.1 and 0.2% of total cases. The appearance of erythema nodosum as one more symptom in the evolutionary context of a pheochromocytoma is a relation poorly documented in the examined literature. We could think it is just a possible coincidence, as searching with Medline we just find out one international bibliographic reference.
Adrenal Gland Neoplasms↗
Erythema nodosum of dental origin.
The association of erythema nodosum and dental infectious foci has rarely been described in the literature. This report concerns four women who developed erythema nodosum either following dental treatment associated with gingival bleeding or due to infectious dental foci. In these cases, tooth extraction, removal of dental deposits, interrupted pulp treatment, apical periodontitis, or a relicted root were identified as causes of the development of erythema nodosum. Upon admission to the hospital, these patients also presented fever and and a maximally elevated erythrocyte sedimentation rate (ESR). In all instances, surgical treatment of the dental foci and/or administration of antibiotics rapidly led to the regression of the erythema nodosum, as well as to the normalization of body temperature and ESR. The cases described indicate that antecedent dental treatment and the possible presence of infectious dental foci should be considered in the differential diagnosis of erythema nodosum when taking the patient's medical history. This approach may avoid unnecessary, possibly invasive diagnostic procedures and can lead to rapid improvement in the patient's clinical status.
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All- trans-retinoic acid-induced erythema nodosum in patients with acute promyelocytic leukemia.
Erythema nodosum associated with all- trans-retinoic acid (ATRA) for acute promyelocytic leukemia (APL) is very rare. We describe four patients with classic APL who developed erythema nodosum during ATRA therapy. Fever and subsequent multiple painful erythematous nodules over extremities developed on D11, D16, D17, and D19, respectively, after ATRA therapy. The skin biopsy taken from each patient was consistent with erythema nodosum. All patients received short course of steroids. Fever subsided rapidly and the skin lesions regressed completely. All patients achieved complete remission without withdrawal of ATRA. ATRA seemed to be the most possible etiology of erythema nodosum in our patients. Short-term use of steroid is very effective in ATRA-induced erythema nodosum.
Adult↗
Erythema nodosum associated with infectious mononucleosis.
Erythema nodosum is an immunoallergic epiphenomenon appearing during the course of various conditions; it has been exceptionally observed in association with infectious mononucleosis. A 9-year-old girl with clinical manifestations of infectious mononucleosis developed cutaneous nodules of erythema nodosum over the shins, which cleared after 12 days. Diagnosis was based on the presence of atypical mononuclear cells, detection of antibodies against Epstein-Barr virus, and positive ox red blood cell hemolysis. Coincidence of both diseases is not surprising because infectious mononucleosis may exhibit diverse immunologic reactions. On the other hand, commonest etiologies were excluded in this case.
Adolescent↗
Erythema nodosum and pyoderma gangrenosum in 50 patients with Crohn's disease.
Erythema nodosum and pyoderma gangrenosum may occur in Crohn's disease. In the present evaluation of consecutive patients with Crohn's disease spanning more than two decades, erythema nodosum was seen in 45 patients and pyoderma gangrenosum was seen in seven patients. Forty-one of 566 women (7.2%) and nine of 449 men (2.0%) were affected. Of these, 45 (4.4%) had erythema nodosum and seven (0.7%) had pyoderma gangrenosum, including two (0.2%) with both dermatological disorders at different times during their clinical courses. Recurrent erythema nodosum was also detected in nine patients (20%) including eight women, while recurrent pyoderma gangrenosum was seen in two patients (28.6%). There was an age-dependent effect on the appearance of erythema nodosum in women, with the highest percentages seen in those younger than 20 years of age. Detection rates for erythema nodosum in women only approached the low men's rates in Crohn's disease at older than 40 years of age. Most patients with these dermatological disorders had colonic disease with or without ileal involvement as well as complex disease, usually with penetrating complications. The present study documents a sex-based and age-dependent effect on the clinical expression of erythema nodosum in Crohn's disease. This suggests that some components of the inflammatory process in Crohn's disease may be modulated by estrogen-mediated events, particularly in adolescents and young adults.
Adult↗
Long-term follow-up of erythema nodosum.
One hundred and fifty-four patients with erythema nodosum who attended the skin clinic at Ramathibodi Hospital from January 1990 to December 2000 were evaluated retrospectively with regard to the etiology of erythema nodosum. Of 49 patients who attended the skin clinic during that time 26 returned for reevaluation. Of the 154 patients, their ages ranged from 10-72 years old; 138 were females, 16 were males. The most common cause of erythema nodosum was tuberculosis (12.3%). Upper respiratory tract infection was found in 3.9 per cent. Other causes included Behcet's disease, sytemic lupus erythematous, drugs, pregnancy, chronic myeloid leukemia, leprosy, Reiter's syndrome and inflammatory bowel disease. Of the 26 patients who returned for reevaluation, pulmonary tuberculosis was identified in only one patient who had developed erythema nodosum 16 months earlier. In conclusion, it was found that tuberculosis is still a predominant cause of erythema nodosum among Thai patients.
Adolescent↗
Erythema nodosum: the underlying conditions.
Erythema nodosum (EN) is a cutaneous reaction consisting of inflammatory, tender nodular lesions and is associated with a wide variety of disease processes. The aim of our study was to investigate the frequency of different aetiologies of EN. One hundred and thirty-two EN patients were investigated in a prospective study during the period 1984-1990. The evaluation of all patients began with a medical and family history and completed with a thorough physical examination and detailed laboratory and immunological work-up. In addition, various diagnostic procedures were performed where and when indicated. One hundred and ten patients (83%) were women. Their mean age was 41.0+/-14.0 years, range 18-79 years. In 35% the cause of EN was not found. Sarcoidosis was revealed in 28% of the patients, infections in 17.3% and tuberculosis in 1.5%. Other aetiologic factors were Adamantiadis-Behçet's syndrome (3.8%), pregnancy (6%), oral contraceptives (3.8%) and other drugs (3.8%). The aetiology of EN was not found in 35% of the patients. Sarcoidosis and infections were frequent causes of EN, whereas autoimmune rheumatic diseases rarely cause EN.
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Erythema nodosum leprosum in Singapore.
Erythema Nodosum Leprosum (ENL) or Type II reaction is an immune complex syndrome seen in multibacillary leprosy. 20 patients with histological confirmation of ENL in leprosy were studied from 1982 to 1986. These patients had a range of clinical signs, from fever, tender dusky nodules, bullae, ulcers to lymphadenopathy, arthralgia and neuritis. The four major histological patterns are: a) classical pattern showing heavy infiltrations of neutrophils in three cases, b) sub-epidermal bulla pattern with marked oedema of the upper dermis, and collections of neutrophils in five cases, c) vasculitis pattern, affecting superficial and mid-dermal vessels, leading to epidermal necrosis, bulla formation and ulceration. Dilated vessels, congestion, lumenal fibrin clots and fibrinoid necrosis of vessels were seen, d) non-specific picture in nine cases with mild oedema, infiltration with neutrophils, and two cases with minimal reaction had chronic ENL with clinical vasculitis. All the five cases with vasculitis showed C1q, C3 and fibrinogen in the vessels. Comparing ENL reactions reported in Asia, our pattern is similar to that of Malaysians with the majority showing sub-epidermal oedema. Vasculitis is more common in India. Oedema with collagen necrosis as seen in acute ENL with iritis in New Guinea. The Lucio's phenomenon was not seen in any of the countries in Asia.
Adult↗
Erythema nodosum associated with pregnancy and oral contraceptives.
Erythema nodosum recurred in a woman during each of her four pregnancies and every time she was started on oral contraceptives. The lesions always disappeared in the fifth month of gestation or when contraceptives were withdrawn. Erythema nodosum is mediated by immune mechanisms, and both pregnancy and oral contraceptive use can interfere with the immune system. The concentrations of oestrogen and progesterone or the ratio between them may be critical to the development of erythema nodosum. The observation that the lesions spontaneously resolved in the fifth month of pregnancy supports this hypothesis.
Adult↗
Erythema nodosum caused by omeprazole.
We report a case of erythema nodosum caused by omeprazole. This side effect of omeprazole has not been previously reported. A 35-year-old white woman developed multiple tender erythematous nodules over the anterior aspect of her upper and lower extremities, fever, malaise, and edema. Her symptoms resolved with withdrawal of all preexisting medications and conservative treatment. Her symptoms flared soon after a rechallenge with omeprazole. A thorough history, physical examination, laboratory evaluation, and roentgenogram failed to reveal another cause for erythema nodosum. It is clear from the rechallenge that this patient's erythema nodosum was caused by omeprazole. We consider that omeprazole should be added to the list of medications known to cause erythema nodosum.
Adult↗
Erythema nodosum heralding recurrent Hodgkin's disease.
The association of erythema nodosum with Hodgkin's disease is acknowledged, although not well-documented in the literature. Two patients with long remissions of their Hodgkin's disease manifested persistent erythema nodosum beginning 7 and 6 months, respectively, before relapse was clinically evident. The skin lesions in both patients partially responded to treatment with indomethacin, but did not resolve completely until chemotherapy was instituted. Erythema nodosum probably reflects an important change in the balance of biologic forces between the host and the neoplasm, the nature of which can only be speculated upon at this time. Erythema nodosum should be considered a warning signal of impending relapse in a patient with a history of Hodgkin's disease.
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Potassium iodide in the treatment of erythema nodosum and nodular vasculitis.
Twenty-nine patients with erythema nodosum, nodular vasculitis, or erythema nodosum-like lesions associated with Behçet's syndrome were treated with potassium iodide. Administration of the drug for systemic effect showed a substantial effect in 11 of 15 patients with erythema nodosum, seven of ten with nodular vasculitis, and one of four with leg lesions of Behçet's syndrome. Relief of subjective symptoms, including tenderness, joint pain, and fever, occurred within 24 hours. Substantial improvement in the eruption occurred within a few days, and the lesions disappeared completely ten to 14 days after therapy was initiated. The patients to whom the medication was administered shortly after the initial onset of erythema nodosum seemed to respond most satisfactorily. The effect of the drug was marked in the patients with positive C-reactive protein reactions, joint pains, and/or fever. Possible mechanisms by which potassium iodide exerts its effect are discussed.
Adult↗
Plasma exchange in severe erythema nodosum leprosum.
Four patients with severe erythema nodosum leprosum were treated by plasma exchange and/or fresh frozen plasma infusions after failure of classical therapy. After the procedures, the patients improved rapidly; with a follow-up between 4 and 7 years after the last plasma exchange, no clinical relapse was noted. The replacement fluids were variable; the most beneficial procedure seemed to be plasma exchange replaced with fresh frozen plasma. Elimination of circulating immune complexes, replacement of a lacking plasma factor are possible mechanisms of action. Plasma exchange may also work like a regulator of immune mechanisms, since it has been shown that there is a depression of suppressor cells in erythema nodosum leprosum.
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