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PubMed1993

Ultrastructure of endothelial cell necrosis in classical erythema nodosum.

As evidence of vascular involvement in classical erythema nodosum unassociated with Behçet's disease, the occurrence of endothelial cell necrosis based on the development of dark cell degeneration was observed by electron microscopy in the vasculature of the dermis and subcutaneous fat. The incidence of endothelial cell necrosis in all segments of the microcirculatory system was roughly 20% in three of 12 patients. The remaining nine patients showed a very low rate of necrosis, including two patients in whom endothelial cell necrosis was totally absent. The presence of necrotic endothelial cells that are forced out and eliminated by neighboring intact endothelial cells into the vascular lumen is closely associated with thrombus formation in the cutaneous vasculature. The incidence at which endothelial cell necrosis occurs in classical erythema nodosum is not always high; however, it is concluded that endothelial cell necrosis may play a significant role in the pathogenesis of erythema nodosum.

Adult↗
PubMed1993

Immunological evaluation of erythema nodosum in tularaemia.

During two tularaemia outbreaks in the Bursa region of Turkey in 1991, a total of 98 patients were diagnosed and evaluated. Thirteen of these patients had erythema nodosum, which is accepted as a secondary skin manifestation. The patients with erythema nodosum, 21 patients without any skin lesions, and 20 healthy controls were studied. Comparable elevations of levels of IgG, IgA, and IgM were detected in the two tularaemia groups. There was no difference in complement C3c and C4 levels between the groups. All of the patients with erythema nodosum had elevated circulating immune complex (CIC) levels, when compared with the patients without skin lesions and the control group. The acute phase response (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) of the erythema nodosum group was significantly higher than the patients with normal skin, and healthy controls (P < 0.001). Serum transferrin levels were significantly decreased in both of the tularaemia groups (P < 0.001). Serum soluble interleukin-2 receptor levels (SIL-2R) were significantly elevated in both tularaemia groups (P < 0.001), and the elevation was more marked in the erythema nodosum group (P < 0.05). Histopathological evaluation of biopsies from two patients with erythema nodosum showed dermal oedema, a perivascular lymphocytic infiltrate, and panniculitis. No immunoglobulin or complement deposits were detected on immunofluorescence. Erythema nodosum in the course of tularaemia is associated with many immunological changes, although it is not clear whether these findings are related to the increased tissue response, or whether they play a role in the pathogenesis of the erythema nodosum.

Adolescent↗
PubMed1997

[Erythema nodosum: 112 cases. Epidemiology, clinical aspects and histopathology].

In a retrospective study we analyzed the cases of 112 patients with erythema nodosum treated during the period 1983-1993 in the Department of Dermatology, University Hospital of Basel, Switzerland. The aim of the study was to investigate the epidemiology, incidence of different etiologies, relevance of laboratory investigations and the histopathologic features in our patients, 83% of whom were females. The peak incidence occurred between the ages of 18 and 34 years. The commonest cause of erythema nodosum was infection. Other etiologic factors were adverse drug reactions, sarcoidosis, Crohn's disease, non-Hodgkin lymphoma, pregnancy, discoid lupus erythematosus, Sharp syndrome and aspartame. Only 47% of patients showed the classic bilateral distribution of the nodes on the extensor surface of the lower extremities. 77% of infection-induced erythema nodosum healed after 7 weeks, the longest course being 18 weeks. In contrast, 30% of idiopathic erythema nodosum lasted more than 6 months. Patients in whom erythema nodosum was associated with non-Hodgkin lymphoma had an extremely protracted course. Erythema nodosum associated with non-Hodgkin lymphoma may precede the diagnosis of lymphoma by months. In 4 cases erythema nodosum was the initial sign of sarcoidosis. In 30% of biopsies we found single vessels with leukocytoclastic vasculitis. The histologic pattern failed to provide etiologic pointers.

Adolescent↗
PubMed1986

Yersinia arthritis with erythema nodosum.

A previously healthy female presented with erythema nodosum and arthritis with serological evidence of infection with Yersinia enterocolitica. Erythema nodosum following this infection has not previously been reported in Britain.

Adolescent↗
PubMed1997

Successful therapy of refractory erythema nodosum associated with Crohn's disease using potassium iodide.

Erythema nodosum is a common extraintestinal manifestation of Crohn's disease. While mild skin involvement often responds to conservative management, severe or refractory cases may require systemic corticosteroid or immunosuppressive therapy. This report describes successful treatment of severe, refractory erythema nodosum associated with Crohn's colitis using oral potassium iodide. While the mechanism of action of this agent is poorly understood, it appears to be an effective and nontoxic therapy for Crohn's-related erythema nodosum and warrants further evaluation in a placebo controlled trial.

Administration, Oral↗
PubMed1977

Erythema nodosum in patients with tinea pedis and onychomycosis.

To document association between erythema nodosum and concomitant fungus infection, we studied seven white women seen during a six-year period in our office practice. Five patients are presented. Unilateral erythema nodosum occurred in three patients on the same side as unilateral tinea. Tests with potassium hydroxide (KOH), cultures of nodules on Sabouraud agar and dermatophyte test medium (DTM), skin biopsy, and clinical examination ruled out nodular granulomatous perifolliculitis of Wilson. Lesions simulating erythema nodosum were produced when Trichophyton antigen was injected subcutaneously in the lower legs. All nodose and fungal lesions cleared after griseofulvin therapy. Fungus infection of feet or nails should be considered a possible cause of erythema nodosum when no other cause is apparent.

Adult↗
PubMed2004

[Erythema nodosum: etiological changes in the last two decades].

OBJECTIVE: To study the etiological factors associated with erythema nodosum in children hospitalized between January 1985 and December 2003. MATERIAL AND METHODS: We performed a retrospective, descriptive study through review of the medical records of children with a diagnosis of erythema nodosum (MBDS-ICD 9-CM, code 6952). Forty-five patients (27 boys and 18 girls) aged between 10 months and 14 years were studied. The following variables were analyzed: age, sex, associated symptoms, complementary investigations (blood count, erythrocyte sedimentation rate, throat swab, chest x-ray, Mantoux test, ASLO titer, stool culture, serology) and final diagnosis. RESULTS: The most frequent etiology was tuberculosis (10 patients), followed by Salmonella enteritidis (7 patients), group A beta -hemolytic Streptococcus (3 patients), Salmonella typhimurium (2 patients), Campylobacter jejuni (2 patients), Yersinia enterocolitica (1 patient), infectious mononucleosis caused by Epstein Barr virus (1 patient), cat scratch disease (1 patient), BCG vaccination (1 patient), associated chronic hepatitis B infection (1 patient), and associated amoxicillin treatment (1 patient). Etiology was unknown in 15 patients. The last case of erythema nodosum associated with tuberculous infection dated back to 1991, after which the most frequent etiologic factors associated with erythema nodosum were gastrointestinal pathogens. CONCLUSIONS: According to our results, the main etiological factor currently associated with erythema nodosum is gastrointestinal infection. Consequently, stool cultures, especially when there are associated gastrointestinal symptoms, are essential.

Adolescent↗
PubMed1975

Erythema nodosum leprosum in Nigeria.

The occurrence of erythema nodosum leprosum among leprosy patients treated with diamino diphenyl sulfone in an endemic area is not rare, unlike in the leprosy patients treated at Lagos University Teaching Hospital. Two Nigerian patients with this disease are described, in whom this rarity was seen. Recurrent monthly fever with painful skin swellings in lepromatous patients from an edemic area is highly suggestive of erythema nodosum leprosum. The occurrence of this reaction in lepromatous leprosy gives a relatively poor prognosis.

Adolescent↗
PubMed2000

Erythema nodosum associated with antiphospholipid antibodies: a report of three cases.

Erythema nodosum is a dermatologic condition characterized by painful, erythematous nodules on the anterior surfaces of the lower extremities. Its association with a variety of conditions has been previously described. We present three cases of erythema nodosum in patients with elevated anticardiolipin antibodies. In one patient, a temporal relationship was seen in the simultaneous detection of antibodies and skin lesions. We propose an association between erythema nodosum and the antiphospholipid antibody syndrome (APS).

Adult↗
PubMed1993

Erythema nodosum versus nodular vasculitis.

BACKGROUND: Erythema nodosum (EN) is usually considered to be a septal panniculitis, and nodular vasculitis (NV) a lobular panniculitis. We tested the usefulness of this histologic classification in clarifying a frequent clinical dilemma: EN versus NV. METHODS: Over 3 years 109 patients with panniculitis were included in this study. After a history and a physical examination, a clinical diagnosis was made according to well-established criteria. RESULTS: From the study of 88 patients, we concluded that in the clinically typical cases, the clinico-pathologic agreement was 93% and 94% for EN and NV respectively, whereas it diminished to 79%, 72%, and 67% in the cases clinically diagnosed as EN migrans, atypical EN, and atypical NV, respectively. Moreover, septal and lobular panniculitis were always two clear-cut, different, opposite patterns of hypodermal inflammation to these conditions. CONCLUSIONS: In the absence of a known pathogenetic mechanism, the histopathology remains the most objective discriminating marker between EN and NV, mainly in the clinically atypical and doubtful cases.

Adolescent↗
PubMed2000

Erythema nodosum in Israeli children.

BACKGROUND: Erythema nodosum, although uncommon in children, is the most frequent form of panniculitis in pediatrics. EN has been associated with various infections and chronic inflammations, and its course varies with age, gender, and racial and geographic factors. There is no information on EN in Israeli children. OBJECTIVES: To examine the clinical course of EN and the conditions with which it is associated in Israeli children. METHODS: We conducted a retrospective study of 24 children with a diagnosis of EN who presented at our Center over a 10 year period (1989-98). RESULTS: EN was more frequent in females than males (ratio 2:1) due to a cluster of adolescent girls. The mean duration of the skin manifestation was 18 days. The course was benign in all patients. Streptococcal infection was the most common cause (25%), followed by Epstein-Barr virus infection (18%) and inflammatory bowel disease (13%). In one-third of cases, no specific cause could be identified. Tuberculosis, an important cause of EN in the past, was not found in our patients. CONCLUSIONS: Most cases of EN in Israeli children are related to streptococcal and EBV infections or to chronic inflammatory conditions. Despite the increase in tuberculosis morbidity in Israel during recent years, we found no association of EN and tuberculosis in our study.

Adolescent↗
PubMed2004

Erythema nodosum and antitubercular therapy.

OBJECTIVE: To establish the efficacy of antitubercular therapy in patients with erythema nodosum with a highly positive Mantoux test. METHODS: A retrospective analysis of all patients diagnosed with idiopathic erythema nodosum with a highly positive Mantoux reaction between 1988 and 2001 was undertaken. In the absence of any other clinical or investigative evidence of active tuberculosis they were treated with antitubercular therapy. RESULTS: Out of a total of 52 patients diagnosed with idiopathic erythema nodosum with a strongly positive Mantoux test (average of 19 mm), data could be analyzed in only 47 patients. After treatment with antitubercular drugs, new lesions stopped appearing in 45 patients within 6-8 weeks and subsided in two. The therapy was well tolerated except for jaundice in one patient and transient urticarial lesions in another. CONCLUSIONS: Antitubercular therapy definitely has a role in the management of patients with erythema nodosum, even in the absence of a detectable focus of tubercular infection, especially in regions where tuberculosis is endemic.

Antitubercular Agents↗
PubMed2006

Role of azathioprine in preventing recurrences in a patient of recurrent erythema nodosum leprosum.

The pathogenesis of erythema nodosum leprosum (ENL) involves both immune complex deposition and dysfunction of cell mediated immunity. Tumour necrosis factor-alpha (TNF-alpha) plays an important role in its pathogenesis. Thalidomide and corticosteroids are the mainstay of treatment for ENL. However, there are often severe limitations to their use. We report a case of recurrent ENL treated successfully with azathioprine. A 15-year-old unmarried girl with lepromatous leprosy had recurrent ENL for 2 years. She was treated with WHO-MB MDT and prednisolone in doses of 40-90 mg a day for 2-12 weeks. Her condition was inadequately controlled. The patient was therefore treated with thalidomide 300 mg and prednisolone 40 mg. The symptoms subsided after 5 days and ENL lesions healed in 2 weeks. Prednisolone was reduced by 10 mg per week and stopped, while thalidomide was reduced to 100 twice daily after 4 weeks. Azathioprine 100 mg (2 mg/kg per day) daily orally was added to prevent recurrences. Thalidomide was further reduced and stopped after another 4 weeks while she continued with azathioprine in the same doses for 8 months. There was no recurrence of ENL lesions and no side effects of the therapy. MB-MDT was stopped 1 year ago, and she is on follow-up without any relapse. Azathioprine, therefore, appears to be an effective and safe drug to prevent recurrences of ENL.

Administration, Oral↗
PubMed1984

Can erythema nodosum and reactive arthritis be a sequel to Shigella flexneri gastroenteritis?

Erythema nodosum and seronegative arthritis associated with diarrhoea was previously regarded as implying the presence of inflammatory bowel disease. Recently, however, erythema nodosum has been described as a sequel to diarrhoea caused by infection with Salmonella typhimurium, Yersinia enterocolitica and Campylobacter jejuni. We report two patients in whom erythema nodosum and reactive arthritis followed acute Shigella flexneri gastroenteritis, a rare association.

Adult↗
PubMed2003

Severe erythema nodosum due to Behçet's disease responsive to erythromycin.

A patient with severe erythema nodosum due to Behçet's disease is reported on here. Erythema nodosum lesions did not respond to classical treatments; however, they cleared after erythromycin treatment, which was prescribed for the treatment of coincidental erythrasma. Erythromycin treatment appears to be an effective treatment option in erythema nodosum. The hypothetical anti-inflammatory effects of erythromycin, besides its antibiotic properties, are reviewed and discussed to explain such a clinical improvement.

Administration, Oral↗
PubMed1995

Sweet's syndrome associated with erythema nodosum.

The association between Sweet's syndrome and erythema nodosum in the same patient is rare. However, it is important that family physicians recognise how to differentiate these conditions clinically and histopathologically. A case is described with a combination of Sweet's syndrome and erythema nodosum, and appropriate treatment is discussed.

Adrenal Cortex Hormones↗