| THE
ERYTHEMA NODOSUM, LOOKING FOR AN ORIGIN !!!
EL ERITEMA
NODOSO, BUSCANDO UN ORIGEN !!!
Data-Médicos
Dermagic/Express No. 5-(122)
30 Junio 2.004 / 30 June 2.004
EDITORIAL ESPANOL
================= Hola
amigos de la red, esta edición del DERMAGIC de junio esta dedicada al tema
ERITEMA NODOSO, BUSCANDO UN ORIGEN, enfermedad dermatológica de múltiples
causas, que puede afectar niños y adultos de ambos sexos
La razón que me llevo a realizar esta revisión fue el haber visto en mi consulta
dos mujeres embrazadas afectadas un clásico eritema nodoso en piernas, el único
hallazgo de laboratorio interesante fue que ambas PRESENTABAN TÍTULOS ELEVADOS
DE ASTO (antiestreptolisina O). infección estreptocócica sin ninguna otra
manifestación clínica. Ambos casos se resolvieron con tratamiento de penicilina.
En la revisión pude comprobar que el eritema nodoso puede presentarse en
embarazo con o sin infección estreptocócica, y que SON MÚLTIPLES LAS CAUSAS DEL
MISMO, desde idiopático, condiciones malignas o benignas, hasta una simple
infección dental.
Los hechos en estas 40 referencias, DONDE PODRÁN COMPROBAR QUE muy probablemente
detrás de un eritema nodoso se encuentra una condición subyacente ! y a veces EL
ORIGEN es mas simple de lo que pensamos.!!!
Atentamente
Dr. José Lapenta R.
EDITORIAL ENGLISH
=================
Hello
friends of the net, this edition of the DERMAGIC of June 2.004 is dedicated to
the topic ERYTHEMA NODOSUM, LOOKING FOR AN ORIGIN, dermatologic disease of
multiple causes, that can affect children and adults of both sexes
The reason that I take myself to carry out this review was having seen in my
consultation two pregnant women affected with a classic erythema nodosum in
legs, the only interesting laboratory discovery was that both PRESENTED HIGH
TITLES of ASO (antistreptolysin O): streptococcal infection without any
other clinical manifestation. Both cases were solved with treatment of
penicillin.
In the review I could check that the erythema nodosum can be presented in
pregnancy with or without streptococcal infection, and that they are MULTIPLE
THE CAUSES OF THE SAME one, from idiopathic, malignant or benign condition,
until a simple dental infection.
The facts in these 40 references, WHERE you can CHECK THAT very probably behind
an ERYTHMA NODOSUM is an underlying condition! and it is sometimes THE ORIGIN
but simple of what we think. !!!
Sincerely
Dr. José Lapenta R.
=====================================================
REFERENCIAS BIBLIOGRAFICAS /
BIBLIOGRAPHICAL REFERENCES
======================================================
1.) Erythema nodosum, estrogens, and pregnancy.
2.) [Erythema nodosum and pregnancy. Report of a case]
3.) Erythema nodosum associated with pregnancy. Case reports.
4.) Long-term follow-up of erythema nodosum.
5.) Conditions currently associated with erythema nodosum in Swiss children.
6.) [Erythema nodosum. Review of 68 cases]
7-) [Erythema nodosum and pregnancy]
8.) [Erythema nodosum: 112 cases. Epidemiology, clinical aspects and
histopathology]
9.) Erythema nodosum: the underlying conditions.
10.) Etiology of erythema nodosum.
11.) Erythema nodosum in Israeli children.
12.) [Erythema nodosum: a study of 160 cases]
13.) [Erythema nodosum in the clinical picture of internal diseases]
14.) Skin manifestations of tularemia: a study of 88 cases in northern Finland
during years (1967-1983).
15.) Erythema nodosum in pregnant patients with coccidioidomycosis.
16.) Erythema nodosum: prospective study of 32 cases.
17.) Risk factors for erythema nodosum leprosum.
18.) Erythema nodosum in children: a prospective study.
19.) Erythema nodosum as a manifestation of HIV infection.
20.) Erythema nodosum: etiologic and predictive factors in a defined population.
21.) [Erythema nodosum in sarcoidosis patients]
22.) [Hairy cell leukemia associated with tuberculosis, disclosed by erythema
nodosum]
23.) [Erythema nodosum in Chlamydia pneumoniae infection]
24.) [Sweet syndrome and erythema nodosum in ulcerative colitis, refractory to
steroids: successful treatment with tacrolimus]
25.) Erythema nodosum associated with antiphospholipid antibodies: a report of
three cases.
26.) Potassium iodide in the treatment of erythema nodosum and nodular
vasculitis.
27.) Primary tuberculosis cases presenting with erythema nodosum.
28.) [Ulcerative colitis concomitant with pyoderma gangrenosum and erythema
nodosum--presentation of two cases]
29.) Erythema nodosum heralding recurrent Hodgkin's disease.
30.) Erythema nodosum of dental origin.
31. Erythema nodosum and giardia intestinalis.
32.) Erythema nodosum following typhoid vaccination.
33.) Salmonella gastroenteritis--another cause of erythema nodosum.
34.) Onset of erythema nodosum during pregnancy: a case report.
35.) Erythema nodosum associated with acute cytomegalovirus mononucleosis in an
adult.
36.) [Erythema nodosum in Campylobacter jejuni colitis]
37.) Granulomatous mastitis--a rare cause of erythema nodosum.
38.) Erythema nodosum in the Negev area--a survey of 50 patients.
39.) Immunoglobulin E in erythema nodosum.
40.) [Erythema nodosum association with malignant lymphoma]
==============================================
==============================================
1.) Erythema nodosum, estrogens, and pregnancy.
==============================================
Arch Dermatol. 1980 May;116(5):557-8.
Salvatore MA, Lynch PJ.
During the past ten years we have seen two or more episodes of erythema nodosum
develop in five patients in association with either pregnancy or the ingestion
of female hormones. No alternative causes of erythema nodosum were found in
these patients. The occurrence of erythema nodosum in association with hormonal
change suggests that female hormones can, under some circumstances, be directly
responsible
==============================================
2.) [Erythema nodosum and pregnancy. Report of a case]
==============================================
Ginecol Obstet Mex. 1991 Jun;59:181-3.
[Article in Spanish]
Rosales Estrada G, Smith Alpizar R, Braham Velasco J.
Hospital de Gineco Obstetricia, Dr. Emilio Chuayffet CH, Toluca, Mexico.Erythema
nodosum is a rare disease, it appears frequently in association with infectious
disease and with some drugs administration. A case associated with pregnancy is
presented. The importance of hormonal behavior in its genesis, is considered. We
conclude that the transitional hormone state in women is a very important factor
in it's appearance. Estrogens play an important roll in the immunological
response.
==============================================
3.) Erythema nodosum associated with pregnancy. Case reports.
==============================================
Eur J Obstet Gynecol Reprod Biol. 1979 Dec;9(6):399-401.
Langer R, Bukovsky I, Lipshitz I, Ariely S, Caspi E.
Four cases of erythema nodosum associated with pregnancy are reported and the
literature reviewed. Erythema nodosum in pregnancy is a self-limited condition
requiring minimal supportive treatment. No adverse effects upon pregnancy course
or fetal outcome were noted. It is suggested that pregnancy may serve as an
etiological basis for the disease.
==============================================
4.) Long-term follow-up of erythema nodosum.
==============================================
J Med Assoc Thai. 2003 Dec;86(12):1095-100.
Tantisirin O, Puavilai S.
Division of Dermatology, Department of Medicine, Faculty of Medicine,
Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
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.
==============================================
5.) Conditions currently associated with erythema nodosum in Swiss children.
==============================================
Eur J Pediatr. 1997 Nov;156(11):851-3.
Hassink RI, Pasquinelli-Egli CE, Jacomella V, Laux-End R, Bianchetti MG.
Kinderklinik, Inselspital, Bern, Switzerland.
A review was made of the 36 paediatric patients in whom the diagnosis of
erythema nodosum had been established between 1977 and 1996 at the Department of
Paediatrics, University of Bern, Switzerland. Infectious diseases were
associated with erythema nodosum in 20 (including 10 streptococcal infections)
and non- infectious inflammatory diseases in 8 patients. None of the 36 patients
had tuberculosis or had been exposed to sulphonamides, phenytoin or hormonal
contraceptives. There were eight patients in whom either the associated disease
was not diagnosed, or there was no other disease. Conclusion: Most cases of
erythema nodosum are nowadays caused by non-mycobacterial infectious diseases or
by non-infectious inflammatory diseases.
==============================================
6.) [Erythema nodosum. Review of 68 cases]
==============================================
Rev Clin Esp. 1983 Dec 31;171(6):405-8.
[Article in Spanish]
More Monreal J, Rodriguez de la Serna A.
PIP: A study was conducted of 68 patients suffering from erythema nodosum (EN)
with special emphasis on the etiological and immunological aspects. 60 of this
group were women (88%). Etiological factors were discovered in 37 cases (54%);
streptococcia in 16, anovulatory drugs in 4, both factors in 3, tuberculosis in
5, sarcoidosis in 5, Crohn's disease in 1, ulcerous colitis in 1, Yersinia in 1,
and Salmonella entetitis in 1. In the other 31 cases, there were elements of
dubious etiology in 25 (37%); streptococcia in 13, tuberculosis in 10, and
pregnancy in 2. In 6 cases (9%), no factor was detected which could be linked
with the EN. In the cases associated with sarcoidosis, the proportion of males
was significantly higher (P0.01). At the same time, polymorphous erythema was
detected in 4 cases and rheumatic fever in 1 cases. The immunological parameters
revealed no significant or specific changes (circulating immunocompleses, ANA
complement, immunoglobulins, and Ag HBs). The authors discuss these results and
compare them with other series, and stress the importance of EN in the diagnosis
of associated, general illnesses. (author's modified)
==============================================
7-) [Erythema nodosum and pregnancy]
==============================================
Rev Med Interne. 1997;18(2):172.
[Article in French]
Mathieu E, Fain O, Bon-Marty M, Feton N, Sitbon M, Thomas M.
Publication Types:
Letter
==============================================
==============================================
8.) [Erythema nodosum: 112 cases. Epidemiology, clinical aspects and
histopathology]
==============================================
Schweiz Med Wochenschr. 1997 Jul 8;127(27-28):1168-76.
Comment in:
Schweiz Med Wochenschr. 1998 Jan 17;128(3):85.
[Article in German]
Bohn S, Buchner S, Itin P.
Dermatologische Universitatsklinik Basel.
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
==============================================
9.) Erythema nodosum: the underlying conditions.
==============================================
Clin Rheumatol. 2000;19(3):212-6.
Psychos DN, Voulgari PV, Skopouli FN, Drosos AA, Moutsopoulos HM.
Department of Internal Medicine, Medical School, University of Ioannina, Greece.
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-Behcet'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.
==============================================
10.) Etiology of erythema nodosum.
==============================================
J Med Assoc Thai. 1995 Feb;78(2):72-5.
Puavilai S, Sakuntabhai A, Sriprachaya-Anunt S, Rajatanavin N, Charuwichitratana
S.
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand.
One hundred patients with biopsy-proven erythema nodosum were studied at
Ramathibodi Hospital from 1982 to 1992 to find out the etiology of this disease.
Eighty-eight were females while twelve were males, with an age range from 6 to
72 years old (mean, 31 years old). Abnormal laboratory findings in these
patients included elevation of erythrocyte sedimentation rate (76.9%), increase
anti- streptolysin-O titer (10.7%), abnormal chest roentgenogram (16.7%),
positive tuberculin test (50%). The cause of erythema nodosum is still unknown
in a large group of patients, and it was found only in twenty-eight patients
(28%). Twelvepatients had tuberculosis, seven had history of antibiotic
administration, six probably had streptococcal infection and the other three had
Behcet's disease.
==============================================
11.) Erythema nodosum in Israeli children.
==============================================
Isr Med Assoc J. 2000 Feb;2(2):145-6.
Garty BZ, Poznanski O.
Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah
Tiqva, Israel. [email protected]
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 whichit 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.
==============================================
12.) [Erythema nodosum: a study of 160 cases]
==============================================
Med Clin (Barc). 1991 Feb 9;96(5):169-72.
[Article in Spanish]
Atanes A, Gomez N, Aspe B, de Toro J, Grana J, Sanchez JM, Galdo F.
Unidad de Reumatologia, Hospital Juan Canalejo, La Coruna.
We have evaluated 160 patients diagnosed of erythema nodosum (EN) on the basis
of clinical and/or histopathological criteria to assess their etiology and their
major epidemiological, clinical and laboratory features in our area. Mean age
was 37.5 years and 86% of patients were females. The etiology could be
determined in 67. 5% of cases: sarcoidosis (20.6%), drugs (18%), streptococcal
infection (16.3%), tuberculosis (6.3%), pregnancy (1.9%), Crohn's disease
(1.3%), Behcet's disease (1.3%), lymphoma (0.6%), adenocarcinoma (0.6%), and
toxoplasmosis (0.6%). 32.5% of cases were idiopathic. We found significant
differences between the different etiological factors regarding mean age, fever,
joint disease, ESR, leukocytosis and serum proteins. We compare our results with
those from other series and we emphasize the need for a systematic workup in all
patients with EN to facilitate their etiological diagnosis.
==============================================
13.) [Erythema nodosum in the clinical picture of internal diseases]
==============================================
Ter Arkh. 1986;58(6):36-9.
[Article in Russian]
Tareev EM, Kornev BM, Moiseev SV.
A study of 64 patients with erythema nodosum (EN), including 53 females, showed
sarcoidosis diagnosed in 65% of the cases to be the principal cause of EN. It
was followed by drug disease (10%), tuberculosis (3%), pregnancy or labor (5%),
tumors (3%) and other underlying diseases (Behcet's diseases, streptococcal
infection, histoplasmosis, nonspecific aorto-arteritis, chronic active
hepatitis). The cause of EN could not be identified in 5% of patients only. Two
or three possible etiologic factors were identified in 17%. Sarcoidosis combined
with EN regressed without treatment in 82% of cases. Corticosteroid therapy was
only given in cases of pulmonary lesion or other systemic manifestations.
Purposeful investigation is believed to be capable of establishing etiology of
EN in virtually all cases.
==============================================
14.) Skin manifestations of tularemia: a study of 88 cases in northern Finland
during 16 years (1967-1983).
==============================================
Acta Derm Venereol. 1984;64(6):513-6.
Syrjala H, Karvonen J, Salminen A.
88 tularemia patients with secondary skin manifestations seen in northern
Finland during 1967-1983 are described in this paper. Tularemia was
ulceroglandular in 57% and pulmonary in 27% of the patients. 68% of the patients
were women. The most common secondary skin manifestation was papular or
vesicopapular eruption which was seen in 42% of the patients. Erythema nodosum
either alone or in combination with some other skin eruption was encountered in
28% and erythema multiforme in 9% of the patients. Erythema nodosum was seen
more often in patients with pulmonary tularemia than in other types of the
disease (p less than 0. 01). The clinical pictures of erythema nodosum and
erythema multiforme caused by tularemia greatly resembled those caused by
Yersinia. Tularemia should be remembered as one possible triggering factor of
erythema nodosum and erythema multiforme.
==============================================
15.) Erythema nodosum in pregnant patients with coccidioidomycosis.
==============================================
Clin Infect Dis. 1998 Nov;27(5):1201-3.
Arsura EL, Kilgore WB, Ratnayake SN.
Department of Internal Medicine, UCLA-Kern Medical Center, Bakersfield,
California, USA.
Pregnant patients with coccidioidomycosis develop dissemination and serious
disease more frequently than do the general population. To assist in prognosis
and management, we analyzed the significance of erythema nodosum in pregnant
patients with coccidioidomycosis. Sixty-one pregnant patients (mean age +/- SD,
26.4 +/- 6.3 years) were evaluated. Seventy percent of the patients were
Hispanic; 15%, African American; 13%, Caucasian; and 2%, unknown race. Of the 30
patients (49%) who developed erythema nodosum, 0 had disseminated disease (P =
.001), 1 (3%) with pulmonary involvement required therapy for > 1 year, and 29
(97%) recovered (P = .0008). Of the 31 patients (51%) without erythema nodosum,
11 (35%) had disseminated disease, 12 (39%) required therapy for > 1 year, 17
(55%) recovered, 1 (3%) died, and 1 (3%) had an outcome that was unknown.
Erythema nodosum appears to be a salient marker of a positive outcome for
pregnant patients, more so than for the general population.
==============================================
16.) Erythema nodosum: prospective study of 32 cases.
==============================================
Rev Inst Med Trop Sao Paulo. 1994 Nov-Dec;36(6):507-13.
Fernandes NC, Maceira J, Muniz Mde M.
Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Hospital
Universitario Clementino Fraga Filho, Brasil.
The results of 32 cases studied lead us to the conclusion that erythema
nodosum's investigation routine is very important, once in our retrospective
study, the percentage of cases of unknown etiology was 69.4%, and in this
prospective study it is 21.8%. In 10 cases (31.2%), more than one causing agent
was suspected. Infections (bacterial, helminthic, fungal, by protozoa) were
diagnosed in 26 cases, streptococcal infection having predominated (12 cases).
Drugs-dipirone, aspirin, anovulatory--were suspected as causing agents in 13
cases. The association of erythema nodosum and histoplasmosis capsulata is
described for the first time in Brazil. We consider erythema nodosum to be a
complex syndrome which should be regarded as a manifestation of underlying
diseases. The fact that all 32 subjects were women, 26 of them during menacme,
suggests that particular hormonal media may favor the action of various
processes (infections and drugs), precipitating erythema nodosum's clinical
picture.
==============================================
17.) Risk factors for erythema nodosum leprosum.
==============================================
Int J Lepr Other Mycobact Dis. 1999 Sep;67(3):270-8.
Manandhar R, LeMaster JW, Roche PW.
Mycobacterial Research Laboratory, Anandaban Leprosy Hospital, Kathmandu,
Nepal.
A retrospective study of new borderline lepromatous and lepromatous patients
reporting for multidrug therapy (MDT) for leprosy at the Anandaban Leprosy
Hospital, Kathmandu, Nepal, over an 8-year period was conducted to determine the
prevalence of erythema nodosum leprosum (ENL), the time and frequency of
reactions, and clinical and laboratory parameters associated with ENL. An
overall prevalence of ENL in this cohort of 19% was found. One third of these
reactions occurred in patients before MDT was given, one third in the first 6
months and one third after 6 months of treatment. Nearly 1 in 10 of the ENL
reactions occurred in patients who had completed 2 years of MDT; 45% of patients
with ENL had more than one episode. Data collected at the patients' first
presentation was used to identify four major risk factors. Patients with
lepromatous disease, skin infiltration or a bacterial index (BI) of > 4+ were at
significantly increased risk. Patients older than 40 were at significantly
decreased risk of ENL. There was a linear relationship in the risk of ENL with
an increasing BI and an inverse relationship to increasing age. These
observations should enable clinicians to recognize patients at first
presentation who will be likely to develop ENL.
==============================================
18.) Erythema nodosum in children: a prospective study.
==============================================
J Am Acad Dermatol. 2001 Jan;44(1):17-21.
Kakourou T, Drosatou P, Psychou F, Aroni K, Nicolaidou P.
First Department of Pediatrics, and the Department of Pathology, Athens
University, Greece.
BACKGROUND: The studies of series of children with erythema nodosum (EN) are
limited and mostly retrospective. OBJECTIVE: We evaluated the epidemiology,
etiology, clinical manifestations, course, and prognosis of EN in children.
METHODS: Thirty-five children with EN (17 boys, 18 girls; mean age, 8 .79 years)
have been studied. Four excluded children proved, on biopsy, to have
leukocytoclastic vasculitis (n = 3) or eosinophilic cellulitis (n = 1). RESULTS:
In 27 of the 35 children (77%), the etiology of EN was established by laboratory
investigations. In 25 children the causative factor of EN was an infectious
agent ( including beta-hemolytic streptococcus [n = 17], and Mycobacterium
tuberculosis [n = 2]), whereas in 2 patients, EN was associated with Crohn's
disease in one and Hodgkin's disease in the other. In 8 of the 35 children (23%)
the etiology of EN remained undetermined. The mean duration of the rash was 11.5
days. Recurrences were noted in only 2 children (1 episode in 1 child and 3
episodes in the other). CONCLUSION: Currently the most common provoking agent of
EN in children in Greece is beta-hemolytic streptococcus. However, Mycobacterium
tuberculosis should still be considered as a cause of the disorder. Also, the
course of EN is benign and recurrences are exceptional.
==============================================
19.) Erythema nodosum as a manifestation of HIV infection.
==============================================
Asian Pac J Allergy Immunol. 2002 Sep;20(3):175-8.
Louthrenoo W, Lertprasertsuke N, Kasitanon N, Sukitawut W.
Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chiang
Mai University, Chiang Mai 50200, Thailand.
Various musculoskeletal syndromes have been well described in patients infected
with the human immunodeficiency virus (HIV). Surprisingly, erythema nodosum, an
inflammation of the adipose tissue of the skin, has rarely been described. We
report a 24-year-old known case of HIV infection, who developed fever and
multiple tender subcutaneous nodules that were proven to be erythema nodosum.
The patient also had polymyositis. She responded well to a high dose of
corticosteroids. Erythema nodosum should be listed as possible the rheumatic
manifestation of HIV infection.
==============================================
20.) Erythema nodosum: etiologic and predictive factors in a defined population.
==============================================
Arthritis Rheum. 2000 Mar;43(3):584-92. Related Articles, Links
Erratum in:
Arthritis Rheum 2000 May;43(5):1061.
Garcia-Porrua C, Gonzalez-Gay MA, Vazquez-Caruncho M, Lopez-Lazaro L,
Lueiro M, Fernandez ML, Alvarez-Ferreira J, Pujol RM.
Hospital Xeral-Calde, Lugo, Spain.
OBJECTIVE: To examine the frequency and features of erythema nodosum (EN),
establish disease associations, and identify the optimal set of predictors for
the occurrence of secondary EN. METHODS: We performed a retrospective study of
an unselected population of patients 14 years and older with biopsy-proven EN
diagnosed at a referral hospital between 1988 and 1997. Patients were classified
as having either idiopathic EN or EN secondary to other diseases if the skin
nodules occurred in the context of a well-defined disease, or if there was a
precipitating event in close temporal proximity to the onset of EN. RESULTS: One
hundred six patients (82 women) were diagnosed as having biopsy-proven EN. At
the time of diagnosis, no precipitating events or underlying diseases were
identified in 36.8% of patients. Sarcoidosis and nonstreptococcal upper
respiratory tract infections (URI) were the most common conditions associated
with secondary EN. Only 1 of 35 patients with an initial diagnosis of idiopathic
EN and a followup of at least 1 year was finally diagnosed as having secondary
EN. The best predictive model of secondary EN included an abnormal results on a
chest radiograph, a previous history of nonstreptococcal URI, and a significant
change in antistreptolysin O ( ASO) titer in 2 consecutive determinations
performed in a 2-4-week interval. Also, the presence of peripheral synovitis, a
positive tuberculin skin test, and a history of diarrhea suggested the presence
of secondary EN. This model showed high sensitivity and specificity. CONCLUSION:
Idiopathic EN is common. A basic procedure including careful medical
history-taking, a physical examination for peripheral synovitis, 2 consecutive
ASO determinations, a tuberculin skin test, and chest radiography may be
sufficient to diagnose EN.
==============================================
21.) [Erythema nodosum in sarcoidosis patients]
==============================================
Probl Tuberk. 1993;(6):25-7.
[Article in Russian]
Ozerova LV.
Erythema nodosum was registered in 45 from 502 sarcoidosis patients (9%).
Erythema often arose in initial sarcoidosis, but was also recorded in the
disease recurrences. Sarcoidosis of the skin and subcutaneous fat occurred in 16
and 4 patients, respectively, this incidence being half of that for erythema
nodosum. Sarcoidosis of the above sites is the second in occurrence among
extrapulmonary lesions following those of peripheral lymph nodes. Positive
effects in the treatment of erythema nodosum were reached after administration
of corticosteroids, noncorticosteroid anti-inflammatory drugs, physiotherapy,
local therapy.
==============================================
22.) [Hairy cell leukemia associated with tuberculosis, disclosed by
erythemanodosum] ==============================================
Sem Hop. 1983 Oct 27;59(39):2716-7.
[Article in French]
Schved JF, Benoist D'Azu G, Brunel M, Vallat G.
A forty-two-year-old man presented with erythema nodosum of undeterminated
etiology and pancytopenia. A bone marrow biopsy revealed extensive hairy-cell
infiltration. Four months later, the diagnosis of pulmonary tuberculosis was
suggested by the appearance of a pulmonary infiltrate in the left upper lobe.
Despite antituberculous chemotherapy, the patient died. Post-mortem
bacteriologic confirmation was given by sputum culture.
==============================================
23.) [Erythema nodosum in Chlamydia pneumoniae infection]
==============================================
Tidsskr Nor Laegeforen. 1991 Apr 30;111(11):1369-70.
[Article in Norwegian]
Haugen O, Ritland S, Iveland H.
Medisinsk avdeling, Buskerud Sentralsykehus, Drammen.
Chlamydia pneumonia is now recognized as a species of the Chlamydia genus
distinct from C psittaci and C trachomatis species. It is a common cause of
pneumonia and other acute respiratory tract infections. We describe a patient
with erythema nodosum secondary to infection with C pneumoniae. Since this agent
usually causes a mild illness, with no distinct clinical findings, we recommend
adding serological tests for C pneumoniae to other relevant laboratory
investigations in patients with erythema nodosum.
==============================================
24.) [Sweet syndrome and erythema nodosum in ulcerative colitis, refractory to
steroids: successful treatment with tacrolimus]
==============================================
Med Klin (Munich). 2001 Feb 15;96(2):105-8.
[Article in German]
Fellermann K, Rudolph B, Witthoft T, Herrlinger KR, Tronnier M, Ludwig D,
Stange EF.
Medizinische Klinik I, Bereich Gastroenterologie, Universitatsklinikum Lubeck.
[email protected]
BACKGROUND: Inflammatory bowel disease is accompanied by cutaneous
manifestations in about 10% of cases. Erythema nodosum and pyoderma gangraenosum
are most frequently observed, which often subside on treatment of the underlying
disease. CASE REPORT: A 30-year-old male with a history of long-standing
ulcerative colitis experienced an acute attack despite treatment with
azathioprine. Further he noticed dull red, elevated and tender maculae on the
forelegs. A disseminated and papulosquamous exanthema arose on the back of the
trunk and the upper extremities without pruritus. Well-being was compromised and
blood sampling revealed an inflammatory response. High-dose steroids with
antibiotics were without benefit until they were combined with tacrolimus, an
immunosuppressive agent acting similar to ciclosporin. Remission occurred
rapidly and the skin lesions resolved. Six months later the patient is currently
still in remission and developed no signs of recurrent exanthema. CONCLUSION:
The cutaneous lesions are thought to be related to ulcerative colitis and were
classified as erythema nodosum and Sweet syndrome. This is the first report on
the successful use of tacrolimus in steroid-refractory ulcerative colitis with
extraintestinal cutaneous involvement.
==============================================
25.) Erythema nodosum associated with antiphospholipid antibodies: a report of
three cases.
==============================================
Lupus. 2000;9(8):641-5.
Nekhlyudov L, Gradzka M, Conti-Kelly AM, Greco TP.
Department of Internal Medicine, Yale University School of Medicine, New Haven,
CT, USA.
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). ==============================================
26.) Potassium iodide in the treatment of erythema nodosum and nodular
vasculitis.
==============================================
Arch Dermatol. 1981 Jan;117(1):29-31.
Horio T, Imamura S, Danno K, Ofuji S.
Twenty-nine patients with erythema nodosum, nodular vasculitis, or erythema
nodosum-like lesions associated with Behcet'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 Behcet'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.
==============================================
27.) Primary tuberculosis cases presenting with erythema nodosum.
==============================================
J Dermatol. 2004 Jan;31(1):66-8.
Mert A, Ozaras R, Tabak F, Ozturk R.
Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty,
University of Istanbul, Turkey.
Erythema nodosum (EN) is seen only in the primary tuberculosis (TB) form of
tuberculous diseases. Among the etiologies of EN, TB is the most frequent
disorder in developing countries. We aimed to assess our patients with EN in
reference to primary TB. We evaluated 335 patients with the diagnosis of TB
during last 20 years; retrospectively 61 (18%) of these cases had pulmonary and
274 (82%) had extrapulmonary TB. Ten (16%) of the pulmonary TB cases were
primary. All 10 patients with primary TB presented with EN. Among 50 patients
with EN diagnosed and followed during the last 10 years, the etiology was
determined in 56%, and primary TB was the most frequent: 20%.
==============================================
28.) [Ulcerative colitis concomitant with pyoderma gangrenosum and erythema
nodosum--presentation of two cases]
==============================================
Przegl Lek. 2001;58(10):945-9.
[Article in Polish]
Wojas-Pelc A, Wielowieyska-Szybinska D, Setkowicz M, Szybinski P,
Bogdaszewska-Czabanowska J.
Katedra i Klinika Dermatologii Collegium Medicum Uniwersytet Jagiellonski,
Krakow.
Authors present case of a 28-year old woman with skin symptoms of pyoderma
gangrenosum and ulcerative colitis seriously advanced. The patient benefited
from wide resection of the colon and steroid therapy. The other patient was
23-year old woman with ulcerative colitis concomitant with skin changes of
erythema nodosum. In this case steroid therapy gave also a very good effect. We
tried to find pathogenetic connection between these diseases based on the
reports from the medical literature.
==============================================
29.) Erythema nodosum heralding recurrent Hodgkin's disease.
==============================================
Cancer. 1985 Sep 15;56(6):1470-2.
Simon S, Azevedo SJ, Byrnes JJ.
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.
==============================================
30.) Erythema nodosum of dental origin.
==============================================
Clin Investig. 1992 Dec;70(12):1073-8.
Kirch W, Duhrsen U.
I Medizinische Klinik, Christian-Albrechts-Universitat Kiel.
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.
==============================================
31. Erythema nodosum and giardia intestinalis.
==============================================
Clin Rheumatol. 1985 Dec;4(4):481-3.
Giordano N, Fioravanti A, Mariani A, Marcolongo R.
We present the first report of erythema nodosum occurring in a woman with an
intestinal infection due to giardia lamblia, an association not previously
described.
The authors suggest the possible role of giardia infection in the pathogenesis
of erythema nodosum.
==============================================
32.) Erythema nodosum following typhoid vaccination.
==============================================
Scott Med J. 1985 Jul;30(3):173.
Thomson BJ, Nuki G.
Erythema nodosum has recently been recognised in association with salmonella
infection (1). We report a case of classical erythema nodosum which developed
following a typhoid vaccination.
==============================================
33.) Salmonella gastroenteritis--another cause of erythema nodosum.
==============================================
Br J Dermatol. 1980 Mar;102(3):339-40.
Scott BB.
Although there are many causes and associations of erythema nodosum, it remains
a useful sign often giving a clue to the diagnosis of a puzzling illness. It is
therefore important for clinicians to be aware of all the possible causes and
associations. The following report is of a patient in whom typical erythema
nodosum developed during the course of severe salmonella gastroenteritis.
==============================================
34.) Onset of erythema nodosum during pregnancy: a case report.
==============================================
Clin Exp Obstet Gynecol. 1998;25(1-2):40-1.
Coaccioli S, Donati L, Di Cato L, Puxeddu A, Villani C.
Medical Clinic, University of Perugia S. Maria Hospital, Termi, Italy.
Publication Types:
Case Reports
==============================================
35.) Erythema nodosum associated with acute cytomegalovirus mononucleosis in an
adult.
==============================================
Arch Intern Med. 1988 Feb;148(2):323-4.
Spear JB, Kessler HA, Dworin A, Semel J.
Department of Medicine, Rush-Presbyterian-St Luke's Medical Center, Chicago.
Acute cytomegalovirus mononucleosis has been associated with maculopapular
rashes, petechiae, purpura, urticaria, ulcerative lesions, and vesicular
eruptions. Although erythema nodosum has been reported in association with a
number of infectious and noninfectious diseases, to our knowledge it has not
been associated with cytomegalovirus infections. We report the first case of an
adult patient with acute cytomegalovirus mononucleosis who presented with
erythema nodosum.
==============================================
36.) [Erythema nodosum in Campylobacter jejuni colitis]
==============================================
Schweiz Med Wochenschr. 1990 Jun 23;120(25):946-7.
[Article in German]
Frohli P, Hanselmann R, Koelz HR.
Gastroenterologie, Medizinische Klinik, Stadtspital Triemli, Zurich.
We report the case of a 27-years-old woman with erythema nodosum associated with
ulcerative colitis due to Campylobacter jejuni as diagnosed by serology,
endoscopy and histology. This case indicates a hitherto rarely described
etiology of erythema nodosum.
==============================================
37.) Granulomatous mastitis--a rare cause of erythema nodosum.
==============================================
Postgrad Med J. 1987 Jul;63(741):581-2.
Adams DH, Hubscher SG, Scott DG.
Department of Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Granulomatous mastitis is a recently described, rare condition of unknown
aetiology. It occurs in young, parous women as a tender extra-areolar breast
lump and therefore needs to be differentiated from carcinoma. Histologically, a
discrete granulomatous lobulitis is seen and because of morphological
similarities to granulomatous thyroiditis it has been suggested it may be
immunologically mediated. We present a patient in whom granulomatous mastitis
presented with periarthritis and erythema nodosum, an association not previously
described.
==============================================
38.) Erythema nodosum in the Negev area--a survey of 50 patients.
==============================================
Isr J Med Sci. 1987 Dec;23(12):1228-31.
Erez A, Horowitz J, Sukenik S.
Department of Medicine A, Soroka Medical Center, Beer Sheva, Israel.
Fifty patients in the Negev area with erythema nodosum (EN) were studied
retrospectively. The clinical picture and demographic characteristics did not
differ markedly from those in the literature. In contrast to most European
studies but like those from Egypt, we found streptococcal pharyngitis to be the
major cause of EN. Conspicuously, sarcoidosis is a rare cause of EN in the
Negev. The low incidence of EN in the Negev--2 cases/100,000 people per year--as
opposed to Europe-- 14 cases/100,000 people per year--is hardly explained by the
low occurrence of sarcoidosis in Israel. Other factors, unknown at present, may
account for this low incidence.
==============================================
39.) Immunoglobulin E in erythema nodosum.
==============================================
Arch Dis Child. 1976 May;51(5):391-3.
Mandalenaki-Lambrou C, Thomaidis T, Benetos S, Ladis B, Matsaniotis N.
Twenty-two children aged from 3 years 6 months to 12 years with erythema nodosum
(EN) were grouped according to aetiology into streptococcal,
tuberculous, and those whose aetiology was undetermined. Serum IgE levels were
determined in all by the radioimmunosorbent technique. Levels were higher (mean
value 991 units/ml) in streptococcal EN than in those of the other two groups
(mean
value 68 units/ml and 97 units/ml, respectively) and healthy age-matched
controls
(mean value 60 units/ml). Increase of IgE levels in individual cases of
streptococcal
EN did not correlate with severity of the clinical manifestations characteristic
of that group.
==============================================
40.) [Erythema nodosum association with malignant lymphoma]
==============================================
Medicina (Kaunas). 2003;39(5):438-42.
[Article in Lithuanian]
Pileckyte M, Griniute R.
Clinic of Rheumatology, Kaunas University of Medicine, Lithuania.
[email protected]
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.
==================================================================
DATA-MÉDICOS/DERMAGIC-EXPRESS No 5-(122) 30/06/2.004 DR. JOSÉ LAPENTA
R.
===================================================================
|
