Erythema Nodosum (Nodal Fever, Dermatitis contusiformis)

Abstract

A partial review of the literature dealing with erythema nodosum and an analysis of the cases observed during a 15 year period in a pediatric hospital in New York City brings to the fore the concept that erythema nodosum is an episode of hypersensitiveness which reflects an allergic response to a specific agent—usually an infection, occasionally a drug. In current American experience, the majority of cases are causally related to infection with beta-hemolytic streptococcus, tuberculosis occupying second rank, and a variety of other infectious diseases bringing up the rear. Cases related to sulfonamide therapy are on the wane, parallel with the diminishing use of sulfathiazole, but are still encountered occasionally in connection with sulfadiazine or other sulfonamide administration. The sensitivity of the skin may be demonstrated by intracutaneous injection of suspensions of killed organisms, or of some of their protein derivatives, or, in appropriate circumstances, of material containing inactivated filtrable virus. On the basis of such tests, the relation of erythema nodosum to the responsible underlying infection can usually be clearly demonstrated. Except in those cases in which the eruption results from medication, the significance to the patient of the development of erythema nodosum is the fact that it reflects the surge of the allergic response to a specific infectious agent and thus calls for adequate measures for identification of the underlying disease of which it is itself merely a surface phenomenon. The course of the underlying infection depends on other factors than the patient's high degree of sensitivity, and the outlook is not necessarily more grave because of the associated eruption; but along with the change in allergy there may occur changes in immunity which are potentially of great import. For the clinician, then, erythema nodosum should properly serve as a flash signal calling for a more probing search into the patient's total problem.