Cause Of Erythema Nodosum Research Articles

Erythema nodosum

Erythema nodosum (EN) is the most frequently occurring form of acute panniculitis. It is characterized by painful red to livid raised nodules or bumps that typically occur symmetrically in the shin area. The cause of EN is often areaction of the immune system to various triggers including infections, inflammatory diseases or medications. In approximately half of the cases no trigger can be identified. After treatment of the underlying pathology EN is typically self-limiting.

Access to Urgent Care Practices Improves Understanding and Management of Endemic Coccidioidomycosis: Maricopa County, Arizona, 2018-2023

BackgroundCoccidioidomycosis within endemic regions is often undiagnosed because appropriate testing is not performed. A dashboard was developed to provide information about the prevalence of coccidioidomycosis throughout the year. MethodsBanner Urgent Care Service has many clinics within Maricopa County, Arizona, a highly endemic region for coccidioidomycosis. All clinic visits and subset analyses for patients with International Classification of Diseases, Tenth Revision codes for pneumonia (J18.*) or erythema nodosum (L52) during 2018-2024 were included. Tabulated were daily frequencies of visits, pneumonia and erythema nodosum coding, coccidioidal testing, and test results. Banner Urgent Care Services’ counts of monthly coccidioidomycosis diagnoses were compared with those of confirmed coccidioidomycosis cases reported to Maricopa County Department of Public Health. ResultsMonthly frequencies of urgent care coccidioidomycosis diagnoses strongly correlated with public health coccidioidomycosis case counts (r = 0.86). Testing frequency for coccidioidomycosis correlated with overall pneumonia frequency (r = 0.52). The proportion of pneumonia due to coccidioidomycosis varied between <5% and >45% within and between years. Coccidioidomycosis was a common cause of erythema nodosum (65%; 95% confidence interval, 45%-67%) and independent of pneumonia. Over half of Banner Urgent Care Services’ coccidioidomycosis diagnoses were coded for neither pneumonia nor erythema nodosum. ConclusionData provided by the coccidioidomycosis dashboard can assist urgent care practitioners in knowing when coccidioidomycosis is prevalent in the community. Patients with exposure to endemic coccidioidomycosis who develop erythema nodosum or pneumonia should routinely be tested for coccidioidomycosis. Data from private health care organizations can augment surveillance of diseases important to public health.

Exploring the connection between hidradenitis suppurativa and erythema nodosum: a case report

Background: Erythema nodosum (EN) is inflammation of subcutaneous fat. Etiologies include autoimmune diseases, drugs, infections, pregnancy, malignancy, and idiopathic origins. Case: A 37- year-old female with a history of recurrent cellulitis and type II diabetes presented with worsening swollen lumps on upper extremities for four months during a Hurley Stage III hidradenitis suppurativa (HS) flare. Exam revealed multiple erythematous pustules and warm indurated nodules over diffuse edema on the upper extremities. Lesions were refractory to trimethoprim/sulfamethoxazole, cefalexin, clindamycin and levofloxacin. Routine blood labs, ESR, and ANA were unremarkable. EN was diagnosed. Trimethoprim/sulfamethoxazole, saturated solution potassium iodide (SSKI) and ibuprofen were prescribed. At three week follow-up, EN had completely resolved except for one lesion. Discussion: Literature review revealed one case of EN manifestation in association with HS but was complicated by Beçhet’s syndrome. We propose HS as an underlying cause of EN and SSKI an effective treatment for EN and HS.

Erythema nodosum as a manifestation of many systemic diseases

Introduction and purpose: Erythema nodosum is a most frequent form of panniculitis and it appears as erythematous, painful rounded, nodules typically localized on the pretibial area. The purpose of our review is to present diseases that can be underlying causes of erythema nodosum and to draw attention to accompanying symptoms that can guide us to the appropriate diagnosis. Brief description of the state of knowledge: Currently, erythema nodosum is thought to be a symptom associated with hypersensitivity reactions to various antigens. Although the majority of the causes are considered idiopathic, erythema nodosum may be caused by many etiological factors. Summary: Erythema nodosum is usually an acute condition that resolves without treatment. However, it can sometimes be the first sign of a serious condition - autoimmune diseases, infections or malignancy. In such cases it is essential to observe it carefully and implement appropriate diagnostics that allow us to make a correct diagnosis.

Érythème noueux compliquant une maladie des griffes du chat : une association et des implications thérapeutiques à connaître

IntroductionCat-scratch disease is a zoonosis caused by Bartonella henselae and transmitted mostly through a break in the skin. This infectious disease is commonly characterized by a benign lymphadenitis. However, more unusual presentations have been observed. Case reportWe report the case of a 44-year-old woman with cat-scratch disease who developed subsequently an erythema nodosum. The non-steroidal anti-inflammatory treatment of the erythema nodosum may have led to worsening of cat-scratch disease with an abscess requiring surgical treatment. ConclusionCat-scratch disease is an uncommon and poorly known cause of erythema nodosum, and must be systematically ruled out. As non-steroidal anti-inflammatory drug are usually prescribed as a treatment of erythema nodosum, it should be used cautiously to reduce the risk of complications in the cat-scratch disease.

Recurrent erythema nodosum after the second dose of the Pfizer-BioNTech BNT162b2 COVID-19 messenger RNA vaccine

Vaccine induced erythema nodosum (EN) is well recognized. In this letter, we report a case of a patient who developed recurrent EN following vaccination with the Pfizer-BioNTech BNT162b2 COVID-19 messenger RNA (mRNA) vaccine. Clinicians should be aware that COVID-19 mRNA vaccines can be a possible cause of EN.

Erythema Nodosum: A Practical Approach and Diagnostic Algorithm.

Erythema nodosum is the most common form of panniculitis and is characterized by tender erythematous nodules mainly in the lower limbs on the pretibial area. The exact cause of erythema nodosum is unknown, although it appears to be a hypersensitivity response to a variety of antigenic stimuli. Although the etiology is mostly idiopathic, ruling out an underlying disease is imperative before diagnosing primary erythema nodosum. Erythema nodosum can be the first sign of a systemic disease that is triggered by a large group of processes, such as infections, inflammatory diseases, neoplasia, and/or drugs. The most common identifiable causes are streptococcal infections, primary tuberculosis, sarcoidosis, Behçet disease, inflammatory bowel disease, drugs, and pregnancy. We propose a diagnostic algorithm to optimize the initial work-up, hence initiating prompt and accurate management of the underlying disease. The algorithm includes an initial assessment of core symptoms, diagnostic work-up, differential diagnosis, and recommended therapies. Several treatment options for the erythema nodosum lesions have been previously reported; nevertheless, these options treat the symptoms, but not the triggering cause. Making an accurate diagnosis will allow the physician to treat the underlying cause and determine an optimal therapeutic strategy.

Examination of the Microbial Spectrum in the Etiology of Erythema Nodosum: A Retrospective Descriptive Study.

Even though infections are the most common cause of erythema nodosum (EN), only certain microorganisms take the great interest such as streptococci in knowledge. Our aim was to examine the frequency and type of infections in EN, to determine the characteristics of patients with an infectious etiology, and to discuss the role of these microbes in EN pathology in the context of their interactions with humans. Charts of 81 patients with EN who were seen between 2003 and 2017 were retrospectively reviewed. Identified etiological factors were classified into three groups: infectious, noninfectious, and idiopathic. While there were no significant demographic and clinical differences between the infectious and idiopathic groups, systemic symptoms (p = 0.034) and the number of EN lesions (p = 0.016) were significantly lower; the mean erythrocyte sedimentation rate was significantly higher (p = 0.049), but the mean aspartate aminotransferase value was significantly lower in the infectious group compared to the noninfectious group (p = 0.019). Besides streptococci, many other microbes, including the ones living on and inside us, were identified in the etiology of EN. There is a need for large-scale prospective studies involving control groups for a better understanding of the microbial immunopathology of EN.

Erythema nodosum: Analysis of 91 hospitalized patients

Erythema Nodosum (EN) is an acute nodular erythematous cutaneous eruption. It is presumed to be a hypersensitivity reaction and it may be idiopathic, or occur in association with diverse diseases and medications. To identify the main etiologies of EN among patients admitted to a medicine service of a clinical hospital. Analysis of medical records of patients discharged with the diagnosis of EN during a ten years period. Patients were considered to have secondary EN when an underlying condition was found, and to have idiopathic EN when no such condition was found. One hundred twenty nine patients were identified, but 91, aged 38 ± 14 years (86% females) had available clinical information. The etiology was idiopathic in 32% and secondary in 68% of patients. The leading etiologies were post-Streptococcal in 32%, followed by sarcoidosis in 11%, primary tuberculosis in 7%, Mycoplasma infection in 3%, Bartonella infection in 3%, Behçet's syndrome in 2%, inflammatory bowel disease in 2%, drugs in 1% and other etiologies in 8%. Secondary cases of EN had higher levels of C Reactive Protein and leucocytes than idiopathic cases. The distribution of causes in our study population were similar to those reported in the literature (With smaller proportion of idiopathic), as was the man/woman (1/6) ratio, and the preponderance of cases in winter and spring. Infectious diseases were the leading causes of EN in this group of patients, and a reasonable initial approach in the hospital should include a diligent medical history and physical examination, complete blood count, ESR, titles ASO, PPD tuberculin skin test, chest X-ray or CT scan and, where deemed appropriate, specific autoimmune and infectious serology.

A Case of Erythema Nodosum Associated withMycoplasma pneumoniaeInfection: Pathologic Findings and a Presumed Pathogenesis

결절성 홍반은 소아에서 가장 흔한 피하지방층의 염증으로 하지의 압통을 동반한 결절을 특징으로 한다. 이 질환은 다양한 원인에 의해 발생되지만 공통된 조직소견을 보여준다. 저자들은 임상적 소견 및혈청학적 방법으로 마이코플라즈마 폐렴균에 의한 결절성 홍반을 진단하였고 조직병리적인 접근을 통해 결절성 홍반의 면역병인에 대해 고찰해 보았다. 조직병리소견은 제 4형 면역반응 염증을 보였으며 이는 다양한 원인에 의한 결절성 홍반의 발생 기전을 이해하는데 도움을 줄 것이다.

Érythème noueux au cours d’une mastite granulomateuse idiopathique

Idiopathic granulomatous mastitis (IGM) is a benign, aseptic inflammatory disease of unknown origin, which must be distinguished from tumoral and infectious processes that affect the breast, including tuberculosis. IGM is a rare cause of erythema nodosum, but it is useful for dermatologists to be aware of this association. A 32-year-old nulliparous woman presented with erythema nodosum, arthralgia and fever. On examination, she had a firm and painful mass of 5cm in the right breast with retraction and axillary adenopathy. The breast lump developed gradually over the preceding 4 months. Although two biopsies showed no evidence of atypical cells, inflammatory areas and a granulomatous process were seen. Culture of breast tissue for mycobacteria was negative. A diagnostic of idiopathic granulomatous mastitis was made. Systemic corticosteroids led to a reduction in size of the mass, but relapse occurred in the contralateral breast on dose-reduction of the corticosteroids. IGM is a rare disease of unknown aetiology. Diagnosis is based on characteristic histological features and exclusion of other granulomatous diseases. Extra-mammary signs are rare and include erythema nodosum, arthralgia and episcleritis. Management is poorly codified.

Erythema nodosum — A diversity of diagnostic potential!

Erythema nodosum results from an inflammatory reaction in the subcutaneous fat and is characterized by acute onset of painful and ill-defined erythematous nodules that can best be seen than felt. Is associated with many differential diagnoses such as infections, drugs, sarcoidosis, inflammatory bowel disease and cancer. What was the etiology present in this case. The authors describe a case of a woman of 72 years old, living in rural areas. Personal history of hypertension and dyslipidemia was medicated with perindopril, indapamide and statin. Admitted by symptoms such as anorexia, weight loss (not quantified), fever and neck pain with 8 days of evolution, associated with the onset of painful erythematous nodules around the abdomen, upper and lower limbs two days before. The patient denied sore throat or flu-like illness in the previous weeks, as well as foreign travel, other new medications or relatives with the same symptoms. On physical examination no changes except painful erythematous nodules in the abdomen, back, upper and lower limbs, in different stages of evolution. Analytically had macrocytic normochromic anemia (9.6 g/dL), leukopenia (3300/μL), increased erythrocyte sedimentation rate (112 mm/h) and monoclonal peak range on the electrophoresis (IgM/kappa). The remaining analytical study performed, including immune, angiotensin converting enzyme, TASO (streptococcal serology) and bacterial, viral or fungal infection, was negative, as all microbiological research. All body CT-scan and digestive endoscopies without any evidence of pathology. Bone marrow biopsy was performed with the diagnostic of myelodysplastic syndrome (refractory anemia with excess blasts (RAEB-1)), checking the presence of 7% blasts and complex karyotypes with multiple chromosomal abnormalities, including del 5q - 16%. With this result it was decided by treatment with Azacitidine. The cause of erythema nodosum is a diagnostic challenge on the Internal Medicine because of the diversity of pathologies associated with it (from a pharyngitis to a neoplasm). With this case report, the authors intend to demonstrate that the presence of myelodysplastic syndrome can also manifest as erythema nodosum, which must be part of the differential diagnosis of this panniculitis.

Pediatric Autoimmune Hepatitis in a Patient Who Presented With Erythema Nodosum: A Case Report

Background: Autoimmune hepatitis (AIH) is a form of chronic hepatitis with unclear causative factors and is characterized by immunological and auto-immunological manifestations. Several extrahepatic manifestations, such as other autoimmune disorders, are associated with AIH. AIH with dermatological conditions as the initial manifestation is rare. We report the case of AIH in which erythema nodosum (EN) was the first manifestation. Case Presentation: An 8-year-old girl with several persistent dermatological lesions was referred to our hospital several months ago. Her skin had nodular, painful, dry, and erythematous lesions, predominantly on the extensor areas of both the legs, with some erythematous patches on her face. Physical examination revealed that she had hepatosplenomegaly as well. Skin biopsy indicated EN. The results of the laboratory tests showed increased levels of several liver enzymes. The patient\'s International Autoimmune Hepatitis Group (IAIHG) score was a definite indicator of AIH. The results of liver biopsy indicated AIH. Other causes of EN and abnormal liver function were ruled out. The only obvious cause of skin lesions was chronic inflammation due to an autoimmune response. The patient was treated for AIH, and her skin lesions along with other signs and symptoms resolved. Conclusions: AIH can present with protean clinical manifestations, and is thus associated with the risk of delayed diagnosis. Dermatological manifestations, including EN, could indicate a serious disease, and further investigation might be required. AIH should be considered as the possible diagnosis in such cases.

Pediatric Autoimmune Hepatitis in a Patient Who Presented With Erythema Nodosum: A Case Report

Autoimmune hepatitis (AIH) is a form of chronic hepatitis with unclear causative factors and is characterized by immunological and auto-immunological manifestations. Several extrahepatic manifestations, such as other autoimmune disorders, are associated with AIH. AIH with dermatological conditions as the initial manifestation is rare. We report the case of AIH in which erythema nodosum (EN) was the first manifestation. An 8-year-old girl with several persistent dermatological lesions was referred to our hospital several months ago. Her skin had nodular, painful, dry, and erythematous lesions, predominantly on the extensor areas of both the legs, with some erythematous patches on her face. Physical examination revealed that she had hepatosplenomegaly as well. Skin biopsy indicated EN. The results of the laboratory tests showed increased levels of several liver enzymes. The patient's International Autoimmune Hepatitis Group (IAIHG) score was a definite indicator of AIH. The results of liver biopsy indicated AIH. Other causes of EN and abnormal liver function were ruled out. The only obvious cause of skin lesions was chronic inflammation due to an autoimmune response. The patient was treated for AIH, and her skin lesions along with other signs and symptoms resolved. AIH can present with protean clinical manifestations, and is thus associated with the risk of delayed diagnosis. Dermatological manifestations, including EN, could indicate a serious disease, and further investigation might be required. AIH should be considered as the possible diagnosis in such cases.

An Unusual Presentation of Inflammatory Bowel Disease

Erythema nodosum (EN) is an infrequent but well-described extraintestinal manifestation of inflammatory bowel disease (IBD). We report a case of a previously healthy 8-year-old girl who presented to her primary care manager with a chief complaint of EN and was later found to have Crohn's disease. This article reviews the causes of EN, the significance of EN in IBD, and the recommended diagnostic approach to IBD in children.

Érythème noueux unilatéral associé à une leishmaniose cutanée homolatérale

ObjectiveThe authors wanted to report an uncommon etiology of erythema nodosum. Case reportA 45-year-old woman presented with numerous encrusted nodular lesions on the left leg and arm. Leishmania was identified after a parasitological examination. Subcutaneous erythematous nodules developed later on the same leg. Erythema nodosum was diagnosed with a biopsy of the nodules. The patient was treated with systemic meglumine 60 mg/kg per day for 13 days. All lesions improved under treatment. DiscussionThis was the first reported case of unilateral erythema nodosum with cutaneous leishmaniasis. Clinical and laboratory exams were in the range of normal and led the authors to exclude common causes of erythema nodosum. Subcutaneous nodules occurred before the beginning of treatment with meglumine. Thus, drug allergy (previously reported) was excluded as an etiology of EN.

Cabergoline-Associated Erythema Nodosum

To report a case of erythema nodosum (EN) and related inflammatory arthropathy in a patient on cabergoline therapy for a microprolactinoma. A 25-year-old white female, who had been receiving cabergoline 0.5 mg orally once per week for the preceding 2 months for a microprolactinoma, developed classic skin lesions of EN (proved by histology) and an associated acute inflammatory arthropathy of her left ankle joint in the absence of any other identifiable causes of EN. She improved substantially (skin lesions of EN and inflammatory arthropathy disappeared) after cessation of cabergoline therapy. Rechallenge with cabergoline in a lower dose of 0.25 mg orally once per week led to a milder recurrence of EN lesions that once again disappeared after withdrawal of the drug. She had not had a recurrence at a 3 month follow-up visit. Although possible autoimmune adverse effects (pleuropulmonary and cardiac) have been reported with the use of cabergoline, to the best of our knowledge, this is the first case report of EN (panniculitis) associated with cabergoline therapy. Causality assessment using the Naranjo probability scale revealed that the adverse drug event was probable. Cabergoline was probably associated with EN (panniculitis) and the related arthritis in a patient being treated for a microprolactinoma. Panniculitis, like EN, needs to be considered a possible but reversible adverse effect of cabergoline therapy for microprolactinoma of the pituitary gland.

Erythema Nodosum: Clinicopathologic Correlations and Their Use in Differential Diagnosis

PurposeTypically, a diagnosis of erythema nodosum (EN) is based on clinical features. However, other diseases manifest with inflammatory nodules of the lower limbs in addition to EN, such as the EN-like lesions of Behçet's disease (BD). The purpose of this retrospective study was to investigate the frequency of histologically proven EN among diseases diagnosed clinically as EN, to determine underlying causes of EN, and to compare clinical and histologic features between EN and other diseases.Patients and MethodsWe selected 99 patients diagnosed clinically with EN and performed skin biopsies. All pathologic slides were evaluated and diagnosed; and after histologic diagnoses were made we reviewed the patients' medical records.ResultsAmong the 99 patients diagnosed clinically with EN, 47 were biopsy-verified EN. The EN-like lesions of BD and nodular vasculitis were both in the primary differential diagnosis of EN. No definite difference in clinical features exists among these three diseases. Histologically, EN demonstrated septal panniculitis in the majority of patients. Lobular panniculitis was frequently observed in NV, and mixed or mostly lobular panniculitis was observed in the EN-like lesion. Vasculitis was rarely observed in EN; however lymphocytic vasculitis was observed frequently in EN-like lesions and neutrophilic vasculitis was observed in NV. The frequency of granulomatous inflammation was highest in NV. Some cases of patients with typical BD demonstrated classic EN lesions.ConclusionIt was extremely difficult to clinically differentiate EN from EN-like lesions or NV. We feel skin biopsy is mandatory for the diagnosis of lower extremity erythematous nodular lesions.

Underlying causes of erythema nodosum

Underlying causes of erythema nodosum

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.