Erythema Nodosum Research Articles

Clinical features of Behçet's disease and prediction of the use of biologics in 488 cases: a single tertiary center study.

The objectives are to describe the demographic and clinical properties of Behçet's disease (BD) and investigate their relationship with the use of biological agents. Four hundred-eighty-eight patients, (299 (61.3%) males, 189 (38.7%) females), who fulfilled the ISG classification criteria for BD were included, retrospectively. The patient's demographics, disease onset age (DOA), clinical findings of the disease, and the drugs were determined and analyzed statistically. The means of patient age and DOA were 40.7±9.9 and 30.8±8.8 years, respectively. The most common initial findings were oral ulcer (OU)s (30.1%), genital ulcer (GU) (27.5%), ocular involvement (OI) (12.5%), and papulopustular lesion (PPL)s (10.1%). The most common clinical manifestations were OUs (96.9%), PPLs (70.2%), HLA-B51 (64.4%), positive pathergy reaction (26.4%), GU (58.8%), OI (44.7%), erythema nodosum (29.8%), and vascular involvement (VSI) (27.3%). Although, the frequency of GU was higher in females (p=0.01), PPLs (p =0.001) and VSI (p=0.001) were higher in males. Sixty-three (8.9%) patients used a biological agent. Its frequency was higher in younger patients (<40 years) (p =0.006), males (p=0.012) and patients with OI (p=0.001). Besides, the DOA (p=0.012) and the current age (p=0.001) were lower in biological agent users. The possibility of using biological agent was increased in males (OR=2.2), patients with OI (OR=2.7) and young patients (OR=0.9). Mucocutaneous lesions are distinctive features of BD, especially OUs precede other findings. GU was more common in females and PPLs and VSI were in males. The probability of using biologics is higher in males, patients with OI, and young patients.

Dystrophic calciphylaxis in panniculitis: features of the clinical picture and diagnosis

The clinical presentation of lobular panniculitis (PN) associated with calciphylaxis (CP, calcification) can vary widely and may be associated with joint and internal organs involvement, making the diagnosis of the disease difficult.Objective: to evaluate the frequency and significance of CP in patients with PN using long-term prospective follow-up.Material and methods. From 2018 to 2023, at the V.A. Nasonova Research Institute of Rheumatology 217 patients with referral diagnosis "erythema nodosum" or "panniculitis" were examined. In 19.3% of cases (9 men and 33 women aged 37 to 72 years) CP was confirmed with an average disease duration of 56.3±11.2 months. Clinical examination of patients was performed according to the standards recommended by the Russian Association of Rheumatologists. International criteria were used to confirm the diagnosis of systemic lupus erythematosus (SLE), idiopathic inflammatory myopathies (IIM), systemic sclerosis (SS), and lipodermatosclerosis (LDS). In 12 patients with indurations, pathological examination of biopsy specimens of skin and subcutaneous fatty tissue from the area of induration was performed, which allowed confirming the diagnosis of idiopathic lobular PN (ILPN) in 3 cases. Four grades of calcification were distinguished according to the size and depth of the calcifications. In addition, considering the type of radiological changes and clinical manifestations, four subtypes of CP were identified: mousse-like, stone-like, mesh-like and lamellar-like.Results and discussion. In the study group, the ratio of women to men was 3.6:1, and the mean age was 43.8±7.6 years. On clinical examination we determined, in 60% of cases CP predominantly stone-like subtype (71.4%) of first grade (47.6%), which was significantly more frequently located on the upper and/or lower extremities and/or trunk (57.1%; p=0.05). Using clinical, laboratory and instrumental data, we confirmed the development of CP in ILPN (n=3), SLE (n=3), LDS (n=21), IIM (n=5), SS (n=1), and idiopathic CP (n=9) with a mean disease duration of 8.7±2.4 years.An increase in ESR and CRP levels occurred in different diseases, while urinary syndrome was associated with SLE (66.6%) and an increase in creatinine phosphokinase with IIM. Decreased calcium and 25-hydroxyvitamin D levels and increased phosphorus and parathyroid hormone levels were found in many patients studied.Conclusion. In the absence of clear diagnostic criteria for CP in patients with PN, early diagnosis is critical for the development of an effective multidisciplinary treatment plan.

Ulcerative colitis and pyoderma gangrenosum presentation of a case and brief literature review

Inflammatory bowel disease (IBD) is a chronic immune-mediated disorder comprised of Crohn's disease and ulcerative colitis. Ulcerative colitis affects the large intestine, while Crohn's disease can affect any part of the gastrointestinal tract (GIT). IBD is a multisystem condition that predominantly affects the gastrointestinal, musculoskeletal, ocular, and cutaneous systems. The following dermatological manifestations associated with IBDs have been identified: Specific manifestations with the same histological features of the underlying only ocurrs in Crohn Disease (CD); cutaneous disorders associated with IBD aphthous stomatitis, erythema nodosum; reactive mucocutaneous manifestations of IBDs pyoderma gangrenosum, Sweet’s syndrome, bowel-associated dermatosis-arthritis syndrome, aseptic abscess ulcers, pyodermatitis y mucocutaneous conditions secondary to treatment including injection site reactions y eczema and manifestations due to nutritional malabsorption such as stomatitis, glossitis, angular cheilitis hair and nail abnormalities. We believe dermatological examination is essential in all IBD patients, especially in candidates to biologic therapies, in whom drug-induced cutaneous reactions may assume marked clinical relevance, such as psoriasiform eruption. One of the cutaneous manifestations associated with UC is pyoderma gangrenosum (PG), which is an inflammatory neutrophilic dermatosis that clinically presents with well-defined ulcers with an erythematous border and mucopurulent or hemorrhagic exudate.We present the case of a 44-year-old female patient, who presented non-specific chronic ulcerative colitis (UC) with active intestinal symptoms, fever, diarrhea and hematochezia, 20 days later it began with pustules on the head, trunk and extremities, which evolved into an ulcer with a border erythematous and well defined whose clinical and histopathological diagnosis corresponded to pyoderma gangrenosum.

Erythema nodosum: a clinical sign of acute pancreatitis

Although pancreatic pathologies are primarily and mostly manifested by abdominal complaints, they can also occur with other organ systems. Erythema nodosum is the most common variant of panniculitis. In this study, we present a patient with acute pancreatitis who developed erythema nodosum. Although this phenomenon was reported by Chiari in the past, extra-abdominal findings can be ignored today.

Immunodeficiency due to a novel variant in PIK3CD: a case report

BackgroundPrimary immunodeficiencies are immunological disorders caused by gene mutations involved in immune system development and activation. Recently, activated phosphoinositide 3-kinase delta syndrome (APDS) due to mutations in the phosphoinositide 3-kinase (PI3K), phosphatidylinositol-4, 5-bisphosphate 3-kinase, catalytic subunit delta gene (PIK3CD), and phosphoinositide 3-kinase regulatory subunit 1 (PIK3R1) genes have been reported to induce a combined immunodeficiency syndrome leading to senescent T cells, lymphadenopathy, and immunodeficiency. The exact diagnosis of these deficiencies is essential for treatment and prognosis. In recent years, targeted treatment with selective PI3Kd inhibitors has had a significant effect on controlling the symptoms of these patients.Case presentationIn this case report, we represent a 27-month-old girl with recurrent fever, an increased level of inflammatory markers, and erythema nodosum, who was referred to the rheumatology clinic. In the course of evaluations, because of the lack of clinical improvement with usual treatments, and a history of frequent respiratory infections, combined immunodeficiency was diagnosed in the immunological investigations. Moreover, whole-exome sequencing was performed for her.ConclusionThe genetic analysis found a novel variant of PIK3CD (c.1429 G > A) in the patient. Following daily antibiotic prophylaxis and monthly IV therapy, the patient’s frequent infections and fevers were controlled.

Erythema Nodosum Leprosum and Thalidomide: How Effective?

Erythema Nodosum Leprosum (ENL) is considered a distinct entity from the reaction state of leprosy, it is a complication observed during lepromatous leprosy, its occurrence before any antibacillary treatment is possible, but relatively rare in our practice [1].

A case of VEXAS syndrome presenting with unusual bone marrow granulomas: a diagnostic dilemma

BackgroundVEXAS is a recently described inflammatory disease caused by mutations in the UBA1 gene. Symptoms are diverse and include fevers, cartilaginous inflammation, lung inflammation, vasculitis, neutrophilic dermatoses, and macrocytic anemia. Cytoplasmic inclusions in myeloid and erythroid progenitors in the bone marrow are a hallmark feature. Here we report the first case of VEXAS with non-caseating granulomas in the bone marrow.Case presentationA 62-year-old Asian male presented with fevers, erythema nodosum, inflammatory arthritis, and periorbital inflammation. Labs were significant for persistently elevated inflammatory markers and macrocytic anemia. Over the years his symptoms and inflammatory markers only improved with glucocorticoids and recurred when prednisone dose was lowered below 15–20 mg daily. He underwent bone marrow biopsy showing non-caseating granulomas and PET scan showing hilar/mediastinal lymphadenopathy. He was initially diagnosed with IgG4-related disease (treated with rituximab) and later sarcoidosis (treated with infliximab). After failing these agents, the possibility of VEXAS was considered and later confirmed by molecular testing.ConclusionsTo the best of our knowledge, this is the first observation of non-caseating granulomas in VEXAS, a cautionary reminder of its non-specificity since misinterpretation can lead to diagnostic delay. VEXAS should be in the differential in patients with symptoms of chronic inflammation responding positively to steroids (but not to B-cell depletion or TNF inhibition), which is in line with previous literature.

Histoid leprosy complicated by erythema nodosum leprosum mimicking connective tissue disease.

Erythema nodosum leprosum (ENL) is an immunological complication of leprosy seen in 50% of lepromatous and 10% of borderline lepromatous leprosy. It usually presents as a multisystem disease with papulo-nodular skin lesions and fever. Arthralgia or arthritis is a common initial presentation of erythema nodosum leprosum. Pure rheumatologic presentation of lepromatous leprosy complicated by erythema nodosum leprosum is extremely rare, mimics connective tissue disease and is treated with steroids.

Erythema nodosum A rare inflammatory disorder

Erythema nodosum is a rare inflammatory disorder that affects the subcutaneous fat layer. We present a case of a 32-yearold male patient who presented with painful nodules on his lower legs, associated with mild fever, malaise, and joint pain. Laboratory tests, including a complete blood count, comprehensive metabolic panel, and C-reactive protein, were within normal limits. A skin biopsy confirmed the diagnosis of erythema nodosum. The patient was started on a course of nonsteroidal anti-inflammatory drugs, and the nodules resolved over several weeks. This case highlights the importance of considering erythema nodosum in the differential diagnosis of a patient presenting with tender nodules on the lower legs and underscores the need for appropriate investigation to identify any underlying systemic cause

The Role of Neutrophil-to-Lymphocyte Ratio as A Potential Biomarker of Erythema Nodosum Leprosum Disease Severity: A Retrospective Study

Background: Erythema nodosum leprosum (ENL) is an acute immunologic complication of multibacillary leprosy (MB) that causes systemic inflammation in various organs. It is a major factor contributing to morbidity, mortality, and financial hardship. ENL is diagnosed clinically, and objective indicators for severe conditions remain unexplored. Simple blood biomarkers that differentiate between different ENL disease severity levels are required. Neutrophilto-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been widely studied as severity biomarkers of numerous neoplastic and inflammatory disorders. Objective: We examined NLR and PLR values at various ENL severities and their role as severe disease indicators for ENL. Methods: This cross-sectional retrospective study examined 246 patients with multibacillary leprosy—with and without ENL reactions and aged 18 and above—and calculated their NLR and PLR values. Then, we compared patients with mild and severe disease states to those without ENL. The severity classification was based on the ENLIST ENL Severity Score (EESS). To determine the NLR and PLR cutoff points of mild and severe ENL, a receiver operating characteristic (ROC) curve was constructed. Results: The NLR value for severe ENL was significantly higher than that for mild ENL (p &lt; 0.05), with a severe disease cutoff point of 5.71 (95.7% sensitivity, 68.7% specificity). No significant differences were found in PLR between patients with mild and severe ENL. Conclusion: While PLR is not an effective assay for evaluating ENL severity, NLR is a potential biomarker for severe ENL reactions in patients with multibacillary leprosy.

Rectal bleeding in pregnant women

The article presents a review of scientific literature on the main causes of rectal bleeding in pregnant women. Anatomical, biochemical and hormonal changes during pregnancy often lead to the progression of typical benign diseases (chronic hemorrhoids, anal fissure, etc.), radical surgical treatment of which can be carried out in the puerperal period. However, Crohn’s disease, ulcerative colitis or malignant colorectal polyps can be triggered by pregnancy and affect its course – this requires immediate examination and drug therapy. Pregnancy causes many physiological changes that affect the interpretation of routine biochemical and hematological examination methods. It is known that pregnancy requires increased iron content, the pregnancy courses often with anemia. The erythrocytes sedimentation rate varies significantly depending on the severity of anemia and the pregnancy term. Therefore, it is necessary to carefully analyze the main clinical manifestations of various intraluminal diseases that can potentially cause rectal bleeding in pregnant women.This article also describes the directions of diagnostic search and treatment strategy of rectal bleeding during pregnancy. Chronic hemorrhoids often accompany pregnancy in the third trimester. Some researchers indicate that up to 75% of pregnant women have complaints which are typical for chronic hemorrhoids. An anal fissure in lateral positions should cause suspicion of Crohn’s disease, tuberculosis, syphilis, human immunodeficiency virus, acquired immunodeficiency syndrome, dermatological diseases (most often psoriasis) and anal carcinoma.Bleeding in sexually acquired proctitis is usually mild and is often accompanied by minor purulent discharge. Rectal bleeding can be a sign of both ulcerative colitis and Crohn’s proctitis or sigmoiditis, but it is more typical for ulcerative colitis. Other associated clinical features are diarrhea, abdominal pain, urge to defecate, and specific extraintestinal manifestations (peripheral arthropathy, sacroiliitis, ankylosing spondylitis, conjunctivitis, iridocyclitis, episcleritis, aphthous skin ulcers, erythema nodosum, or pyoderma gangrenosum). If the bleeding is caused by a benign polyp, endoscopic polypectomy solves the bleeding problem.Therefore, rectal bleeding in pregnant women is diagnosed quite often. In most cases, it is caused by benign diseases of the rectum (chronic hemorrhoids or anal fissure), which are amenable to conservative therapy and usually do not threaten the life and health of a woman or a child. However, there is a rate of pregnant women whose rectal bleeding is caused by colorectal diseases, which require a comprehensive approach to diagnosis and treatment. In these women, the benefit and risk should be determined when choosing a diagnostic and treatment algorithm.

Principles of effective use of non-steroidal anti-inflammatory drugs

The article provides an overview of references on the rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in modern medicine. Nonsteroidal anti-inflammatory drugs are a group of drugs with different chemical structures (mostly acid derivatives) that have anti-inflammatory, analgesic, antipyretic, antiplatelet (acetylsalicylic acid, acetylsalicylate, ketoprofen, diclofenac sodium, niflumic acid, indomethacin) effects. NSAIDs are divided according to the selectivity of action relative to cyclooxygenase (COX) isoforms: non-selective COX inhibitors, selective COX-1 inhibitors, approximately equal inhibition of COX-1 and COX-2, selective COX-2 inhibitors. They are characterized by general pharmacological properties: high degree of absorption in the gastrointestinal tract; a high degree of binding to albumins; approximately the same volume of distribution; the ability to accumulate in the focus of inflammation. Indications for NSAIDs use are: acute arthritis and chronic arthritis; acute and chronic pain syndrome of various nature (lower back pain syndrome, joint and soft tissue injuries, migraine, dysmenorrhea, preoperative and postoperative pain, renal colic, fever in various rheumatic and non-rheumatic diseases). Аdditional indications for prescribing NSAIDs are: pleurisy, pericarditis, erythema nodosum, polycystic lung disease, sciatica. The most frequent and dangerous side effects include gastrointestinal, kidney complications. Special attention is paid to the cardiovascular safety of NSAIDs and, above all, COX-2 inhibitors because of risk of cardiovascular events. The most effective drug with the best tolerability should be selected for a specific patient. Before starting NSAID therapy, the patient's age, comorbidities, previous medical or surgical history, concomitant use of medications (including antiplatelet agents, anticoagulants, corticosteroids, ACE inhibitors, and selective serotonin reuptake inhibitors), H. pylori infection, and blood pressure monitoring should be considered. Keywords: inflammation, pain, side effects, gastropathy, selectivity.

Pan-immune-inflammation value and systemic immune-inflammation index: Are they useful markers in sarcoidosis?

Background/Aim: Sarcoidosis is a multisystem inflammatory disease characterized by the infiltration of various organs. Due to the lack of a widely-accepted biomarker, researchers have explored alternative and previously unexplored parameters in sarcoidosis. This study aimed to investigate the utility of various markers, including the systemic immune-inflammation index (SII) and pan-immune-inflammation value (PIV), in patients with sarcoidosis. Methods: A case-control study was conducted between January 2019 and February 2023. The study included 75 patients diagnosed with sarcoidosis, and 93 healthy individuals matched for age, sex, and body mass index. Sarcoidosis-related features, such as lung stage and extrapulmonary involvement, were recorded. The researchers investigated SII, PIV, procalcitonin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), other biochemical results, and complete blood counts (including neutrophil, lymphocyte, monocyte, platelet counts, hemoglobin, mean platelet volume [MPV], and red cell distribution width [RDW]). Results: The age and sex distribution were similar in both the case and control groups (P=0.258 and P=0.196, respectively). The patient group had a significantly lower absolute lymphocyte count than the control group (P=0.035). Patients’ RDW (P=0.007), platelet-to-lymphocyte ratio (P=0.028), and ESR (P&lt;0.001) values were significantly higher compared to controls. No significant difference was observed between the two groups regarding other variables, including PIV and SII. There was a significant weak positive correlation between PIV and lung stage, as well as between MPV and the presence of erythema nodosum. Conclusion: PIV and SII values in patients with sarcoidosis were similar to controls. The positive correlations between PIV and lung stage and between MPV and erythema nodosum suggest potential relationships with sarcoidosis-related features and demonstrate the value of these readily available and inexpensive markers in patient management. Comprehensive studies are needed to clarify whether SII and/or PIV can be used to assess the characteristics of patients with sarcoidosis.

CPC01 A puzzling panniculitis

Abstract A 51-year-old White woman was seen by dermatology services for a 3-day history of a painful subcutaneous nodule affecting her right distal calf, which was on a background of recurrent erythema nodosum diagnosed in childhood and an admission 6 months prior secondary to neutrophilic panniculitis affecting the right groin. The patient had sustained a traumatic injury to the leg following a fall. She was treated with oral antibiotics for a presumed infected haematoma. As her pain increased, she presented to the emergency department 3 weeks after the fall. On examination, a tender erythematous subcutaneous lesion with central sloughing was noted. She was tachycardic and hypotensive on presentation. Her C-reactive protein was elevated (172 mg L−1), and leucocytosis (15 × 109 cells L−1), with associated neutrophilia and anaemia (9.0 g dL−1), was noted on complete blood count review. Two days later, despite treatment with intravenous (IV) benzylpenicillin, flucloxacillin, clindamycin and topical clobetasol propionate, the lesion enlarged rapidly. Dermatology was consulted. Viral screens, including HIV, herpes simplex virus, Epstein–Barr virus, cytomegalovirus, and hepatitis B and C, were all negative. Serum protein electrophoresis and serum angiotensin-converting enzyme were within normal limits. Her α-1 antitrypsin level was elevated (3.16 g L−1; reference interval 1.1–2.1 g L−1). Her admission was complicated by sepsis, which required escalation of IV antibiotics to meropenem, vancomycin and clindamycin. Punch biopsy revealed epidermal necrosis and ulceration with extensive neutrophilic dermatosis and dermal abscess formation. The inflammation was seen to extend into the subcutis. Findings were reported as consistent with neutrophilic panniculitis. Colchicine was commenced based on ongoing sepsis and anaemia secondary to acute-on-chronic inflammation. Over 2 weeks, the lesion rapidly enlarged, prompting the introduction of oral corticosteroids (0.5 mg kg−1). Adalimumab and doxycycline were further introduced to reduce steroid requirements. Outpatient echocardiogram and colonoscopy revealed no pathology. Reduced levels of α-1 antitrypsin were noted on two occasions (0.89 g L−1 and 0.91 g L−1), coinciding with normal inflammatory markers following her acute illness. To date, no α-1 antitrypsin genetic abnormality has been detected. Panniculitis can be a rare and life-threatening manifestation of α-1 antitrypsin deficiency. Patients presenting with systemic inflammatory response syndrome and panniculitis have a reportedly high mortality risk. No hepatic or respiratory manifestation of α-1 antitrypsin deficiency was seen in this case, highlighting the importance of considering α-1 antitrypsin deficiency in the assessment of panniculitis and rechecking α-1 antitrypsin in this context as it is an acute-phase reactant.

Fulminant acne induced by simultaneous taking of isotretinoin and anabolic steroids

Acne fulminans is a rare disease characterized by the sudden appearance of painful nodules with a pronounced tendency to ulceration, accompanied by general symptoms, including fever, arthralgia, hepatomegaly and impaired blood parameters. Among its most frequent triggers are anabolic steroids and isotretinoin.&#x0D; The article describes a patient whose disease was caused by the sequential administration of anabolic steroids and systemic isotretinoin. The clinical picture of acne fulminans in the patient was represented by typical skin rashes, changes in blood parameters, arthralgia and myalgia, as well as nodular erythema. Systemic antibacterial therapy with doxycycline was ineffective. The patient was hospitalized in the Saint Petersburg State Budgetary Healthcare Institution "City Dermatovenerological Dispensary", where he was treated with prednisone and then with systemic isotretinoin. Due to the severe course of the process, the cumulative dose of isotretinoin achieved 240 mg/kg. Against the background of treatment, studies of aspartate aminotransferases, alanine aminotransferases, bilirubin, cholesterol, triglyceride indicators were regularly conducted, the values of which did not exceed the limits of reference indicators. The remission of the disease was 3 years, there are residual phenomena in the form of scars. Scar correction is carried out using a fractional CO2 laser (SmartXide Touch), no more than 3% of the skin is treated in one procedure.&#x0D; The peculiarity of the observation presented by us is the association of fulminant acne with simultaneous administration of steroid hormones and isotretinoin, the combination of fulminant acne with erythema nodosum, as well as good tolerance of high doses of isotretinoin.&#x0D; The literature review discusses data on etiopathogenesis, features of clinical manifestations, approaches to the treatment of fulminant acne. Modern approaches to the classification of the disease are also presented.

The correlation of neutrophil-lymphocyte ratio and ENLIST ENL severity scale in type 2 leprosy reactions

Link of Video Abstract: https://youtu.be/PlVYFXCyDlY Introduction: Type 2 leprosy reaction or Erythema Nodosum Leprosum (ENL) is an episode of acute inflammation that appears in the clinical course of leprosy. In ENL, antigen-antibody immune complex responses and the complement immune system are suspected. The Neutrophil-Lymphocyte Ratio (NLR) is an easy, inexpensive, and usable parameter related to clinical outcome and disease severity. The ENLIST ENL Severity Scale (EESS) is the world's first validated ENL severity scale. This study aimed to determine correlations between the NLR and the EESS in type 2 leprosy reactions. Methods: Observational analytic study with a cross-sectional approach was used in this study. The sample of the study was 30 subjects with type 2 leprosy reactions. The recording of basic data and examination of the study subjects included assessing the degree of severity using the ENLIST ENL severity scale and measuring the neutrophil-lymphocyte ratio. Statistical analysis was performed using Pearson's correlation coefficient, with p≤0.05 considered statistically significant. Results: The research subjects with the highest distribution were in the age group &lt;40 years (73.33%) and male (66.67%). The mean EESS score was 7.97 ± 1.73, with the category of the highest degree of severity in all subjects being mild (60.0%). The mean NLR value for all issues was 7.60 ± 3.58. There was a significantly strong positive correlation between NLR and EESS in type 2 leprosy reactions (p&lt;0.001, r=0.653). Conclusions: There was a strong correlation between NLR and EESS in type 2 leprosy reactions.

Ethnic Issues and Disparities in Inflammatory Bowel Diseases: What Can We Learn from the Arab Population in Israel?

Inflammatory bowel diseases are increasing among different ethnic groups. We aimed to compare the clinical characteristics, complications, and outcomes among Arab and Jewish people sharing the same healthcare system. All patients older than 18 years with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) between the years 2000 and 2021 were included. Data regarding demographics, disease characteristics, extraintestinal manifestation, treatment, comorbidities, and mortality were retrieved. A total of 1263 (9.8%) Arab CD patients were compared with 11,625 Jewish CD patients, and 1461 (11.8%) Arab UC patients were compared to 10,920 Jewish patients. Arab CD patients were younger at diagnosis, 36.11 ± 16.7 compared to 39.98 ± 19.4 years, p < 0.001, 59.5% males compared to 48.7%, p < 0.001; in addition, Arab CD patients had a higher rate of anal fissure, perianal abscess, erythema nodosum, diabetes mellitus, obesity, liver cirrhosis, and male infertility. Arab CD patients were less frequently treated with azathioprine or mercaptopurine compared with Jewish patients. No significant difference was found in the rate of anti-TNF treatment, but a higher rate of steroids treatment was found. The all-cause mortality of CD patients was lower among Arab patients (8.4% vs. 10.2%, p = 0.039). Significant differences were found regarding disease characteristics, course, comorbidities, and treatment among Arab and Jewish patients with IBD.

Erythema nodosum following COVID‐19 vaccination: A case report and literature review

AbstractThere have been a few reported cases of erythema nodosum (EN) after coronavirus disease 2019 (COVID‐19) vaccination. A 48‐year‐old healthy woman was referred to our department with multiple erythematous nodules of varying sizes on her extremities 10 days after receiving the third COVID‐19 vaccine dose. The clinical and pathological findings of the patients were consistent with EN. We reviewed 18 EN cases post‐COVID‐19 vaccination. Considering the low number of reported EN cases, a causal link between EN and COVID‐19 vaccination is still under debate.

(2952) Proposal to conserve the name Coccidioides posadasii against Posadasia esferiformis, Coccidium posadasi, Pseudococcidioides mazzae, Geotrichum louisianoideum, Glenospora meteuropea, Glenospora metamericana and Trichosporon proteolyticum (Ascomycota)

(2952) Proposal to conserve the name <i>Coccidioides posadasii</i> against <i>Posadasia esferiformis</i>, <i>Coccidium posadasi</i>, <i>Pseudococcidioides mazzae</i>, <i>Geotrichum louisianoideum</i>, <i>Glenospora meteuropea</i>, <i>Glenospora metamericana</i> and <i>Trichosporon proteolyticum</i> (<i>Ascomycota</i>)

Lucio phenomenon or necrotic erythema nodosum leprosum in an untreated case of leprosy?? A diagnostic dilemma…

Lucio phenomenon (LP) or erythema necroticans is a rare reaction pattern seen in untreated or partially treated lepromatous (LL) or borderline lepromatous (BL) leprosy cases. Necrotic Erythema Nodosum Leprosum (nENL), although seen in the same spectrum of leprosy, is seen in cases already undergoing treatment for leprosy and rarely in untreated cases. A 33-year-old male, a serving soldier presented to the medical clinic, in a remote area in the Northeast part of India with complaints of tender violaceous rash over previously normal looking skin, for 10 days along with myalgia and arthralgia, followed by low grade fever for 5 days. Cutaneous examination showed the presence of hyperpigmented to erythematous, irregularly shaped, discrete as well as coalescing purpuric macules and a few papules, with the presence of angular superficial ulcerations and haemorrhagic crusting, located over the trunk, abdomen, bilateral upper and lower extremities, including the palms and soles. He was started on systemic antibiotics by the physicians. Unfortunately, despite the treatment, the patient succumbed to the illness. A post-mortem biopsy sent from various parts of the body showed diffuse infiltration in the dermis with macrophages and lympho-histiocytic cells, numerous foam cells, panniculitis and necrotizing vasculitis. Fite-Faraco stain showed numerous cigar shaped bacilli arranged in the form of globi within macrophages. The cutaneous features were suggestive of LP, but the systemic features and histopathology favoured nENL, even though the patient had not been on any multibacillary therapy for leprosy, and showed no nodular eruptions preceding the haemorrhagic crusting.