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erythema nodosum

Updated: Jan 5

Erythema nodosum

Incidence

  1. Male : female 1:4

  2. Age group 18-34

  3. 2.4 per 10,000 per year

Clinical

  1.  fever and joint pain 1-2 day before eruption

  2. Erythema ill-define painful nodule

  3. Usually extensor surface of leg

  4. Each lesion resolve with in 2 week from redness in first week to bruise like but no pus or ulcer over lying can be desquamation

  5. New lesion can continue appear for 3-6 week

Association symptom

  1. Bilateral lymphadenopathy may associate sarcoidosis

  2. Unilateral lymphadenopathy may associate infection or malignancy

  3. Joint pain usually ankle knee , RF neg may last to 6 month

Cause

Most common in children streptococcal infection

Adult streptococcal infection or sarcoidosis

Bacteria Infection

  1. Streptococcal infection

  2. Tuberculosis

  3. Yersinia enterolytica : diarrhea ,abdominal pain

  4. Mycoplasma pneumoniae

  5. Lymphogranuloma venereum

  6. Campyrobacter

  7. Salmonella

Fungal infection

  1. Coccidiomycosis ,respiratory infection

  2. Histoplasmosis

  3. Blastomycosis

Drug

  1. Sulfa

  2. Oral conceptive

Inflamation disease

  1. Ulcerative colitis

  2. Crohn ,inflammatory bowel disease

  3. Bechet disease

  4. Sarcoidosis

  5. Malignancy Malignancy : non hodgkin and hodgkin lymphoma

  6. Pregnancy

Ddx

erythema nodosum leprosum

Investigation

Biopsy : leukocytoclastic vasculitis

  1. throat culture for group A beta hemolyticus strep

  2. ESR , usually high

  3. ASO titer

  4. stool exam

  5. blood culture

  6. chest Xray for TB and Sarcoidosis

treatment

self limit

  1. NSAID [brufen , naproxen , indomethacin]

  2. colchicine in refractory case

  3. bed rest

  4. cool compress

  5. elevation, restrict mobility in case of pain

  6. systemic steroid consider case by case 1 mg/kg/day [before give make sure not from CA or infectious cause ]

Prognosis

  1. Infectious cause usually heal in 2 month

  2. 30% idiopathic may last upto 6 months

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