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ERYTHEMA NODOSUM - EN

ERYTHEMA NODOSUM - EN. Orna Katz Internal Medicine B Sheba Medical Center 11/2009. Erythema Nodosum- Definition. Painful Inflammatory process involving the septa between subcutaneous fat lobules with radial granulomas with no vasculitis Most common type of Panniculitis

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ERYTHEMA NODOSUM - EN

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  1. ERYTHEMA NODOSUM - EN Orna Katz Internal Medicine B Sheba Medical Center 11/2009

  2. Erythema Nodosum- Definition • Painful Inflammatory process involving the septa between subcutaneous fat lobules with radial granulomas with no vasculitis • Most common type of Panniculitis • Tends to be self limited • The shin is the most common location

  3. Erythema nodosum – Clinical features • Tender painful- highly sensitive to touch • Erythematous • Subcutaneous nodules • Located symmetrically on anterior surface of lower extremities • Does not Ulcerate Usually resolves without atrophy or scarring – within 2-8 weeks.

  4. Erythema nodosum – Clinical features • Polyartralgia • Fever • Malaise • Elevated ESR

  5. Erythema nodosum

  6. Erythema nodosum- Etiology • m/p – involvement of type 4 hypersesitivity response to numerous Ag. • recent streptococcal infection

  7. Erythema nodosum –Dg workup • CBC complete blood count • ESR erythrocyte sedimentation rate • CRP • Streptococcal evaluation Throat culture, ASO titer, PCR • Bx deep incisional • TB evaluation- PPD, chest radiograph, stool culture • Liver enzymes , bilirubin, albumin

  8. Erythema nodosum - causes • Streptococcal pharyngitis– throat culture, ASO titer • Sarcoidosis – Northern Europe and north America • Lofgren’s syndrome – 1.hilar adenopathy 2.acute polyarthritis 3.EN • Tuberculosis - endemic regions • Coccidioidomycosis • Histoplasmosis • Inflammatory bowel disease – Crohn’s disease. • Drugs -oral contraceptives, sulfonamides, penicillins, bromides, iodides). • Cancer • Less common associations include bacterial gastroenteritis (Yersinia, Salmonella) , Chlamydophila pneumoniae, brucellosis, and infections with or Chlamydia trachomatis, M. pneumoniae, or hepatitis B virus. • Leprosy • Idiophatic- exclusion

  9. Erythema nodosum - DD • Erythema induratum (Bazin disease)- posterior legs, ulceration, recurrence (TB) • Weber christian disease • Superficial thrombophlebitis

  10. Weber christian disease • Relapsing febrile nodular Panniculitis • Infiltrative inflammatory disease of fat • Occurs in young white females • Tender skin nodules , fever, arthralgias, myalgias • Typical –subcutaneous nodules- atrophy, induration,scarring hyperpigmentation

  11. Okay now forgot about Weber christian disease….

  12. Eryrhema nodosum- treatment • Usually self limited • Symptomatic • Rash- NSAIDs, potassium iodide

  13. Erythema nodosum -Conclusion • Be alert since it is mostly a clinical Dg!!! That can point to other diseases.

  14. Thank you!

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