Skip to main content

Advertisement

Log in

Multiclinical experiences in erythema nodosum: rheumatology clinics versus dermatology and infection diseases clinics

Rheumatology International Aims and scope Submit manuscript

Abstract

Erythema nodosum (EN) is the most common cause of inflammatory nodules and usually affects the lower extremities and especially pretibial regions. EN may be idiopathic or associated with a wide spectrum of conditions including systemic diseases, infection, treatment with various drugs, pregnancy, and exceptionally with malignancies. The purpose of this study is to investigate the EN patients with different etiologies and laboratory features admitted to the rheumatology department and to compare them with other EN patients admitted to different departments including dermatology and infectious diseases. Totally, 107 patients diagnosed with EN (male/female: 37/70) were enrolled in the study. Of the 107 EN patients, 37 participants who were categorized as primary (idiopathic) EN (34.6 %) had not any underlying diseases or precipitating events. Majority of the participants were women (male/female: 12/25; mean age: 42.9 ± 9.2 years). Precisely, 70 EN (secondary EN) patients (65.4 %) had an underlying disease (male/female: 25/45; mean age: 36.1 ± 10.1). Behçet’s disease (BD) was the foremost (n = 40, 37.4 %), followed by sarcoidosis (n = 17, 15.9 %), post-streptococcal (n = 9, 8.4 %), and other rheumatologic disease (one patient temporal arthritis, one patient Sjögren’s syndrome, 1.9 %). Consequently, it is observed that BD, sarcoidosis, and post-streptococcal infection were found as the main etiologies of EN patients treated in our rheumatology department. These diseases should be kept in mind as an etiological factor in the management of EN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. White JW Jr (1985) Erythema nodosum. Dermatol Clin 3:119–127

    PubMed  Google Scholar 

  2. García-Porrúa C, González-Gay MA, Vázquez-Caruncho M et al (2000) Erythema nodosum: etiologic and predictive factors in a defined population. Arthritis Rheum 43(3):584–592

    Article  PubMed  Google Scholar 

  3. Hannuksela M (1986) Erythema nodosum. Clin Dermatol 4:88–95

    Article  PubMed  CAS  Google Scholar 

  4. Dellaripa PF, Wechsler ME, Roth M, Drazen J et al (2000) Recurrent panniculitis in a man with asthma receiving treatment with leukotriene-modifying agents. Mayo Clin Proc 75(6):643–645

    Article  PubMed  CAS  Google Scholar 

  5. Bhargava P, Kuldeep CM, Mathur NK (1996) Recurrent erythema nodosum leprosum precipitated by antileprosy drugs. Int J Lepr Other Mycobact Dis 64(4):458–459

    PubMed  CAS  Google Scholar 

  6. Bombardieri S, Di Munno O, Di Punzio C (1977) Erythema nodosum associated with pregnancy and oral contraceptives. Br Med J 11:1509–1510

    Article  Google Scholar 

  7. Cheong KA, Rodgers NG, Kirkwood ID (2003) Erythema nodosum associated with diffuse, large B-cell non-Hodgkin lymphoma detected by FDG PET. Clin Nucl Med 28(8):652–654

    PubMed  Google Scholar 

  8. Nishie W, Kimura T, Kanagawa M (2002) Sweet’s syndrome evolved from recurrent erythema nodosum in a patient with myelodysplastic syndrome. J Dermatol 29(2):91–95

    Article  PubMed  Google Scholar 

  9. Coaccioli S, Donati L, Di Cato L et al (1998) Onset of erythema nodosum during pregnancy: a case report. Clin Exp Obstet Gynecol 25(1–2):40–41

    PubMed  CAS  Google Scholar 

  10. Criteria for diagnosis of Behçet’s disease (1990) International study group for Behçet’s disease lancet 335(8697):1078–1080 (Review 5 May)

  11. Hunder GG, Bloch DA, Michel BA et al (1990) The American College of rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 33(8):1122–1128

    Article  PubMed  CAS  Google Scholar 

  12. Vitali C, Bombardieri S, Jonsson R et al (2002) European study group on classification criteria for Sjögren’s syndrome. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European consensus group. Ann Rheum Dis 61(6):554–558 (Review)

    Google Scholar 

  13. Jillson OF (1982) Erythema nodosum. Cutis 29:142–146

    PubMed  CAS  Google Scholar 

  14. Mert A, Kumbasar H, Ozaras R et al (2007) R. Erythema nodosum: an evaluation of 100 cases. Clin Exp Rheumatol 25(4):563–570

    PubMed  CAS  Google Scholar 

  15. Tay YK (2000) Erythema nodosum in Singapore, National Skin Centre, Singapore. Clin Exp Dermatol 25:377–380

    Article  PubMed  CAS  Google Scholar 

  16. Oğuz O, Serdaroğlu S, Tüzün Y (1992) Acute febrile neutrophilic dermatosis (Sweet’s syndrome) associated with Behçet’s disease. Int J Dermatol 31(9):645–646

    Article  PubMed  Google Scholar 

  17. Cho KH, Shin KS, Sohn SJ et al (1989) Behçet’s disease with Sweet’s syndrome-like presentation—a report of six cases. Clin Exp Dermatol 14(1):20–24

    Article  PubMed  CAS  Google Scholar 

  18. Lee ES, Bang D, Lee S (1997) Dermatologic manifestation of Behçet’s disease. Yonsei Med J 38(6):380–389 (Review)

    Google Scholar 

  19. Golan G, Beeri R, Mevorach D (1994) Henoch-Schönlein purpura-like disease representing a flare of Behçet’s disease. Br J Rheumatol 33(12):1198–1199

    Article  PubMed  CAS  Google Scholar 

  20. Coskun B, Oztürk P, Saral Y (2005) Are erythema nodosum-like lesions and superficial thrombophlebitis prodromal in terms of visceral involvement in Behcet’s disease? Int J Clin Pract 59(1):69–71

    Article  PubMed  CAS  Google Scholar 

  21. Zouboulis CC (1999) Epidemiology of Adamantiades-Behçet’s disease. Ann Med Int 150(6):488–498

    CAS  Google Scholar 

  22. Loddenkemper R, Kloppenborg A, Schoenfeld N et al (1998) Clinical findings in 715 patients with newly detected pulmonary sarcoidosis—results of a cooperative study in former West Germany and Switzerland. WATL study group. Sarcoidosis Vasc Diffuse Lung Dis 15(2):178–182

    PubMed  CAS  Google Scholar 

  23. Requena L, Sánchez Yus E (2001). Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol 45(3):325–361 (quiz 362–364 Review)

  24. Kakourou T, Drosatou P, Psychou F et al (2001) Erythema nodosum in children: a prospective study. J Am Acad Dermatol 44(1):17–21

    Article  PubMed  CAS  Google Scholar 

  25. Cribier B, Caille A, Heid E, Grosshans E (1998) Erythema nodosum and associated diseases. A study of 129 cases. Int J Dermatol 37(9):667–672

    Article  PubMed  CAS  Google Scholar 

  26. Whitehouse AC, Buckley CE, Nagaya H et al (1967) Macroglobulinemia and vasculitis in Sjögren’s syndrome. Experimental observations relating to pathogenesis. Am J Med 43(4):609–619

    Article  PubMed  CAS  Google Scholar 

  27. Alexander EL, Provost TT (1983) Cutaneous manifestations of primary Sjögren’s syndrome: a reflection of vasculitis and association with anti-Ro(SSA) antibodies. J Invest Dermatol 80(5):386–391

    Article  PubMed  CAS  Google Scholar 

  28. Ferreiro JE, Pasarin G, Quesada R et al (1986) Benign hypergammaglobulinemic purpura of Waldenström associated with Sjögren’s syndrome. Case report and review of immunologic aspects. Am J Med 81(4):734–740

    Article  PubMed  CAS  Google Scholar 

  29. Teramoto N, Katayama I, Arai H et al (1989) Annular erythema: a possible association with primary Sjögren’s syndrome. J Am Acad Dermatol 20(4):596–601

    Article  PubMed  CAS  Google Scholar 

  30. Person JR (1984) Autoimmune anhidrosis. J Am Acad Dermatol 10(1):117

    Article  PubMed  CAS  Google Scholar 

  31. Yamamoto T, Yokoyama A, Yamamoto Y (1997) Erythema nodosum associated with Sjögren’s syndrome. Br J Rheumatol 36(6):707–708

    Article  PubMed  CAS  Google Scholar 

  32. Goldberg JW, Lee ML, Sajjad SM (1987) Giant cell arteritis of the skin simulating erythema nodosum. Ann Rheum Dis 46(9):706–708

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bunyamin Kisacik.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kisacik, B., Onat, A.M. & Pehlivan, Y. Multiclinical experiences in erythema nodosum: rheumatology clinics versus dermatology and infection diseases clinics. Rheumatol Int 33, 315–318 (2013). https://doi.org/10.1007/s00296-012-2413-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-012-2413-5

Keywords

Navigation