Erythema nodosum in Adult
Associated bacterial, viral, fungal, and protozoal infections are numerous and include Streptococcus, Shigella, Yersinia, Histoplasma, Coccidioides, human immunodeficiency virus (HIV), and Giardia. Tuberculosis remains an important cause in areas of endemic disease. Autoinflammatory associations include sarcoidosis, inflammatory bowel disease, Sjögren syndrome, reactive arthritis, Behçet syndrome, and Sweet syndrome. Malignancy, such as lymphoma, is a rare cause of EN.
The eruption typically persists for 3-6 weeks and spontaneously regresses without scarring or atrophy. Recurrences are sometimes seen, especially with reoccurrence of the precipitating factors.
Arthralgias are reported by a majority of patients, regardless of the etiology of EN. Upper respiratory tract infection or flu-like symptoms may precede or accompany the development of the eruption.
No specific genetic predilection exists except for the underlying diseases (eg, sarcoidosis is more common in individuals of African descent). EN can occur at any age, but most cases occur between the ages of 20 and 45, particularly in women.
Löfgren syndrome is a benign variant of sarcoidosis with EN and bilateral enlargement of the hilar lymph nodes. It occurs more commonly in females, especially during pregnancy.
L52 – Erythema nodosum
32861005 – Erythema nodosum
- Subacute migratory panniculitis is often more focal, painless, and unilateral.
- Nodular vasculitis / erythema induratum is typically on the posterior calves.
- Primary infectious panniculitis occurs through septic seeding or direct inoculation of a variety of infectious organisms. Tissue culture and polymerase chain reaction (PCR) aids in diagnosis.
- Pancreatic panniculitis favors the lower legs but is often ulcerated.
- Lupus panniculitis favors the face and upper trunk. Most cases are not associated with systemic lupus erythematosus.
- Panniculitis of dermatomyositis (abdomen, thighs, arms) may be the first manifestation of dermatomyositis.