Materiały źródłowe

• #1 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Erythema nodosum is the most common form of panniculitis and is characterized by tender erythematous nodules mainly in the lower limbs on the pretibial area. […] Although the etiology is mostly idiopathic, ruling out an underlying disease is imperative before diagnosing primary erythema nodosum. […] We propose a diagnostic algorithm to optimize the initial work-up, hence initiating prompt and accurate management of the underlying disease. […] Making an accurate diagnosis will allow the physician to treat the underlying cause and determine an optimal therapeutic strategy. […] The diagnosis is usually made in a characteristic clinical scenario and is easily distinguished from other nodular lesions. However, it should be confirmed by a deep incisional or excisional biopsy with a generous portion of subcutaneous fat.

• #1 Erythema Nodosum – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-nodosum

  Erythema nodosum is a form of panniculitis (inflammation of the fat layer beneath the skin) that produces tender red or violet bumps (nodules) under the skin, most often over the shins but occasionally on the arms and other areas. […] The diagnosis is based on symptoms and may be supported by results of tests that suggest a possible cause, a chest x-ray, blood tests, and a biopsy. […] Sometimes a nodule is removed and analyzed with a microscope (biopsy) to confirm the diagnosis. […] Other testing is done to look for possible causes and can include a chest x-ray, blood tests, and skin testing for tuberculosis.

• #1 Erythema nodosum – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/erythema-nodosum/

  The key features of erythema nodosum (EN) typically include sudden onset of bilateral, 1-5 cm tender, erythematous, subcutaneous nodules arising in crops, most commonly on the pretibial areas. […] Although diagnosis is not usually difficult, other conditions that can mimic EN include the following: […] A clinical clue to the diagnosis is the predictable change in color over time from red to purple to yellow-green, resulting in bruise-like changes. When the diagnosis is in doubt, a skin biopsy can aid in diagnosis. […] EN is generally diagnosed with history and physical examination, as it has a characteristic clinical picture. A clinical clue to diagnosis is the predictable evolution in color over time resulting in bruise-like changes. […] If needed, skin punch biopsy can help confirm the diagnosis. It is usually needed only when patients have an atypical presentation or protracted course. Histologically, erythema nodosum is the prototypical septal panniculitis. Early lesions show edematous septa and mild lymphocytic infiltrates.

• #1 Erythema nodosum – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/332

  Erythema nodosum presents with tender, non-ulcerated, erythematous nodules located most commonly over the shins, and may sometimes be associated with arthralgia and fever. […] Histopathology demonstrates a septal panniculitis without vasculitis. Miescher’s radial granulomas are a diagnostical feature, but are not necessary for confirmation. […] Key diagnostic factors include presence of risk factors, nodules on shins, uveitis, red eyes, retinal nodules, or candle-wax drippings, nodules on other skin areas, and anaesthetic skin lesions. […] Other diagnostic factors include joint pains, fever, diarrhoea, constipation, abdominal pain, haematochezia, enlarged spleen, and miliary nodules on the retina. […] 1st investigations to order include FBC, anti-streptolysin-O titre, chest x-ray, and tuberculin skin test, interferon gamma release assay.

• #1 Erythema nodosum: Symptoms, Causes, and Management — DermNet

  https://dermnetnz.org/topics/erythema-nodosum

  Erythema nodosum is primarily a clinical diagnosis confirmed by laboratory tests and histopathology. The pathology of erythema nodosum shows inflammation primarily of the septa between the subcutaneous fat lobules without vasculitis. […] Appropriate tests may include: Complete blood count with differential, C-reactive protein levels (infectious and inflammatory causes), Chest X-ray (tuberculosis and sarcoidosis), Throat swab and anti-streptolysin O and streptodornase serology (streptococcal infection), Viral serology (preferably two samples at four-week intervals), Stool culture and evaluation for ova and parasites in patients with gastrointestinal symptoms, Mantoux test or QuantiFERON gold (tests for TB), Deep incisional or excisional skin biopsy.

• #1 Erythema nodosum – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/332

  Erythema nodosum presents with tender, nonulcerated, erythematous nodules located most commonly over the shins, and may sometimes be associated with arthralgia and fever. […] Histopathology demonstrates a septal panniculitis without vasculitis. Miescher radial granulomas are a diagnostic feature, but are not necessary for confirmation. […] Key diagnostic factors include nodules on shins, uveitis, red eyes, retinal nodules, or candle-wax drippings, and nodules on other skin areas. […] 1st investigations to order include CBC, antistreptolysin-O titer, chest x-ray, and tuberculin skin test, interferon gamma release assay. […] Investigations to consider include serum ACE level, skin lesion biopsy, coccidioidin skin test, histoplasmin skin test, lepromin skin test, blastomycosis serology, brucellosis serology, psittacosis serology, x-ray symptomatic joints, rheumatoid factor testing, Yersinia agglutination titer, Yersinia stool cultures, colonoscopy, serum IgD, and deep punch biopsies including subcutaneous fat, or incisional biopsies.

• #1 Erythema Nodosum: Causes, Symptoms, and Treatment

  https://patient.info/skin-conditions/erythema-nodosum

  Blood tests to look for signs of inflammation. […] Tests for streptococcal infection. For example, a sample (swab) may be taken from your throat. The swab is then sent to the laboratory to see if infection is present. A special blood test can also show if you have had a recent streptococcal infection. […] Chest X-ray. If your doctor suspects that you may have TB or sarcoidosis, they may suggest that you have a chest X-ray. […] Other investigations for TB. Your doctor may suggest a special test called a tuberculin skin test. The test involves having a small injection into your arm. It is used to see if you have TB. If you have a cough, your doctor may suggest that a sample of your phlegm (sputum) be sent to the laboratory to look for TB infection. […] Other investigations for sarcoidosis. If your doctor suspects that you may have sarcoidosis, they may refer you to a lung specialist for further investigations. […] Bowel investigations. If your doctor suspects that you may have underlying inflammatory bowel disease such as ulcerative colitis or Crohn’s disease, they may suggest that you have investigations to look for this. For example, you may have an examination of your bowel with a camera (a colonoscopy).

• #1 Erythema Nodosum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470369/

  Erythema nodosum (EN) is a common acute nodular septal panniculitis, characterized by the sudden onset of erythematous, firm, solid, deep nodules or plaques that are painful on palpation and mainly localized on extensor surfaces of the legs. […] Skin biopsy is not usually needed in the typical forms as a diagnosis can be reached from a detailed history and physical examination. […] The positive diagnosis of EN is primarily clinical. However, a thorough anamnesis (looking for tuberculous contagion, fever, bloody diarrhea, abdominal pain, respiratory problems, dysphagia, etc.) should be conducted as well as a complete clinical examination, always looking for associated signs. […] In typical cases, a complementary investigation for positive diagnosis is not necessary. Nevertheless, it finds its place in the etiological diagnosis. Taking into account the above, the etiological assessment of an EN should include examinations according to the clinical orientation. […] The prognosis for patients with EN is good but there is a small risk of recurrence. The skin lesions often take months to resolve but there is usually no scarring or pigmentation change.

• #1 Erythema Nodosum Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1081633-workup

  Chest radiographs should be ordered as part of the initial workup to exclude sarcoidosis and tuberculosis and to document hilar adenopathy. […] Intradermal skin tests can be used to exclude tuberculosis and coccidioidomycosis. […] Because the diagnosis of EN frequently can be made on clinical grounds alone, biopsy is reserved for diagnostically difficult cases. Punch biopsies usually are not adequate. Deep skin incisional biopsies are required to sample the subcutaneous tissue adequately. Findings are localized to the subcutaneous tissue. […] The classic features of EN on histopathology include a septal panniculitis with slight superficial and deep perivascular inflammatory lymphocytic infiltrate. The septa of subcutaneous fat usually are thickened. Early-stage lesions demonstrate vascular damage in the septa with neutrophils and eosinophils, similar to that seen in leukocytoclastic vasculitis. As lesions evolve, periseptal fibrosis, giant cells, and granulation tissue appear. Miescher granulomas are a hallmark feature of EN. Small well-defined nodular aggregates of histiocytes around a central stellate cleft are scattered throughout the lesions. A lymphohistiocytic infiltrate is noted in the septum and in small and medium-sized vessels.

• #1 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  A skin biopsy is not required to make the diagnosis of EN in patients with classic presentation, but may be helpful in confirming the diagnosis. […] EN has a somewhat specific clinical appearance and course, and often the challenge is determining the cause of EN, rather than distinguishing EN itself from other panniculitides. […] When evaluating EN, the differential diagnosis often includes erythema induratum, also known as nodular vasculitis, which generally occurs on the posterior lower legs and ulcerates far more frequently than EN. […] All patients presenting with EN should have chest radiography performed; the presence of hilar adenopathy should prompt clinicians to consider sarcoidosis. […] The presence of arthritis and fever may be helpful, but in cases where the diagnosis is in question, clinicians are advised to maintain a broad differential diagnosis and consider further evaluations. […] A basic initial laboratory workup and chest radiography is indicated in all patients (complete blood count, ESR and CRP, ASO or anti-DNAse titer, throat culture, urinalysis, urine pregnancy test, and PPD). […] A skin biopsy may be helpful in supporting the diagnosis or ruling out other entities.

• #1 Erythema Nodosum: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1081633-overview

  Erythema nodosum (EN) is an acute, nodular, erythematous eruption that usually is limited to the extensor aspects of the lower legs. […] EN is presumed to be a hypersensitivity reaction and may occur in association with several systemic diseases or drug therapies, or it may be idiopathic. […] The inflammatory reaction occurs in the panniculus. […] EN probably is a delayed hypersensitivity reaction to a variety of antigens; circulating immune complexes have not been found in idiopathic or uncomplicated cases but may be demonstrated in patients with inflammatory bowel disease (IBD). […] EN associated with enteropathies correlates with flares of the disease. […] The mean duration of chronic ulcerative colitis before the onset of EN is 5 years, and EN is controlled with adequate treatment of the colitis.

• #1 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Once the pathological diagnosis has been made, the real challenge is the identification of the underlying etiology of EN, if present, before considering it idiopathic. […] Diagnosis of EN is based on clinical presentation and histopathological findings. […] To identify the underlying cause, the initial work-up must contain a detailed medical history and physical examination. […] We propose a diagnostic algorithm to assist clinicians in making an accurate and timely diagnosis to initiate appropriate treatment for the underlying condition. […] If the initial work-up is inconclusive, further laboratory testing and imaging studies should be performed. […] Unfortunately, in most cases, no specific etiology can be found; therefore, these patients are considered as idiopathic or primary EN.

• #2

  https://link.springer.com/article/10.1007/s40257-021-00592-w

  Erythema nodosum is the most common form of panniculitis and is characterized by tender erythematous nodules mainly in the lower limbs on the pretibial area. […] Although the etiology is mostly idiopathic, ruling out an underlying disease is imperative before diagnosing primary erythema nodosum. […] We propose a diagnostic algorithm to optimize the initial work-up, hence initiating prompt and accurate management of the underlying disease. […] Making an accurate diagnosis will allow the physician to treat the underlying cause and determine an optimal therapeutic strategy.

• #2 Erythema Nodosum Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1081633-workup

  Chest radiographs should be ordered as part of the initial workup to exclude sarcoidosis and tuberculosis and to document hilar adenopathy. […] Intradermal skin tests can be used to exclude tuberculosis and coccidioidomycosis. […] Because the diagnosis of EN frequently can be made on clinical grounds alone, biopsy is reserved for diagnostically difficult cases. Punch biopsies usually are not adequate. Deep skin incisional biopsies are required to sample the subcutaneous tissue adequately. Findings are localized to the subcutaneous tissue. […] The classic features of EN on histopathology include a septal panniculitis with slight superficial and deep perivascular inflammatory lymphocytic infiltrate. The septa of subcutaneous fat usually are thickened. Early-stage lesions demonstrate vascular damage in the septa with neutrophils and eosinophils, similar to that seen in leukocytoclastic vasculitis. As lesions evolve, periseptal fibrosis, giant cells, and granulation tissue appear. Miescher granulomas are a hallmark feature of EN. Small well-defined nodular aggregates of histiocytes around a central stellate cleft are scattered throughout the lesions. A lymphohistiocytic infiltrate is noted in the septum and in small and medium-sized vessels.

• #2 2025 ICD-10-CM Diagnosis Code L52: Erythema nodosum

  https://www.icd10data.com/ICD10CM/Codes/L00-L99/L49-L54/L52-/L52

  L52 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. […] Clinical Information: An erythematous eruption commonly associated with drug reactions or infection and characterized by inflammatory nodules that are usually tender, multiple, and bilateral. These nodules are located predominantly on the shins with less common occurrence on the thighs and forearms. They undergo characteristic color changes ending in temporary bruise-like areas. This condition usually subsides in 3-6 weeks without scarring or atrophy. […] Erythematous eruption commonly associated with drug reactions or infection and characterized by inflammatory nodules that are usually tender, multiple, and bilateral; these nodules are located predominantly on the shins with less common occurrence on the thighs and forearms; they undergo characteristic color changes ending in temporary bruise-like areas; this condition usually subsides in 3-6 weeks without scarring or atrophy.

• #2 Erythema Nodosum | Musculoskeletal Key

  https://musculoskeletalkey.com/erythema-nodosum/

  Fig. 3.1 Erythema nodosum of limbs: symmetrical, erythematous, tender, rounded and oval nodules The peak incidence is closed to the 2030 years of age and the sex ratio favours females (36 times). The clinical picture is always that of a nonspecific systemic illness with mild-grade fever (in 60 % of cases with 3839 C), arthralgias (60 %), sometimes arthritis (30 %) and fatigue, while associated illness, in case of any, may prevail the presentation. It is consensually agreed that EN is a hypersensitive reaction to different antigenic stimuli and can therefore occur within the course of many diseases including infections, inflammatory and immune disorders, malignancies or drug therapy. However, an underlying aetiology cannot be found in about half of cases. […] In the large majority of cases, which exhibit typical EN, there is no indication to perform a skin biopsy. The dermatological diagnosis is based on clinical features. However, in very few atypical cases of unusual presentation, a skin biopsy can be performed to rule out other diagnoses. Histopathologically, erythema nodosum is a septal panniculitis, which is characterised by inflammation of fibrous septa between fat lobules variably spreading into the lobules, septa being thickened. Inflammatory cells often extend to the periseptal areas of the fat lobules.

• #2 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Erythema nodosum, a painful disorder of the subcutaneous fat, is the most common type of panniculitis. […] Erythema nodosum may be the first sign of a systemic disease such as tuberculosis, bacterial or deep fungal infection, sarcoidosis, inflammatory bowel disease, or cancer. […] A deep incisional or excisional biopsy specimen should be obtained for adequate visualization. […] Diagnostic evaluation after comprehensive history and physical examination includes complete blood count with differential; erythrocyte sedimentation rate, C-reactive protein level, or both; testing for streptococcal infection (i.e., throat culture, rapid antigen test, antistreptolysin-O titer, and polymerase chain reaction assay); and biopsy. […] Erythema nodosum usually is idiopathic, but there are many possible causes.

• #2 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  Erythema nodosum (EN) is the most common form of panniculitis. […] The list of associated diseases is lengthy and ever-expanding, and often a thorough history is the most crucial diagnostic test in determining the underlying etiology, and, thus, the optimal investigations and best therapeutic approach. […] A detailed history is integral in narrowing the scope of investigations and leading clinicians towards the most likely underlying trigger for EN. […] Evaluation of all patients should include a detailed medication history and comprehensive review of systems. […] Initial laboratory investigations should include a complete blood count (with differential), ESR and CRP, antistreptolysin O (ASO) titer or anti-DNAse titer, throat culture, urinalysis and urine pregnancy test, purified protein derivative (PPD) intradermal tuberculin test, and chest radiography.

• #2 Erythema nodosum – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/332

  Investigations to consider include serum ACE level, skin lesion biopsy, coccidioidin skin test, histoplasmin skin test, lepromin skin test, blastomycosis serology, brucellosis serology, psittacosis serology, x-ray symptomatic joints, rheumatoid factor testing, Yersinia agglutination titre, Yersinia stool cultures, colonoscopy, serum IgD, and deep punch biopsies including subcutaneous fat, or incisional biopsies.

• #2 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  A skin biopsy is not required to make the diagnosis of EN in patients with classic presentation, but may be helpful in confirming the diagnosis. […] EN has a somewhat specific clinical appearance and course, and often the challenge is determining the cause of EN, rather than distinguishing EN itself from other panniculitides. […] When evaluating EN, the differential diagnosis often includes erythema induratum, also known as nodular vasculitis, which generally occurs on the posterior lower legs and ulcerates far more frequently than EN. […] All patients presenting with EN should have chest radiography performed; the presence of hilar adenopathy should prompt clinicians to consider sarcoidosis. […] The presence of arthritis and fever may be helpful, but in cases where the diagnosis is in question, clinicians are advised to maintain a broad differential diagnosis and consider further evaluations. […] A basic initial laboratory workup and chest radiography is indicated in all patients (complete blood count, ESR and CRP, ASO or anti-DNAse titer, throat culture, urinalysis, urine pregnancy test, and PPD). […] A skin biopsy may be helpful in supporting the diagnosis or ruling out other entities.

• #2 Erythema Nodosum – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-nodosum

  Erythema nodosum is a specific form of panniculitis characterized by tender, red or violet, palpable, subcutaneous nodules on the shins and occasionally other locations. […] Diagnosis is by clinical evaluation and sometimes biopsy. […] Diagnosis of erythema nodosum is usually by clinical appearance and can be confirmed by incisional wedge biopsy of a nodule when necessary. […] A diagnosis of erythema nodosum should prompt evaluation for causes. Evaluation might include biopsy, tuberculosis skin testing (using purified protein derivative [PPD] or anergy panel), and possibly other tests (eg, antinuclear antibodies, complete blood count, chest radiograph, and serial antistreptolysin O titers or a pharyngeal culture). […] Diagnose erythema nodosum primarily by clinical appearance but, when necessary, incisional wedge biopsy may be performed for confirmation.

• #2 Erythema Nodosum

  http://www.perinatology.com/exposures/Maternal/Dermatology/Erythema%20Nodosum.htm

  Erythema nodosum (EN) is an inflammation of the subcutaneous fat characterized by painful, red swellings over the shins. […] Excisional biopsy of the lesions in the early stages of EN shows a perivascular infiltrate of neutrophils in the interlobular septa that is subsequently replaced by lymphocytes, and a granulomatous infiltrate with giant cells. […] If a biopsy is necessary to confirm the diagnosis, deep skin incisional biopsies are required to sample the subcutaneous tissue adequately. […] Other conditions to consider in the differential diagnosis include alpha-1 antitrypsin deficiency panniculitis, lupus panniculitis, cutaneous polyarteritis nodosa, superficial thrombophlebitis, and erythema induratum. […] Evaluation should include throat culture, antistreptolysin-O (ASO) titer, CBC, erythrocyte sedimentation rate, intradermal skin tests for tuberculosis and coccidioidomycosis, chest film to evaluate for hilar adenopathy, and stool culture in patients with GI symptoms. […] Consultation with a dermatologist and/or internist for evaluation of underlying cause of EN may be helpful.

• #2 Erythema Nodosum: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1081633-overview

  EN is the most frequent dermatologic symptom in IBD, and it is strongly associated with Crohn disease. […] EN associated with non-Hodgkin lymphoma may precede the diagnosis of lymphoma by months. […] Approximately 10-22% of all EN cases are caused by sarcoidosis, and EN is the most common cutaneous manifestation of sarcoidosis. […] This presentation has a good prognosis, with most cases resolving completely within several months. […] The prognosis for patients with EN is generally excellent. In most cases, the condition resolves without any adverse reactions.

• #2 Erythema Nodosum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470369/

  Erythema nodosum (EN) is a common acute nodular septal panniculitis, characterized by the sudden onset of erythematous, firm, solid, deep nodules or plaques that are painful on palpation and mainly localized on extensor surfaces of the legs. […] Skin biopsy is not usually needed in the typical forms as a diagnosis can be reached from a detailed history and physical examination. […] The positive diagnosis of EN is primarily clinical. However, a thorough anamnesis (looking for tuberculous contagion, fever, bloody diarrhea, abdominal pain, respiratory problems, dysphagia, etc.) should be conducted as well as a complete clinical examination, always looking for associated signs. […] In typical cases, a complementary investigation for positive diagnosis is not necessary. Nevertheless, it finds its place in the etiological diagnosis. Taking into account the above, the etiological assessment of an EN should include examinations according to the clinical orientation. […] The prognosis for patients with EN is good but there is a small risk of recurrence. The skin lesions often take months to resolve but there is usually no scarring or pigmentation change.

• #3 Erythema Nodosum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470369/

  Erythema nodosum (EN) is a common acute nodular septal panniculitis, characterized by the sudden onset of erythematous, firm, solid, deep nodules or plaques that are painful on palpation and mainly localized on extensor surfaces of the legs. […] Skin biopsy is not usually needed in the typical forms as a diagnosis can be reached from a detailed history and physical examination. […] The positive diagnosis of EN is primarily clinical. However, a thorough anamnesis (looking for tuberculous contagion, fever, bloody diarrhea, abdominal pain, respiratory problems, dysphagia, etc.) should be conducted as well as a complete clinical examination, always looking for associated signs. […] In typical cases, a complementary investigation for positive diagnosis is not necessary. Nevertheless, it finds its place in the etiological diagnosis. Taking into account the above, the etiological assessment of an EN should include examinations according to the clinical orientation. […] The prognosis for patients with EN is good but there is a small risk of recurrence. The skin lesions often take months to resolve but there is usually no scarring or pigmentation change.

• #3 Erythema nodosum – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/332

  Erythema nodosum presents with tender, non-ulcerated, erythematous nodules located most commonly over the shins, and may sometimes be associated with arthralgia and fever. […] Histopathology demonstrates a septal panniculitis without vasculitis. Miescher’s radial granulomas are a diagnostical feature, but are not necessary for confirmation. […] Key diagnostic factors include presence of risk factors, nodules on shins, uveitis, red eyes, retinal nodules, or candle-wax drippings, nodules on other skin areas, and anaesthetic skin lesions. […] Other diagnostic factors include joint pains, fever, diarrhoea, constipation, abdominal pain, haematochezia, enlarged spleen, and miliary nodules on the retina. […] 1st investigations to order include FBC, anti-streptolysin-O titre, chest x-ray, and tuberculin skin test, interferon gamma release assay.

• #3 Erythema nodosum – Wikipedia

  https://en.wikipedia.org/wiki/Erythema_nodosum

  Erythema nodosum is diagnosed clinically. A biopsy can be taken and examined microscopically to confirm an uncertain diagnosis. Microscopic examination usually reveals a neutrophilic infiltrate surrounding capillaries that results in septal thickening, with fibrotic changes in the fat around blood vessels. A characteristic microscopic finding is radial granulomas, well-defined nodular aggregates of histiocytes surrounding a stellate cleft. […] Additional evaluation should be performed to determine the underlying cause of erythema nodosum. This may include a full blood count (FBC), erythrocyte sedimentation rate (ESR), antistreptolysin-O (ASO) titer and throat culture, urinalysis, intradermal tuberculin test, and a chest x-ray. The ESR is typically high, the C-reactive protein elevated, and the blood showing an increase in white blood cells. […] The ESR is initially very high and falls as the nodules of erythema nodosum. The ASO titer is high in cases associated with a streptococcal throat infection. A chest X-ray should be performed to rule out pulmonary diseases, in particular sarcoidosis and Lfgren syndrome.

• #3 Erythema nodosum – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/erythema-nodosum/

  A high ASO titer usually is seen in cases associated with streptococcal infections. A significant change, at least 30%, in ASO titer in two consecutive tests performed in a 2- to 4-week interval usually indicates a recent streptococcal infection. […] The remainder of testing should be directed based on suspicion for underlying causes.

• #3

  https://step1.medbullets.com/dermatology/115058/erythema-nodosum

  Biopsy is indicated only if diagnosis is unclear clinically. […] Histology shows septal panniculitis without vasculitis, with septa thickened and having inflammatory infiltration. […] Management approach includes treating the underlying cause. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated for symptomatic relief as needed.

• #3 Erythema Nodosum Autoimmunity: Symptoms & Treatment Guide | Maggie Yu MD, IFMCP

  https://drmaggieyu.com/blog/erythema-nodosum-autoimmunity-symptoms-treatment-guide/

  Differential diagnosis is essential to exclude other conditions with similar symptoms. Conditions like vasculitis or subcutaneous sarcoidosis need to be ruled out. […] Identifying the cause of erythema nodosum is vital. Doctors look at potential triggers like infections, medications, or systemic diseases.

• #3 Erythema Nodosum | Musculoskeletal Key

  https://musculoskeletalkey.com/erythema-nodosum/

  Some series have reported the characteristic of EN patients seen in rheumatology. A series from Greece included 110 patients (83 % women, mean age 41.014.0 years). Sarcoidosis was diagnosed in 28 % of the patients, infections in 17.3 % and tuberculosis in 1.5 %. Other aetiologic factors were Adamantiadis-Behets syndrome (3.8 %), pregnancy (6 %), oral contraceptives (3.8 %) and other drugs (3.8 %). The aetiology of EN was not found in 35 % of the patients. Among 100 Turkish patients, the leading aetiology was poststreptococcal (11 %), followed by primary tuberculosis (10 %), sarcoidosis (10 %), Behets syndrome (6 %), drugs (5 %), inflammatory bowel diseases (IBD) (3 %) and pregnancy (2 %), but nearly half (53 %) of the cases had undetermined aetiology. Recurrences occurred in patients having primary EN in 62 % (33/53) of patients. The outcomes were usually favourable within 7 days, patients being at bed rest and receiving nonsteroidal anti-inflammatory drugs, together with specific treatment for patients with an underlying disease.

• #3 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  A skin biopsy is not required to make the diagnosis of EN in patients with classic presentation, but may be helpful in confirming the diagnosis. […] EN has a somewhat specific clinical appearance and course, and often the challenge is determining the cause of EN, rather than distinguishing EN itself from other panniculitides. […] When evaluating EN, the differential diagnosis often includes erythema induratum, also known as nodular vasculitis, which generally occurs on the posterior lower legs and ulcerates far more frequently than EN. […] All patients presenting with EN should have chest radiography performed; the presence of hilar adenopathy should prompt clinicians to consider sarcoidosis. […] The presence of arthritis and fever may be helpful, but in cases where the diagnosis is in question, clinicians are advised to maintain a broad differential diagnosis and consider further evaluations. […] A basic initial laboratory workup and chest radiography is indicated in all patients (complete blood count, ESR and CRP, ASO or anti-DNAse titer, throat culture, urinalysis, urine pregnancy test, and PPD). […] A skin biopsy may be helpful in supporting the diagnosis or ruling out other entities.

• #3 Erythema Nodosum | Doctor

  https://patient.info/doctor/erythema-nodosum-pro

  Most cases are self-limiting and require only symptomatic relief. […] If an aetiology has been discovered then appropriate therapy is in order, depending on the underlying condition. […] The literature on erythema nodosum lists a host of possible treatments for persisting cases – these include potassium iodide, oral steroids, tetracyclines, macrolides and biologic drugs; however, it would seem wise to involve secondary care at this point to be sure that an underlying diagnosis isn’t being missed. […] Erythema nodosum usually resolves within six weeks but it may be more protracted, especially if the underlying cause of erythema nodosum remains or when it is idiopathic.

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