What erythema nodosum research was published this month?
It has been a busy year so far in erythema nodosum research. January brought us some interesting insights into EN and IgA deficiency. In February, researchers saw EN in several studies about other illnesses, found a successful treatment for EN and idiopathic mastitis, and asked some interesting questions about granulomas. Ā
These articles were all indexed by Google Scholar in the month of February and have publication dates in January, February, or March. Most of these articles are behind a paywall, but if you are interested in one of them, I can help you find somewhere to read it.
Coexistence of idiopathic granulomatous mastitis and erythema nodosum: successful treatment with corticosteroids
Eleven patients who had both erythema nodosum and idiopathic granulomatous mastitis (IGM) were treated with methylprednisolone. The erythema nodosum was completely gone from all of the patients within two weeks of starting the medicine. Within twelve weeks, the IGM symptoms were also gone from all of the patients. The researchers kept up with all of the patient for sixty months: neither condition came back.
HTLV-1 seroprevalance in sarcoidosis. A clinical and laboratory study in northeast of Iran
125 sarcoidosis patients in northeast Iran were tested for a virus that is known to dysregulate the immune system. 76 of those patients had erythema nodosum (63.2%). If I am reading their tables correctly, only two of those patients were positive for the virus. In the end, the study did not see the virus more in sarcoidosis patients than was normal for the area.
New insights on tuberculous aortitis
Tuberculosis infections in the aorta are very rare. This study compared eleven patients with tuberculosis aoritis, three of whom had erythema nodosum.
The effect of vitamin D on clinical manifestations and activity of BehƧetās disease
In this study, 68 patients with BehƧetās disease had their vitamin D levels tested. The authors wanted to know if treating BehƧetās patients with vitamin D would help with their symptoms. The vitamin D didnāt seem to help. Four of the 68 patients had erythema nodosum. Their vitamin D levels were lower than in BehƧetās patients without EN, but there were not enough patients to determine anything.
Association between rheumatic diseases and cancer: results from a clinical practice cohort study
1750 patient records from an Italian rheumatology clinic were analyzed for a connection between autoimmune diseases and cancer. Erythema nodosum was not studied on its own, but instead was part of a group called āisolated immunologic manifestations.ā This group was not discussed much in the article; out of the 112 patients in the āIMMā group, only 3 got cancer within two years. The article does not mention specifically how many EN cases were included.
Evaluation of asymptomatic venous disease by Doppler ultrasonography in BehƧetās disease patients
22 patients with BehƧetās disease and 22 controls were tested for vein disease. Eleven (50%) of the BD patients had EN.
A granulomatous conundrum: Concurrent necrobiosis lipoidica, cutaneous sarcoidosis and erythema nodosum in a nondiabetic patient
This very interesting case from Australia describes a woman with three different skin conditions on her shins at the same time: necrobiosis lipidica, cutaneous sarcoidosis, and EN. All three appeared at different times and responded differently to treatments, but the authors wonder if they were all related since all three were granulomatous. (Granulomas are collections of immune cells; they are basically your bodyās way of trying to wall off foreign substances.) There is still a lot we donāt know about the way granulomatous disorders work, and as far as the authors (or I) can tell, this is the first time all three of these conditions have happened concurrently.
Pulmonary Sarcoidosis in BehƧet's Disease Treated with Adalimumab
In this case, a man had BehƧetās disease that wasnāt responding to treatment. His doctors put him on adalimumab, an anti-TNF agent which suppresses the immune system, and he quickly got better. Six months later, he went back to the doctor because of night fevers, muscle pain, and joint swelling. A few days later his chest started to hurt, and he had erythema nodosum on both legs, among other symptoms. He tested positive for the Legionella pneumophila bacteria, and he was diagnosed with Legionnaireās disease. But, after treatment for the Legionnaireās, they discovered that he also had sarcoidosis of the lungs. Both Legionnaireās and the sarcoidosis are potential side effects of anti-TNF drugs, and they both are associated with erythema nodosum, although sarcoidosis is much more common.
Image challenge: Painful leg lesions in a young woman
This āpop quizā style case study has a photo of an unusual presentation of hormone-related EN. The spots are around both of the patientās knees and a large, dark red patch is around her left ankle. The skin appears to be splitting around the ankle as well, although itās hard to tell from the photo.
Fever and arthralgia after āvolcano boardingā in Nicaragua
A man and a woman both contracted histoplasmosis after a trip to Nicaragua; the woman developed erythema nodosum. The authors of the article blame āvolcano boarding,ā despite not finding the fungus that causes histoplasmosis in a sand sample.
Adverse reactions to fluoroquinolones in the Nigerian population: an audit of reports submitted to the National Pharmacovigilance Centre from 2004 to 2016
A Nigerian patient taking Levofloxacin developed erythema nodosum, likely as a drug reaction. This reminded me of a case from 2012 when a kidney transplant patient was treated for pneumonia.
A randomized, double-blind trial of abatacept (CTLA4-ig) for the treatment of takayasu's arteritis
One patient in this double-blind trial of a drug for takayasuās arteritis had erythema nodosum during a relapse of their disease. Takayasuās arteritis is a rare disease that damages the arteries around the heart.
Books and Review Articles:
Dermatopathology 101: Part 1 ā Inflammatory skin diseases
Three German doctors published an article about diagnosing different inflammatory skin diseases under a microscope and included a section about erythema nodosum. The biopsy slides they included are clear, straightforward examples of the microscopic features of EN.
A clinicoepidemiologicalstudy of cutaneous tuberculosis in a tertiary care teaching hospital in Andhra Pradesh, India
In this article, a case of erythema induratum was originally diagnosed as erythema nodosum.
I am interested in reading this article, but I donāt have access to it:
Lee, Jonathan J. (02/01/2017). "Cutaneous Reactions to Targeted Therapy". The American journal of dermatopathology (0193-1091), 39 (2), p. 67.
This post was an experiment. Would you like to see monthly research round-ups on this blog? Let me know!Ā