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Lee WH, Abass F. Erythema Nodosum in an Infant Associated With Meningococcal ACWY, Measles, Mumps, Rubella, and Pneumococcal Vaccines: A Case Report. Clin Pediatr (Phila) 2024; 63:191-194. [PMID: 37932922 DOI: 10.1177/00099228231211151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Wei Hao Lee
- Department of General Paediatrics, Armadale Health Service, Perth, WA, Australia
- Department of General Paediatrics, Perth Children's Hospital, Perth, WA, Australia
| | - Fuad Abass
- Department of General Paediatrics, Armadale Health Service, Perth, WA, Australia
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2
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Savaş Erdoğan S, Cebeci Kahraman F. Fixed drug eruption after pentavalent diphtheria, tetanus, acellular pertussis, inactivated poliovirus and Haemophilus influenzae type b combined vaccine in an infant. Eur J Hosp Pharm 2023; 30:e16. [PMID: 34233904 PMCID: PMC10359794 DOI: 10.1136/ejhpharm-2021-002875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/28/2021] [Indexed: 11/04/2022] Open
Abstract
In Turkey, diphtheria-tetanus-acellular pertussis-inactivated poliovirus and Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine has been administered to all children in the second, fourth, sixth and 18th months within the scope of the national vaccination programme. Here we present a rare case of fixed drug eruption (FDE) that occurred as a result of the administration of a pentavalent DTaP-IPV-Hib combined vaccine in a 4-month-old girl. There was no history of taking any other medication before or when the lesion appeared. The lesion responded well to 1 week of topical methylprednisolone aceponate cream application and regressed within 1 week, leaving mild hyperpigmentation. Few cases of FDE have been reported occurring after administration of various vaccines and it is extremely rare in children. To our knowledge, this is the first reported case of FDE developing in an infant after the combined pentavalent DTaP-IPV-Hib vaccine.
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Affiliation(s)
- Sevil Savaş Erdoğan
- Department of Dermatology, University of Health Sciences, Sultan 2.Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Filiz Cebeci Kahraman
- Department of Dermatology, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
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Alghamdi N, Alamrie RM, Alshafie AY, Almuhaidib SR. Delayed Recurrent Erythema Nodosum Following COVID-19 Vaccine: A Case Report. Cureus 2023; 15:e42776. [PMID: 37663975 PMCID: PMC10469539 DOI: 10.7759/cureus.42776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Erythema nodosum (EN) is a skin lesion that presents due to an inflammation of the subcutaneous fat, which is manifested clinically as a sudden onset of tender erythematous lesions. These lesions are typically localized to the pretibial surface. The cause of EN is mainly idiopathic, other causes are drugs, infections, autoimmune diseases, and inflammatory bowel disease. As vaccines are rarely known to cause EN, we are reporting a case of a 19-year-old female with a delayed recurrent reaction following the second dose of the COVID-19 vaccine.
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Affiliation(s)
- Nada Alghamdi
- Department of Dermatology, King Fahad University Hospital, Khobar, SAU
| | | | - Anmar Y Alshafie
- Department of Dermatology, King Fahad University Hospital, Khobar, SAU
| | - Serene R Almuhaidib
- Department of Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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4
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Juddoo V, Juddoo S, Mégarbane B. Erythema nodosum triggered by BNT162b2 mRNA COVID-19 vaccine. Vaccine 2022; 40:2650-2651. [PMID: 35365342 PMCID: PMC8958097 DOI: 10.1016/j.vaccine.2022.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Vanessa Juddoo
- Department of Endocrinology and Diabetology, Lariboisière Hospital, Paris, France
| | - Sonia Juddoo
- Department of Geriatrics, Avicenne Hospital, Bobigny, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris University, INSERM UMRS-1144 Paris, France.
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Trapani S, Rubino C, Lodi L, Resti M, Indolfi G. Erythema Nodosum in Children: A Narrative Review and a Practical Approach. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040511. [PMID: 35455555 PMCID: PMC9025345 DOI: 10.3390/children9040511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/22/2022]
Abstract
Erythema nodosum (EN) is the most frequent form of panniculitis in children. We performed a literature review analyzing studies on pediatric EN published from 1990 to February 2022. EN is rare in pediatric age. It can be primary/idiopathic in 23–55% cases, or secondary in 47–77% cases. Secondary EN is related to a wide variety of conditions including infectious diseases, autoimmune disorders, malignancy, drugs, vaccinations, and pregnancy. The diagnosis of EN is clinical, based on the acute appearance of painful and red nodules localized to lower limbs, bilaterally distributed. If EN is diagnosed, basic work-up should include inflammatory markers, serum aminotransferases, lactate dehydrogenase, creatinine, protein electrophoresis, immunoglobulins, testing for streptococcal infection, and a tuberculin skin test. Based on the medical history and associated manifestations, further laboratory and radiological exams should be performed. The prognosis of EN is excellent, with spontaneous resolution in most patients within 2–6 weeks. Treatment, if needed, is addressed to the underlying condition. Despite being a rare manifestation in children, EN can be isolated or the first manifestation of a systemic or infectious condition. EN diagnosis is clinical, and a high index of suspicion is needed to perform investigations for the underlying disorders.
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Affiliation(s)
- Sandra Trapani
- Pediatric Unit, Department of Health Sciences, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
- Correspondence: ; Tel.: +39-055-5662480
| | - Chiara Rubino
- Pediatric Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (C.R.); (M.R.)
| | - Lorenzo Lodi
- Immunology and Molecular Microbiology Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
| | - Massimo Resti
- Pediatric Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (C.R.); (M.R.)
| | - Giuseppe Indolfi
- Pediatric Unit, Department of NEUROFARBA, Meyer Children’s University Hospital University of Florence, Viale Pieraccini 24, 50137 Florence, Italy;
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7
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Damevska K, Simeonovski V. Covid-19 Vaccine Associated Erythema Nodosum: factors to consider. Dermatol Ther 2022; 35:e15410. [PMID: 35218272 PMCID: PMC9111800 DOI: 10.1111/dth.15410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Katerina Damevska
- University Clinic for Dermatology, Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, Skopje, Republic of Macedonia
| | - Viktor Simeonovski
- University Clinic for Dermatology, Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, Skopje, Republic of Macedonia
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Aly MH, Alshehri AA, Mohammed A, Almalki AM, Ahmed WA, Almuflihi AM, Alwafi AA. First Case of Erythema Nodosum Associated With Pfizer Vaccine. Cureus 2021; 13:e19529. [PMID: 34934549 PMCID: PMC8668049 DOI: 10.7759/cureus.19529] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/05/2022] Open
Abstract
Vaccine-related erythema nodosum is uncommon, especially after the coronavirus disease 2019 (COVID-19) vaccine. This study presents the first case of the Pfizer vaccine associated with erythema nodosum. A 22-year-old healthy woman presented with a five-day history of several red painful areas with swelling in the lower extremities that started one day after receiving the first dose of Pfizer vaccine. Past medical history, laboratory investigation, and chest radiograph revealed normal results. Erythema nodosum is an immune reaction that manifests as multiple, painful nodules commonly seen on the shin that resolved spontaneously two to eight weeks after the onset. In the absence of laboratory and chest radiograph abnormalities and shortly after receiving the Pfizer vaccine, vaccine-related erythema nodosum is the only possible explanation.
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Affiliation(s)
- Mohammed H Aly
- Department of Internal Medicine, Security Forces Hospital, Makkah, SAU
| | | | | | - Abdulrahman M Almalki
- Department of Medicine, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Walaa A Ahmed
- Department of Medicine, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Alhanouf M Almuflihi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Atheer A Alwafi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
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9
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Cameli N, Silvestri M, Mariano M, Bennardo L, Nisticò SP, Cristaudo A. Erythema nodosum following the first dose of ChAdOx1-S nCoV-19 vaccine. J Eur Acad Dermatol Venereol 2021; 36:e161-e162. [PMID: 34662466 PMCID: PMC9088690 DOI: 10.1111/jdv.17762] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- N Cameli
- Department of Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - M Silvestri
- Department of Health Sciences, Unit of Dermatology, Magna Graecia University, Catanzaro, Italy
| | - M Mariano
- Department of Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - L Bennardo
- Department of Health Sciences, Unit of Dermatology, Magna Graecia University, Catanzaro, Italy
| | - S P Nisticò
- Department of Health Sciences, Unit of Dermatology, Magna Graecia University, Catanzaro, Italy
| | - A Cristaudo
- Department of Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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10
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Hsu HT, Su HA, Chen YC. Erythema nodosum, after Medigen vaccination against COVID-19? J Formos Med Assoc 2021; 121:723-724. [PMID: 34656402 PMCID: PMC8501263 DOI: 10.1016/j.jfma.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Hui-Te Hsu
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsuan-An Su
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Chia Chen
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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11
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Mehta H, Handa S, Malhotra P, Patial M, Gupta S, Mukherjee A, Chatterjee D, Takkar A, Mahajan R. Erythema nodosum, zoster duplex and pityriasis rosea as possible cutaneous adverse effects of Oxford-AstraZeneca COVID-19 vaccine: report of three cases from India. J Eur Acad Dermatol Venereol 2021; 36:e16-e18. [PMID: 34547126 PMCID: PMC8657518 DOI: 10.1111/jdv.17678] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M Patial
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gupta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Mukherjee
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Takkar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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12
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Pérez-Garza DM, Chavez-Alvarez S, Ocampo-Candiani J, Gomez-Flores M. Erythema Nodosum: A Practical Approach and Diagnostic Algorithm. Am J Clin Dermatol 2021; 22:367-378. [PMID: 33683567 PMCID: PMC7938036 DOI: 10.1007/s40257-021-00592-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
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. The exact cause of erythema nodosum is unknown, although it appears to be a hypersensitivity response to a variety of antigenic stimuli. Although the etiology is mostly idiopathic, ruling out an underlying disease is imperative before diagnosing primary erythema nodosum. Erythema nodosum can be the first sign of a systemic disease that is triggered by a large group of processes, such as infections, inflammatory diseases, neoplasia, and/or drugs. The most common identifiable causes are streptococcal infections, primary tuberculosis, sarcoidosis, Behçet disease, inflammatory bowel disease, drugs, and pregnancy. We propose a diagnostic algorithm to optimize the initial work-up, hence initiating prompt and accurate management of the underlying disease. The algorithm includes an initial assessment of core symptoms, diagnostic work-up, differential diagnosis, and recommended therapies. Several treatment options for the erythema nodosum lesions have been previously reported; nevertheless, these options treat the symptoms, but not the triggering cause. Making an accurate diagnosis will allow the physician to treat the underlying cause and determine an optimal therapeutic strategy.
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Affiliation(s)
- Daniela Michelle Pérez-Garza
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Nuevo León, Mexico
| | - Sonia Chavez-Alvarez
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Nuevo León, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Nuevo León, Mexico
| | - Minerva Gomez-Flores
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Nuevo León, Mexico.
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Tomás-Pérez M, Gómez-Traseira C, González-Muñoz M, Quirce S. Adverse reaction with hexavalent vaccine: An unusual case. Allergol Immunopathol (Madr) 2020; 48:801-803. [PMID: 32402623 DOI: 10.1016/j.aller.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
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Sarti L, Lezmi G, Mori F, Giovannini M, Caubet JC. Diagnosis and management of hypersensitivity reactions to vaccines. Expert Rev Clin Immunol 2020; 16:883-896. [PMID: 32838592 DOI: 10.1080/1744666x.2020.1814745] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Many countries in Europe now recommend and enforce mandatory vaccinations to improve vaccination coverage. Thus, the number of adverse events following immunization (AEFI) may show an increase. Among these events, severe hypersensitivity reactions to vaccines are rare. However, it is important that they be identified and recognized so that they may be adequately managed. AREAS COVERED The literature search was undertaken through PubMed and Embase to identify English-language papers focusing on hypersensitivity to vaccines. EXPERT OPINION Hypersensitivity reactions following vaccinations are rare and are classified according to their chronology and extension: immediate when they occur within the first 4 hours following administration and non-immediate when they occur later. Local reactions are the most common adverse event following injection of vaccines and generally do not require any allergy workup. Immediate reactions, however, are potentially IgE-mediated and require an allergy workup. In general, a previously known food allergy (i.e., egg or milk) is not a contraindication to immunizations. Patients with a known allergy to gelatin, yeast, latex, antibiotics, or other specific components of vaccines require an allergy workup before administration of the vaccine.
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Affiliation(s)
- Lucrezia Sarti
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital , Florence, Italy
| | - Guillaume Lezmi
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Necker-Enfants Malades , Paris, France.,Faculty of Medicine, Université Paris Descartes , Paris, France
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital , Florence, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital , Florence, Italy
| | - Jean-Christoph Caubet
- Division of Pediatric Allergy, Department of Pediatrics, University Hospitals of Geneva , Geneva, Switzerland
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Pool V, Mege L, Abou-Ali A. Arthus Reaction as an Adverse Event Following Tdap Vaccination. Vaccines (Basel) 2020; 8:vaccines8030385. [PMID: 32674495 PMCID: PMC7563237 DOI: 10.3390/vaccines8030385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022] Open
Abstract
Repeat administration of tetanus toxoid-containing vaccines has rarely been associated with Arthus phenomenon, an immune-complex reaction. In the US, since 2013, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines (Tdap) have been recommended for administration during each pregnancy. Separately, in 2019, one Tdap was approved for repeat administration in adults in the US. We aimed to describe trends in spontaneously reported Arthus reactions following Tdap in the US and to assess the risk of this phenomenon in persons receiving Tdap repeatedly. We reviewed Arthus reports in the Vaccine Adverse Events Reporting System (VAERS), 1990-2018. Reporting rates were estimated using Tdap doses distributed data. A systematic literature review was conducted in MEDLINE for any Arthus cases reported in Tdap clinical trials and observational studies published between 2000 and 2019. We found 192 Arthus reports in VAERS after any vaccine, of which 36 occurred after Tdap and none were reported during pregnancy. The Arthus reporting rate was estimated at 0.1 per million doses distributed. We identified eight published studies of Tdap administration within five years after a previous dose of tetanus toxoid-containing vaccine; no Arthus cases were reported. We conclude that Arthus reaction following Tdap is extremely rare. Increasing frequency of repeat Tdap administration in adults in the US did not result in a detectable increase in reporting rates of this phenomenon, confirming the favorable safety profile of Tdap.
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Affiliation(s)
- Vitali Pool
- Sanofi Pasteur Inc., Discovery Drive, Swiftwater, PA 18370, USA
- Correspondence:
| | - Larissa Mege
- Sanofi Pasteur SA, 14 Espace Henry Vallée, 69007 Lyon, France;
| | - Adel Abou-Ali
- Astellas Pharma Global Development, Inc., Northbrook, IL 60062, USA;
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Stone CA, Rukasin CR, Beachkofsky TM, Phillips EJ. Immune-mediated adverse reactions to vaccines. Br J Clin Pharmacol 2019; 85:2694-2706. [PMID: 31472022 PMCID: PMC6955412 DOI: 10.1111/bcp.14112] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023] Open
Abstract
Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent infectious diseases. Severe immunologically mediated reactions are rare and less common with the vaccine than the true infection. However, these events can cause public fearfulness and loss of confidence in the safety of vaccination. In this paper, we perform a systematic literature search and narrative review of immune-mediated vaccine adverse events and their known and proposed mechanisms, and outline directions for future research. Improving our knowledge base of severe immunologically mediated vaccine reactions and their management drives better vaccine safety and efficacy outcomes.
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Affiliation(s)
- Cosby A. Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Christine R.F. Rukasin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | | | - Elizabeth J. Phillips
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt University Medical SchoolNashvilleTennessee
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Abstract
BACKGROUND Erythema nodosum can be associated with a number of systemic diseases. There is, however, a paucity of information in the pediatric literature on this condition. The purpose of this article is to familiarize pediatricians with the evaluation, diagnosis, and treatment of erythema nodosum. DATA SOURCES A PubMed search was completed in Clinical Queries using the key terms "erythema nodosum". RESULTS Clinically, erythema nodosum presents with a sudden onset of painful, erythematous, subcutaneous nodules mainly localized to the pretibial areas. Lesions are usually bilateral and symmetrical, ranging from 1 to 5 cm in diameter. Erythema nodosum may be associated with a variety of conditions such as infection, medications, sarcoidosis, pregnancy, inflammatory bowel disease, vaccination, autoimmune disease, malignancy, and miscellaneous causes. The condition is idiopathic in approximately 50% of cases. The diagnosis is mainly clinical with biopsy reserved for atypical cases. To evaluate for the underlying cause, some basic laboratory screening studies are worthwhile in most cases and include a complete blood cell count, erythrocyte sedimentation rate and/or C-reactive protein, throat swab culture, antistreptococcal O titers, and a chest radiograph. Other tests should be individualized, guided by the history and physical examination results. Most cases of erythema nodosum are self-limited and require no treatment. Bed rest and leg elevation are generally recommended to reduce the discomfort. Nonsteroidal anti-inflammatory drugs are the first-line treatment for pain management. CONCLUSIONS As erythema nodosum is often a cutaneous manifestation of a systemic disease, a thorough search should be performed to reveal the underlying cause.
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