1
|
Weber V, Weimann K, Kolm I, Meier-Schiesser B. [Erythema nodosum]. Z Rheumatol 2024:10.1007/s00393-024-01529-4. [PMID: 38884811 DOI: 10.1007/s00393-024-01529-4] [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: 05/14/2024] [Indexed: 06/18/2024]
Abstract
Erythema nodosum (EN) is the most frequently occurring form of acute panniculitis. It is characterized by painful red to livid raised nodules or bumps that typically occur symmetrically in the shin area. The cause of EN is often a reaction of the immune system to various triggers including infections, inflammatory diseases or medications. In approximately half of the cases no trigger can be identified. After treatment of the underlying pathology EN is typically self-limiting.
Collapse
Affiliation(s)
- Viktoria Weber
- Dermatologische Klinik, Universitätsspital Zürich, Rämistr. 100, 8901, Zürich, Schweiz
| | - Konstantin Weimann
- Dermatologische Klinik, Universitätsspital Zürich, Rämistr. 100, 8901, Zürich, Schweiz
| | - Isabel Kolm
- Pathologisches Institut, Luzerner Kantonsspital, Spitalstr., 6000, Luzern 16, Schweiz
| | | |
Collapse
|
2
|
Yokoi S, Iwata Y, Sugiura K. A retrospective clinicopathological study of erythema nodosum. J Dermatol 2024. [PMID: 38507514 DOI: 10.1111/1346-8138.17195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
Erythema nodosum (EN) may be idiopathic or secondary, and usually resolves naturally within 1-2 months. In atypical EN cases, the rash extends beyond the lower limbs to the upper limbs and trunk, and histopathological findings may be accompanied by vasculitis in addition to septal panniculitis. Few studies have examined the differences in the clinical characteristics of patients with EN based on rash distribution. We retrospectively examined whether there was a correlation with clinical information, such as the presence or absence of underlying diseases, by classifying the patients into two groups: the lower limbs group (the EN rash was confined to the lower limbs) and the beyond lower limbs group (the EN rash appeared beyond the lower limbs). Among the 86 adult patients diagnosed with EN at the Dermatology Department of Fujita Medical University between 2015 and 2020, there were 65 cases of the lower limbs group and 21 cases of the beyond lower limbs group. The frequency of underlying diseases was significantly higher in the beyond lower limbs group (76.2%, 16 cases) than in the lower limbs group (40.0%, 26 cases; P < 0.005). Vasculitis was more notable in the beyond lower limbs group (P < 0.05). Significantly higher vasculitis was noted in the EN group with underlying diseases (30.2%, 13 cases) than in the idiopathic EN group without underlying diseases (11.6%, 5 cases; P < 0.05). Neutrophil extracellular traps were positive in approximately 40% of cases in both groups. In the beyond lower limbs group, the possibility of severe cases with underlying diseases, vasculitis, and inflammation must be considered for effective treatment.
Collapse
Affiliation(s)
- Satomi Yokoi
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yohei Iwata
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kazumitsu Sugiura
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
3
|
Borges T, Silva S. Panniculitis: A Cardinal Sign of Autoinflammation. Curr Rheumatol Rev 2024; 20:350-360. [PMID: 37921131 DOI: 10.2174/0115733971254702231020060633] [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: 03/26/2023] [Revised: 08/19/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023]
Abstract
Panniculitis was first described in the nineteenth century and is characterized by inflammation of the subcutaneous fat. It may be categorized in septal or lobular subtypes, but other histopathological features (e.g., presence of vasculitis, nature of inflammatory infiltrates, characteristics of fat necrosis) are also important for diagnostic purposes. Clinically, panniculitis is characterized by the presence of subcutaneous nodules, and both ulcerative and nonulcerative clinical subtypes have been proposed. In this review, we aimed to describe the occurrence of panniculitis in autoinflammatory disorders (AIDs) and related diseases. Among monogenic AIDs, panniculitis is common in IFN-mediated disorders. Panniculitis is a distinctive feature in proteasome-associated autoinflammatory syndromes (PRAAS), including chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome and Nakajo-Nishimura syndrome. On the other hand, erythema nodosum corresponds to the most common clinical form of panniculitis and is common in polygenic AIDs, such as Behçet's syndrome, inflammatory bowel disease, and sarcoidosis. Cytophagic histiocytic panniculitis, lipoatrophic panniculitis of children, and otulipenia are rare disorders that may also present with inflammation of the subcutaneous fat. Therefore, panniculitis can identify a specific subgroup of patients with AIDs and may potentially be regarded as a cardinal sign of autoinflammation.
Collapse
Affiliation(s)
- Tiago Borges
- Trofa Saúde Gaia, Rua Fernão de Magalhães nº 2 Fr E, 4404-501 Vila Nova de Gaia, Portugal
| | - Sérgio Silva
- Trofa Saúde Gaia, Rua Fernão de Magalhães nº 2 Fr E, 4404-501 Vila Nova de Gaia, Portugal
| |
Collapse
|
4
|
He R, Zhao S, Cui M, Chen Y, Ma J, Li J, Wang X. Cutaneous manifestations of inflammatory bowel disease: basic characteristics, therapy, and potential pathophysiological associations. Front Immunol 2023; 14:1234535. [PMID: 37954590 PMCID: PMC10637386 DOI: 10.3389/fimmu.2023.1234535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disease typically involving the gastrointestinal tract but not limited to it. IBD can be subdivided into Crohn's disease (CD) and ulcerative colitis (UC). Extraintestinal manifestations (EIMs) are observed in up to 47% of patients with IBD, with the most frequent reports of cutaneous manifestations. Among these, pyoderma gangrenosum (PG) and erythema nodosum (EN) are the two most common skin manifestations in IBD, and both are immune-related inflammatory skin diseases. The presence of cutaneous EIMs may either be concordant with intestinal disease activity or have an independent course. Despite some progress in research on EIMs, for instance, ectopic expression of gut-specific mucosal address cell adhesion molecule-1 (MAdCAM-1) and chemokine CCL25 on the vascular endothelium of the portal tract have been demonstrated in IBD-related primary sclerosing cholangitis (PSC), little is understood about the potential pathophysiological associations between IBD and cutaneous EIMs. Whether cutaneous EIMs are inflammatory events with a commonly shared genetic background or environmental risk factors with IBD but independent of IBD or are the result of an extraintestinal extension of intestinal inflammation, remains unclear. The review aims to provide an overview of the two most representative cutaneous manifestations of IBD, describe IBD's epidemiology, clinical characteristics, and histology, and discuss the immunopathophysiology and existing treatment strategies with biologic agents, with a focus on the potential pathophysiological associations between IBD and cutaneous EIMs.
Collapse
Affiliation(s)
- Ronghua He
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Subei Zhao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingyu Cui
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yanhao Chen
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jinrong Ma
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jintao Li
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaodong Wang
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
5
|
Saito M, Fujii K, Banno H, Ito Y, Nakano S. Development of Erythema Nodosum After Olaparib Treatment in a Patient With Recurrent Breast Cancer and BRCA2 Mutation: A Case Report. Cureus 2023; 15:e44864. [PMID: 37692183 PMCID: PMC10484634 DOI: 10.7759/cureus.44864] [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: 09/02/2023] [Indexed: 09/12/2023] Open
Abstract
BRCA1 and 2 mutations are known to be associated with breast cancer, and olaparib, a poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor, has been shown to be effective in cells carrying these mutations in some studies. Erythema nodosum (EN), which is one adverse event of olaparib and is discussed in this paper, is considered to be a very rare condition. A 69-year-old female patient underwent left breast conservative surgery with axillary lymph node dissection for left invasive ductal breast cancer (stage IIB). Her family history included a sister who developed ovarian cancer at age 63. Five years postoperatively, systemic metastases were discovered in the lung, bone, hilar, and poststernal lymph nodes. The surgically removed metastatic lung nodule was diagnosed as an estrogen receptor (ER)-positive, progesterone receptor (PgR)-negative, and human epidermal growth factor receptor 2 (HER2)-negative metastatic adenocarcinoma of breast cancer origin. And germline mutations of BRCA1/2 were assessed using BRACAnalysis CDx® (Myriad Genetics, Salt Lake City, UT, USA), and BRCA2 1241 delC was identified as a deleterious mutation. Oral administration of olaparib was started. On day 4 of this treatment, numerous erythematous plaques characterized by intense tenderness and infiltration appeared on the extensor surfaces of the bilateral lower legs. On the basis of the clinical findings, the lesions were diagnosed as EN. Oral prednisolone was started at the same time as olaparib discontinuation, and the EN lesions disappeared in one week. EN is an inflammatory lesion characterized by tender subcutaneous induration with a flushed surface, predominantly on the bilateral lower legs. EN occurring after olaparib administration is considered to be very rare. This article describes such a case and reviews the relevant literature.
Collapse
Affiliation(s)
- Masayuki Saito
- Department of Surgery, Aichi Medical University, Nagakute, JPN
| | - Kimihito Fujii
- Department of Surgery, Aichi Medical University, Nagakute, JPN
| | - Hirona Banno
- Department of Surgery, Aichi Medical University, Nagakute, JPN
| | - Yukie Ito
- Department of Surgery, Aichi Medical University, Nagakute, JPN
| | - Shogo Nakano
- Department of Surgery, Aichi Medical University, Nagakute, JPN
| |
Collapse
|
6
|
Li S, Ji B, Teng Y, Tang H, Cui H, Tao X, Fan Y, Huang Y. Erythema Nodosum following Nocardia Infection: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121873. [PMID: 36557075 PMCID: PMC9785723 DOI: 10.3390/medicina58121873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Cutaneous nocardiosis is a rare bacterial infection that can result in various dermatologic manifestations such as actinomycetoma, lymphocutaneous infection, superficial skin infection, and secondary infection due to hematogenous dissemination. We report on a Chinese patient with erythema nodosum-like exanthema, possibly secondary to nocardiosis. Our diagnosis for this patient was based on the clinical presentation, histopathological evidence, and microbiological findings. Given the protean manifestation of Nocardia, persistent reports on new presentations of the disease are important for early identification and treatment.
Collapse
Affiliation(s)
- Sujing Li
- Department of Dermatology, Health Management Center, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, China
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu 233030, China
| | - Bingzhou Ji
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410000, China
| | - Yan Teng
- Department of Dermatology, Health Management Center, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, China
| | - Hui Tang
- Department of Dermatology, Health Management Center, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, China
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu 233030, China
| | - Hong Cui
- Department of Dermatology, Health Management Center, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, China
| | - Xiaohua Tao
- Department of Dermatology, Health Management Center, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, China
| | - Yibin Fan
- Department of Dermatology, Health Management Center, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, China
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu 233030, China
- Correspondence: (Y.F.); (Y.H.)
| | - Youming Huang
- Department of Dermatology, Health Management Center, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, China
- Correspondence: (Y.F.); (Y.H.)
| |
Collapse
|
7
|
Limtong P, Suchonwanit P, Chanprapaph K, Rutnin S. Clinicopathological Characteristics Related to Etiologies of Erythema Nodosum: A 10-Year Retrospective Study. Clin Cosmet Investig Dermatol 2021; 14:1819-1829. [PMID: 34876828 PMCID: PMC8643131 DOI: 10.2147/ccid.s343351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022]
Abstract
Background Erythema nodosum (EN) is the most common panniculitis associated with a wide variety of conditions. Updated studies regarding the clinicopathological manifestations related to etiologies of EN and its prognosis are limited. Objective We aimed to explore the clinicopathological features in relation to the etiologies of EN and determine characteristics of disease recurrence and its predictive factors. Methods A total of 169 patients with biopsy-proven EN or septal panniculitis from January 2008 to September 2018 were retrospectively reviewed. Patients were classified as either idiopathic or secondary EN. Patients’ general information, clinical manifestations, investigations, and recurrence of EN were recorded. The details on histopathological findings were reviewed by a blinded dermatopathologist. Results The mean age at diagnosis of EN was 40.6 ± 17.3 years. The majority of patients (85.2%) were female. Idiopathic EN was found in 62.7% of patients. Tuberculosis (23.8%) and drugs (23.8%) were the leading causes of secondary EN. In univariate logistic regression analysis, lesions on upper extremities (p = 0.018), fever (p = 0.003), clinical lymphadenopathy (p < 0.001) favored secondary EN. Histopathologically, the presence of focal peripheral lobular panniculitis with eosinophils was linked to idiopathic EN (p = 0.03). However, multivariable logistic regression analysis failed to demonstrate factors associated with secondary EN. Recurrence was found in 46.6% of patients with no identifiable predictive factors. Conclusion Although no clinical risk factors were associated with the etiology of EN, the histopathological presence of eosinophils in focal peripheral lobular panniculitis suggested idiopathic EN.
Collapse
Affiliation(s)
- Preeyachat Limtong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthinee Rutnin
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
8
|
Neutrophilic Infiltrates in Panniculitis: Comprehensive Review and Diagnostic Algorithm Proposal. Am J Dermatopathol 2021; 42:717-730. [PMID: 32956080 DOI: 10.1097/dad.0000000000001597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Neutrophilic infiltrates in panniculitis can be seen in different clinical-pathological entities. There are a "mostly neutrophilic inflammatory infiltrate" in some entities classically defined as neutrophilic panniculitis and already included in algorithms, such as enzymatic panniculitis, infective and factitial ones, erythema induratum, or subcutaneous Sweet syndrome, but there are also other panniculitis where neutrophils are frequently observed such as panniculitis associated with inflammatory bowel disease or rheumatoid arthritis, or drug-induced panniculitis associated with BRAF inhibitors, and finally, some panniculitis are better classified in other panniculitides groups but may present with neutrophil-rich variants, such as the neutrophil-rich subcutaneous fat necrosis of the newborn. We review the main clinical and histopathological features of most of these panniculitides and construct a diagnostic algorithm including these diseases.
Collapse
|
9
|
Singer R, Özekinci S. Etiological factors and histopathological features in erythema nodosum: a 6-year retrospective cross-sectional study. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2021. [DOI: 10.15570/actaapa.2021.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Chauhan A, Thomas R. Magnetic Resonance Imaging Appearance of Erythema Nodosum: A Case Report. J Radiol Case Rep 2021; 15:21-29. [PMID: 33717404 DOI: 10.3941/jrcr.v15i1.3919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Erythema nodosum (EN) is the commonest inflammation of the subcutaneous fat tissue (panniculitis). Erythema nodosum (EN) requires an interdisciplinary approach and exclusion of all underlying causes. We present a case of an 18-year-old female with a history of recurrent streptococcal infections over the years, who developed pain and swelling in the left ankle. To evaluate the persistent ankle swelling, the physician ordered a magnetic resonance imaging (MRI) of the left lower extremity. The MRI appearance of EN has not been described in detail in the literature so far.
Collapse
Affiliation(s)
- Ankita Chauhan
- University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Richard Thomas
- Department of Radiology, John R. Oishei Children's Hospital, Buffalo, USA
| |
Collapse
|
12
|
Shavit E, Marzano AV, Alavi A. Ulcerative versus non-ulcerative panniculitis: is it time for a novel clinical approach to panniculitis? Int J Dermatol 2020; 60:407-417. [PMID: 33040341 DOI: 10.1111/ijd.15224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 01/10/2023]
Abstract
Panniculitis, or inflammation of the fatty tissue, is an ongoing diagnostic challenge to both dermatologists and pathologists. The basis of the current panniculitis classification is histology, whether the inflammation is mainly located in the fibrovascular septa or in the adipose lobules thereafter with or without vasculitis. However, overall, the difficulty rises due to various terminologies and lack of clinical relevance with this classification. In addition to that, the majority of panniculitides have mixed infiltration of both lobular and septal and not a clear-cut distinction. The aim of this article is to provide a novel clinical algorithm to the diagnosis of panniculitis and thus to provide guidelines for all clinicians who may encounter this challenging condition in their clinical practice.
Collapse
Affiliation(s)
- Eran Shavit
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Dermatology Unit, Barzilai University Medical Center, Ashkelon, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
13
|
Rebsamen U, Guenova E, Vallelian F. [Not Available]. PRAXIS 2017; 106:973-979. [PMID: 28875753 DOI: 10.1024/1661-8157/a002775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Erythema nodosum ist die häufigste Form einer akuten Pannikulitis. Klinisch manifestiert es sich als erythematöse bis livide, druckdolente, subkutane Plaques und Knoten. Diese treten meist symmetrisch im Bereich der Unterschenkelstreckseiten auf. Die häufigsten Auslöser sind Infekte und entzündliche Erkrankungen; in etwa der Hälfte der Fälle lässt sich keine Ursache finden. Aufgrund der Heterogenität der Trigger und des meist selbstlimitierenden Verlaufes stellt sich in der Praxis die Frage, was die Ursache ist und inwieweit sie gesucht werden soll. In diesem Artikel möchten wir auf die Abklärungsstrategie und die wichtigsten Auslöser des Erythema nodosum eingehen.
Collapse
Affiliation(s)
- Ursina Rebsamen
- 1 Klinik und Poliklinik für Innere Medizin Universitätsspital Zürich
| | | | | |
Collapse
|
14
|
Abstract
Panniculitides are diseases of the subcutaneous tissue with heterogeneous etiology. They may develop consequent to infections, as a reaction to drugs, after thermal injury, as part of autoimmune diseases, in metabolic disorders or due to infectious organisms. The clinical presentation with subcutaneous nodules is often nonspecific. Moreover, the differentiation from vasculitides of medium-sized vessels can be clinically challenging. Microscopic examination of biopsy specimens is of high importance in the differential diagnosis of panniculitides. Histopathologically, panniculitides can be classified according to the predominantly infiltrated area in septal and lobular panniculitides and they can be separated from vasculitides of medium-sized vessels. Diagnostic difficulties arise from inadequate biopsy specimens and from lack of clinicopathological correlation. This article summarizes diagnostic criteria of frequent and clinically important panniculitides.
Collapse
Affiliation(s)
- A Böer-Auer
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland.
| |
Collapse
|
15
|
Abstract
The diagnosis of panniculitis is felt to be a confusing topic by some pathologists. This summarical article presents inflammatory diseases of the subcutis in a systematic fashion, based on whether they are centered on fibrovascular septa or the adipose lobules, and whether morphologic vasculitis is present or not. Septocentric, non-vasculitis disorders include erythema nodosum, panniculitis that follows the use of "biological" therapeutic agents, lipodermatosclerosis, post-irradiation panniculitis, morphea profunda, and necrobiosis lipodica profunda. Polyarteritis nodosa and Behçet's disease are the conditions that are based in the subcutaneous septa with vasculitis. Predominantly-lobular panniculitides with no vasculitis include pancreatogenic panniculitis, the panniculitis of alpha-1-antitrypsin deficiency, panniculitis associated with lupus erythematosus and dermatomyositis, subcutaneous Sweet syndrome, eosinophilic panniculitis, factitial panniculitis, cold panniculitis, panniculitis following injections of corticosteroids, lipomembranous (ischemic) panniculitis; sclerema neonatorum and subcutaneous fat necrosis of the newborn, and Rosai-Dorfman disease of the subcutis. Erythema induratum and infectious panniculitis are vasculitic and lobulocentric conditions. This article reviews the histological features of these diseases.
Collapse
Affiliation(s)
- Mark R Wick
- Section of Dermatopathology,Dermatopathology, Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, Charlottesville, VA, USA.
| |
Collapse
|
16
|
Chowaniec M, Starba A, Wiland P. Erythema nodosum - review of the literature. Reumatologia 2016; 54:79-82. [PMID: 27407284 PMCID: PMC4918048 DOI: 10.5114/reum.2016.60217] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 04/22/2016] [Indexed: 12/30/2022] Open
Abstract
Erythema nodosum is the most common form of panniculitis. It may have many aetiological factors. Erythema nodosum occurs three to five times more often in female patients. It appears as erythematous painful rounded nodules, located most often on the anterior surface of the lower extremities, and may be accompanied by systemic symptoms such as fever, malaise and arthralgia. During diagnosis, oncological vigilance should be maintained, because erythema nodosum may be a paraneoplastic symptom. It requires an interdisciplinary approach and exclusion of many underlying causes.
Collapse
Affiliation(s)
- Małgorzata Chowaniec
- Department of Rheumatology and Internal Diseases, University Hospital in Wroclaw, Wroclaw, Poland
| | - Aleksandra Starba
- Department of Rheumatology and Internal Diseases, University Hospital in Wroclaw, Wroclaw, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Diseases, University Hospital in Wroclaw, Wroclaw, Poland
| |
Collapse
|
17
|
Woo YR, Koo DW, Jung KE, Lee JS. Erythema Nodosum Associated with Valproate. Ann Dermatol 2016; 27:765-6. [PMID: 26719651 PMCID: PMC4695434 DOI: 10.5021/ad.2015.27.6.765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/14/2015] [Accepted: 02/04/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Dae Won Koo
- Department of Dermatology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Kyung Eun Jung
- Department of Dermatology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Joong Sun Lee
- Department of Dermatology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| |
Collapse
|
18
|
van Assche G, Dignass A, Bokemeyer B, Danese S, Gionchetti P, Moser G, Beaugerie L, Gomollón F, Häuser W, Herrlinger K, Oldenburg B, Panes J, Portela F, Rogler G, Stein J, Tilg H, Travis S, Lindsay JO. [Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 3: Special situations (Spanish version)]. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2015; 80:74-106. [PMID: 25769216 DOI: 10.1016/j.rgmx.2014.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 12/12/2022]
Affiliation(s)
- G van Assche
- En nombre de la ECCO; G.V.A. y A.D. actúan como coordinadores del consenso y han contribuido igualmente para este trabajo.
| | - A Dignass
- G.V.A. y A.D. actúan como coordinadores del consenso y han contribuido igualmente para este trabajo.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Rohatgi S, Basavaraj KH, Ashwini PK, Kanthraj GR. Role of tetracycline in recalcitrant erythema nodosum. Indian Dermatol Online J 2014; 5:314-5. [PMID: 25165653 PMCID: PMC4144221 DOI: 10.4103/2229-5178.137787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Erythema nodosum is a type of septal panniculitis. We report a case of 40 year old male of chronic and recalcitrant erythema nodosum who responded to tetracycline. The possible mechanism of action of tetracycline is analyzed. Tetracycline should be considered as a logical option in recalcitrant erythema nodosum.
Collapse
Affiliation(s)
- Shaurya Rohatgi
- Department of Dermatology, Venereology and Leprosy, JSS Medical College Hospital, JSS University, Mysore, Karnataka, India
| | - Kabbur Hanumantappa Basavaraj
- Department of Dermatology, Venereology and Leprosy, JSS Medical College Hospital, JSS University, Mysore, Karnataka, India
| | - P K Ashwini
- Department of Dermatology, Venereology and Leprosy, JSS Medical College Hospital, JSS University, Mysore, Karnataka, India
| | - Garehatty Rudrappa Kanthraj
- Department of Dermatology, Venereology and Leprosy, JSS Medical College Hospital, JSS University, Mysore, Karnataka, India
| |
Collapse
|
20
|
Combined reduced-antigen content tetanus, diphtheria, and acellular pertussis (tdap) vaccine-related erythema nodosum: case report and review of vaccine-associated erythema nodosum. Dermatol Ther (Heidelb) 2013; 3:191-7. [PMID: 24318418 PMCID: PMC3889310 DOI: 10.1007/s13555-013-0035-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Indexed: 11/26/2022] Open
Abstract
Background Vaccination programs reduce the morbidity and mortality of diphtheria, pertussis, and tetanus. Erythema nodosum is a reactive erythema that can be associated with infections, drugs, and many conditions. The new onset of erythema nodosum after receiving vaccination is uncommon. Purpose Combined reduced-antigen content tetanus, diphtheria, and acellular pertussis (Tdap) vaccine-associated erythema nodosum is described and the reports of vaccine-related erythema nodosum are summarized. Methods The clinical features of a 39-year-old woman who developed erythema nodosum after receiving Tdap vaccine are reported. Using the PubMed database, an extensive literature search was performed on erythema nodosum, vaccine, and vaccination. Results Tdap, the most commonly used booster vaccine against tetanus, diphtheria, and pertussis, is well tolerated in all age groups. Local injection-site reactions are the most common adverse events, whereas headache, fatigue, gastrointestinal symptoms, and fever are the most frequent systemic events. Erythema nodosum has not previously been reported in patients who have received Tdap vaccine. The patient developed erythema nodosum within 48 h after receiving Tdap vaccine; her symptoms cleared and nearly all skin lesions resolved within 2 weeks after initiating oral treatment with ibuprofen, fexofenadine, and prednisone. Vaccine-associated erythema nodosum has previously been reported following vaccination for cholera, hepatitis B, human papillomavirus, malaria, rabies, small pox, tuberculosis, and typhoid. Conclusion Vaccine-associated erythema nodosum is uncommon. Erythema nodosum occurring after Tdap vaccination is a rare, yet potential, adverse effect.
Collapse
|
21
|
Boynosky NA, Stokking LB. Potassium bromide-associated panniculitis. J Small Anim Pract 2013; 55:640-2. [DOI: 10.1111/jsap.12129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 06/17/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- N. A. Boynosky
- Department of Dermatology; Veterinary Specialty Hospital; San Diego CA 92121 USA
| | - L. B. Stokking
- Department of Dermatology; Veterinary Specialty Hospital; San Diego CA 92121 USA
| |
Collapse
|
22
|
Acosta KA, Haver MC, Kelly B. Etiology and therapeutic management of erythema nodosum during pregnancy: an update. Am J Clin Dermatol 2013; 14:215-22. [PMID: 23625180 DOI: 10.1007/s40257-013-0024-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Erythema nodosum (EN) is the most common form of panniculitis. It is characterized by erythematous, raised, tender nodules that usually occur bilaterally on the extensor surfaces of the lower extremities. EN is associated with many underlying conditions including infection, sarcoidosis, malignancy, and pregnancy. Its underlying etiology, however, is unknown in up to half of cases. Pregnancy is thought to create an optimal background for EN to develop, although the exact mechanisms are unclear. Immune complexes may play a role in the pathogenesis of EN during pregnancy, or EN may be a hypersensitivity reaction to either estrogens or progesterone. EN is a self-limiting process, and non-pharmacologic means such as bed rest and elastic web bandages may be sufficient to control the symptoms. Potassium iodide, systemic and intralesional corticosteroids, non-steroidal anti-inflammatory drugs, salicylates, tumor necrosis factor-α inhibitors, hydroxychloroquine, colchicine, and dapsone are other treatment options available, but some of these drugs are contraindicated in pregnancy while others are considered safe. Before prescribing one of these treatments to a pregnant patient, the patient's obstetrician should be consulted, and a careful risk-benefit analysis should be performed.
Collapse
Affiliation(s)
- K Alexandra Acosta
- School of Medicine, University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX 77555-0783, USA
| | | | | |
Collapse
|
23
|
Chen S, Chen J, Chen L, Zhang Q, Luo X, Zhang W. Mycobacterium tuberculosis infection is associated with the development of erythema nodosum and nodular vasculitis. PLoS One 2013; 8:e62653. [PMID: 23650522 PMCID: PMC3641092 DOI: 10.1371/journal.pone.0062653] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/25/2013] [Indexed: 11/25/2022] Open
Abstract
Background Mycobacterium tuberculosis (MTB) infection has been suggested to contribute to the pathogenesis of erythema nodosum (EN) and nodular vasculitis (NV), the classic forms of panniculitis. However, there is little evidence to demonstrate the presence of MTB in the skin lesions. This study is aimed at evaluating the association between MTB infection and the development of EN and NV in a Chinese population. Methods A total of 107 patients (36 EN, 27 NV, and 44 others) with vasculitis and 40 control cases with other skin diseases were recruited and their skin lesion samples were subjected to real time polymerase chain reaction (PCR) analysis of the IS6110 and mpt64 gene fragments of MTB. Their blood mononuclear cells were tested for MTB antigen-specific IFN-γ responses by QuantiFERON®-TB Gold In-Tube (IT) assays. Results PCR analysis revealed that 7/23 (30.4%) and 7/18 (38.9%) of the EN and NV samples were positive for the IS6110 DNA, respectively, which were significantly higher than 3/34 (8.8%) of other vasculitis (OV) and 3/40 (7.5%) of the control samples (p<0.05). The nested Real-Time PCR assay indicated that 6/7 (86%) of the IS6110-positive EN samples, all of the IS6110-positive NV and control samples, but only 1/3 of the IS6110-positive OV samples, were positive for the mpt64 gene. Similarly, 19/32 (59.4%) of the EN patients, 20/26 (76.9%) of the NV patients, and 17/36 (47.2%) of the OV patients were positive for MTB antigen-specific IFN-γ responses, which were significantly higher than 6/40 (15%) of the controls (p<0.05). Conclusion Our data strongly suggest that MTB infection and active TB are associated with the development of NV and EN in Chinese.
Collapse
Affiliation(s)
- Sheng’an Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiazhen Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Lianjun Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiao’an Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoqun Luo
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
- * E-mail: (XL); (WZ)
| | - Wenhong Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
- * E-mail: (XL); (WZ)
| |
Collapse
|
24
|
Van Assche G, Dignass A, Bokemeyer B, Danese S, Gionchetti P, Moser G, Beaugerie L, Gomollón F, Häuser W, Herrlinger K, Oldenburg B, Panes J, Portela F, Rogler G, Stein J, Tilg H, Travis S, Lindsay JO. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations. J Crohns Colitis 2013; 7:1-33. [PMID: 23040453 DOI: 10.1016/j.crohns.2012.09.005] [Citation(s) in RCA: 329] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 09/03/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Gert Van Assche
- Division of Gastroenterology, Department of Medicine, Mt. Sinai Hospital and University Health Network,University of Toronto and University of Leuven, 600 University Avenue, Toronto, ON, Canada M5G 1X5.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Simultaneous occurrence of erythema nodosum in monozygotic twin sisters. Case Rep Med 2012; 2012:109427. [PMID: 22719770 PMCID: PMC3375150 DOI: 10.1155/2012/109427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 03/21/2012] [Accepted: 04/11/2012] [Indexed: 11/18/2022] Open
Abstract
Erythema nodosum (EN) is the most frequent clinicopathologic variant of panniculitis with painful red or violaceous nodules on the anterior surfaces of the legs. The condition is a cutaneous reaction that might be associated with a wide variety of disorders or might be caused by medications that produce painful nodules on the shins, and less commonly on the thighs and forearms. In this paper, we describe, for the first time in the world, erythema nodosum as the simultaneous presenting complaint of monozygotic twin sisters after streptococcal pharyngitis. This paper might support the effect of heredity in the occurrence of erythema nodosum.
Collapse
|
26
|
Pediatric Autoimmune Hepatitis in a Patient Who Presented With Erythema Nodosum: A Case Report. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hepatmon.4376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
27
|
Pediatric Autoimmune Hepatitis in a Patient Who Presented With Erythema Nodosum: A Case Report. HEPATITIS MONTHLY 2012. [DOI: 10.5812/kowsar.1735143x.4376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
28
|
Kavehmanesh Z, Kavehmanesh Z, Beiraghdar F, Beiraghdar F, Saburi A, Saburi A, Hajihashemi A, Hajihashemi A, Amirsalari S, Amirsalari S, Movahed M, Movahed M. Pediatric Autoimmune Hepatitis in a Patient Who Presented With Erythema Nodosum: A Case Report. HEPATITIS MONTHLY 2012; 12:42-45. [DOI: 10.5812/kowsar.1735143x.803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
29
|
Bastos F, Pérez LT, Narváes CPDL, Costa O, Silva MÓIDSE, Silva RCSD, Van-Dunem JCVD, Miranda SMDRND, Cordeiro LB, Tembo TE, Almeida RVD, Conceição AMVD. Panniculitis in the newborn: a case report. EINSTEIN-SAO PAULO 2011; 9:534-7. [PMID: 26761261 DOI: 10.1590/s1679-45082011rc2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 11/01/2011] [Indexed: 11/22/2022] Open
Abstract
The authors present a case of panniculitis in a newborn, a rare disease in the neonatal period discussing its causes and differential diagnosis, emphasizing a possible diagnosis of erythema nodosum.
Collapse
Affiliation(s)
| | | | | | - Olívia Costa
- Intensive Care Unit, Clínica Girassol, Luanda, AN
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Rose C, Leverkus M, Fleischer M, Shimanovich I. Histopathology of panniculitis--aspects of biopsy techniques and difficulties in diagnosis. J Dtsch Dermatol Ges 2011; 10:421-5. [PMID: 22084866 DOI: 10.1111/j.1610-0387.2011.07831.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinical and histologic diagnosis of panniculitis may be difficult. The patients usually present with erythematous subcutaneous nodules with or without additional symptoms. If a skin biopsy does not include enough subcutaneous fat, histopathologic assessment is limited and the correct diagnosis may be delayed and require further sampling. PATIENTS AND METHODS To illustrate the difficulties in the diagnosis of panniculitis, we performed a retrospective examination of four patients with different forms of panniculitis. RESULTS In two patients with subcutaneous panniculitis-like T cell lymphoma and lupus panniculitis, the correct diagnosis could only be ascertained after a delay of several months because repeated biopsies had to be obtained throughout the course of disease. In two further patients with cold panniculitis and pancreatic panniculitis, clinicians did not even suspect an inflammatory process in the subcutaneous tissue. The correct diagnosis was made with a deep punch biopsy that included subcutaneous fat. CONCLUSIONS On the one hand, these examples demonstrate the importance of sampling subcutaneous tissue when obtaining routine punch biopsies. On the other hand, in cases where the diagnosis is uncertain, it is necessary to perform large and deep incisional biopsies.
Collapse
|
31
|
Longueville C, Doffoel-Hantz V, Hantz S, Souyri N, Nouaille Y, Bédane C, Sparsa A. [Gardasil®-induced erythema nodosum]. Rev Med Interne 2011; 33:e17-8. [PMID: 21435755 DOI: 10.1016/j.revmed.2011.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 02/06/2011] [Accepted: 02/12/2011] [Indexed: 10/18/2022]
Abstract
Erythema nodosum is a panniculitis occurring more frequently in young women. We report a 16-year-old woman who presented with erythema nodosum that occurred following Gardasil® administration (vaccine against HPV types 6, 11, 16 and 18) and that is proposed to young female. This adverse effect is not a contraindication to the HPV vaccination because its benefit against the oncogene risk of Papillomavirus is documented.
Collapse
Affiliation(s)
- C Longueville
- Service de dermatologie, CHU Dupuytren, 2 avenue Martin-Luther-King, Limoges, France
| | | | | | | | | | | | | |
Collapse
|
32
|
Zhu ZZ, Hou L, Bollati V, Tarantini L, Marinelli B, Cantone L, Yang AS, Vokonas P, Lissowska J, Fustinoni S, Pesatori AC, Bonzini M, Apostoli P, Costa G, Bertazzi PA, Chow WH, Schwartz J, Baccarelli A. Predictors of global methylation levels in blood DNA of healthy subjects: a combined analysis. Int J Epidemiol 2010; 41:126-39. [PMID: 20846947 DOI: 10.1093/ije/dyq154] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Estimates of global DNA methylation from repetitive DNA elements, such as Alu and LINE-1, have been increasingly used in epidemiological investigations because of their relative low-cost, high-throughput and quantitative results. Nevertheless, determinants of these methylation measures in healthy individuals are still largely unknown. The aim of this study was to examine whether age, gender, smoking habits, alcohol drinking and body mass index (BMI) are associated with Alu or LINE-1 methylation levels in blood leucocyte DNA of healthy individuals. METHODS Individual data from five studies including a total of 1465 healthy subjects were combined. DNA methylation was quantified by PCR-pyrosequencing. RESULTS Age [β = -0.011% of 5-methyl-cytosine (%5 mC)/year, 95% confidence interval (CI) -0.020 to -0.001%5 mC/year] and alcohol drinking (β = -0.214, 95% CI -0.415 to -0.013) were inversely associated with Alu methylation. Compared with females, males had lower Alu methylation (β = -0.385, 95% CI -0.665 to -0.104) and higher LINE-1 methylation (β = 0.796, 95% CI 0.261 to 1.330). No associations were found with smoking or BMI. Percent neutrophils and lymphocytes in blood counts exhibited a positive (β = 0.036, 95% CI 0.010 to 0.061) and negative (β = -0.038, 95% CI -0.065 to -0.012) association with LINE-1 methylation, respectively. CONCLUSIONS Global methylation measures in blood DNA vary in relation with certain host and lifestyle characteristics, including age, gender, alcohol drinking and white blood cell counts. These findings need to be considered in designing epidemiological investigations aimed at identifying associations between DNA methylation and health outcomes.
Collapse
Affiliation(s)
- Zhong-Zheng Zhu
- Center of Molecular and Genetic Epidemiology, Department of Environmental and Occupational Health, Università degli Studi di Milano and IRCCS Maggiore Policlinico Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Gilchrist H, Patterson JW. Erythema nodosum and erythema induratum (nodular vasculitis): diagnosis and management. Dermatol Ther 2010; 23:320-7. [DOI: 10.1111/j.1529-8019.2010.01332.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
34
|
Hariprasad G, Kumar M, Kaur P, Singh TP, Kumar RP. Human group III PLA2 as a drug target: structural analysis and inhibitor binding studies. Int J Biol Macromol 2010; 47:496-501. [PMID: 20654644 DOI: 10.1016/j.ijbiomac.2010.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/13/2010] [Accepted: 07/13/2010] [Indexed: 11/24/2022]
Abstract
Group III phospholipase A(2) is a known mediator of inflammation, atherosclerosis and cancer in mammals. This enzyme, therefore, is a potential drug target. The availability of the human group III phospholipase A(2) (hIIIPLA(2)) amino acid sequence offers an opportunity to study its structural features by modeling. The monomeric hIII PLA(2) model is based on the 44% identity it has with the bee venom PLA(2), the only known representative structure of this group. The overall structure comprises of three α-helices, a β-wing and the calcium binding loop which is present at the N-terminus of the enzyme. However, the unique structural features of hIIIPLA(2) in comparison to the other well known group I/II PLA(2)s are: (1) the replacement of the 'conserved' tyrosine residue by phenylalanine at position 87 in the active site; (2) a decrease in the volume of the substrate binding hydrophobic channel and (3) presence of a C-terminal extension which has a close proximity to the third helix. Docking studies of the enzyme with small molecules gives a detailed insight into the participating residues of the enzyme and also the possible type of interactions with the drug molecules. The ligand molecules have binding affinities predicted to range from micromolar to nanomolar range, thereby making them either potential lead molecules or potent drugs. This analysis paves the way for possible therapeutic applications in pathological states caused by this enzyme.
Collapse
Affiliation(s)
- Gururao Hariprasad
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India.
| | | | | | | | | |
Collapse
|
35
|
Outbreak of Erythema Nodosum of Unknown Cause—New Mexico, November 2007–January 2008. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
36
|
H Syndrome: Recently Defined Genodermatosis With Distinct Histologic Features. A Morphological, Histochemical, Immunohistochemical, and Ultrastructural Study of 10 Cases. Am J Dermatopathol 2010; 32:118-28. [DOI: 10.1097/dad.0b013e3181b28572] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
37
|
Van Assche G, Dignass A, Reinisch W, van der Woude CJ, Sturm A, De Vos M, Guslandi M, Oldenburg B, Dotan I, Marteau P, Ardizzone A, Baumgart DC, D'Haens G, Gionchetti P, Portela F, Vucelic B, Söderholm J, Escher J, Koletzko S, Kolho KL, Lukas M, Mottet C, Tilg H, Vermeire S, Carbonnel F, Cole A, Novacek G, Reinshagen M, Tsianos E, Herrlinger K, Oldenburg B, Bouhnik Y, Kiesslich R, Stange E, Travis S, Lindsay J. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations. J Crohns Colitis 2010; 4:63-101. [PMID: 21122490 DOI: 10.1016/j.crohns.2009.09.009] [Citation(s) in RCA: 526] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 09/28/2009] [Accepted: 09/28/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Gert Van Assche
- Division of Gastroenterology, Leuven University Hospitals, 49 Herestraat, BE 3000, Leuven, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Kerr S, Kusmak JM, Stratman EJ. Dermatology for the general surgeon. Surg Clin North Am 2009; 89:563-86. [PMID: 19465197 DOI: 10.1016/j.suc.2009.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Preparation of the patient with preexisting skin disease for surgery can be challenging. In addition to encountering the skin with nearly every procedure, the surgeon will also likely experience skin-related conundrums, concerns, and associated conditions in the preoperative, perioperative, or postoperative periods. These concerns are reviewed using best available evidence.
Collapse
Affiliation(s)
- Sarah Kerr
- Department of Dermatology, Marshfield Clinic, Marshfield, WI 54449, USA
| | | | | |
Collapse
|
39
|
Ríos Blanco JJ, Sendagorta Cudós E, González-Beato Merino MJ. Eritema nudoso. Med Clin (Barc) 2009; 132:75-9. [DOI: 10.1016/j.medcli.2008.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 09/18/2008] [Indexed: 11/29/2022]
|
40
|
Wu Y, Ellis RD, Shaffer D, Fontes E, Malkin EM, Mahanty S, Fay MP, Narum D, Rausch K, Miles AP, Aebig J, Orcutt A, Muratova O, Song G, Lambert L, Zhu D, Miura K, Long C, Saul A, Miller LH, Durbin AP. Phase 1 trial of malaria transmission blocking vaccine candidates Pfs25 and Pvs25 formulated with montanide ISA 51. PLoS One 2008; 3:e2636. [PMID: 18612426 PMCID: PMC2440546 DOI: 10.1371/journal.pone.0002636] [Citation(s) in RCA: 296] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 06/04/2008] [Indexed: 11/18/2022] Open
Abstract
Background Pfs25 and Pvs25, surface proteins of mosquito stage of the malaria parasites P. falciparum and P. vivax, respectively, are leading candidates for vaccines preventing malaria transmission by mosquitoes. This single blinded, dose escalating, controlled Phase 1 study assessed the safety and immunogenicity of recombinant Pfs25 and Pvs25 formulated with Montanide ISA 51, a water-in-oil emulsion. Methodology/Principal Findings The trial was conducted at The Johns Hopkins Center for Immunization Research, Washington DC, USA, between May 16, 2005–April 30, 2007. The trial was designed to enroll 72 healthy male and non-pregnant female volunteers into 1 group to receive adjuvant control and 6 groups to receive escalating doses of the vaccines. Due to unexpected reactogenicity, the vaccination was halted and only 36 volunteers were enrolled into 4 groups: 3 groups of 10 volunteers each were immunized with 5 µg of Pfs25/ISA 51, 5 µg of Pvs25/ISA 51, or 20 µg of Pvs25/ISA 51, respectively. A fourth group of 6 volunteers received adjuvant control (PBS/ISA 51). Frequent local reactogenicity was observed. Systemic adverse events included two cases of erythema nodosum considered to be probably related to the combination of the antigen and the adjuvant. Significant antibody responses were detected in volunteers who completed the lowest scheduled doses of Pfs25/ISA 51. Serum anti-Pfs25 levels correlated with transmission blocking activity. Conclusion/Significance It is feasible to induce transmission blocking immunity in humans using the Pfs25/ISA 51 vaccine, but these vaccines are unexpectedly reactogenic for further development. This is the first report that the formulation is associated with systemic adverse events including erythema nodosum. Trial Registration ClinicalTrials.gov NCT00295581
Collapse
MESH Headings
- Adolescent
- Adult
- Animals
- Antigens, Protozoan/chemistry
- Antigens, Protozoan/immunology
- Antigens, Surface/chemistry
- Antigens, Surface/immunology
- Disease Transmission, Infectious
- Female
- Humans
- Malaria Vaccines/adverse effects
- Malaria Vaccines/chemistry
- Malaria Vaccines/immunology
- Malaria, Falciparum/prevention & control
- Malaria, Falciparum/transmission
- Malaria, Vivax/prevention & control
- Malaria, Vivax/transmission
- Male
- Mannitol/administration & dosage
- Mannitol/analogs & derivatives
- Mannitol/chemistry
- Middle Aged
- Oleic Acids/administration & dosage
- Oleic Acids/chemistry
- Plasmodium falciparum/immunology
- Plasmodium vivax/immunology
- Protozoan Proteins/adverse effects
- Protozoan Proteins/chemistry
- Protozoan Proteins/immunology
- Recombinant Proteins/adverse effects
- Recombinant Proteins/immunology
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/chemistry
Collapse
Affiliation(s)
- Yimin Wu
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
- * E-mail: (YW); (AD)
| | - Ruth D. Ellis
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Donna Shaffer
- Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Erica Fontes
- Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elissa M. Malkin
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Siddhartha Mahanty
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Michael P. Fay
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - David Narum
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Kelly Rausch
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Aaron P. Miles
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Joan Aebig
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Andrew Orcutt
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Olga Muratova
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Guanhong Song
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Lynn Lambert
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Daming Zhu
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Kazutoyo Miura
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Carole Long
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Allan Saul
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Louis H. Miller
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Anna P. Durbin
- Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: (YW); (AD)
| |
Collapse
|
41
|
Quin A, Kane S, Ulitsky O. A case of fistulizing Crohn's disease and erythema nodosum managed with adalimumab. ACTA ACUST UNITED AC 2008; 5:278-81. [PMID: 18364718 DOI: 10.1038/ncpgasthep1099] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 01/14/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND A 20-year-old female presented to her gastroenterologist with fevers and right-labial pain and swelling. Painful erythematous nodules developed in her pretibial region soon after admission to a medical ward. She had a 10-year history of Crohn's colitis, perirectal abscesses and fistulizing disease, and had undergone a diverting ileostomy 16 months earlier; however, she was not on any medication for her Crohn's disease owing to her history of drug intolerance and side effects. INVESTIGATIONS Physical examination, laboratory investigations, examination under anesthesia, proctoscopy, MRI, and skin biopsy. DIAGNOSIS Active Crohn's disease with perianal fistula and sigmoid colitis, and erythema nodosum. MANAGEMENT Subcutaneous injections of adalimumab: an initial 160 mg dose, followed by 80 mg in week 2 and then 40 mg every other week. Antibiotics were also prescribed.
Collapse
Affiliation(s)
- Alissa Quin
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA.
| | | | | |
Collapse
|
42
|
Current World Literature. Curr Opin Rheumatol 2008; 20:111-20. [DOI: 10.1097/bor.0b013e3282f408ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|