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Ziadlou R, Pandian GN, Hafner J, Akdis CA, Stingl G, Maverakis E, Brüggen MC. Subcutaneous adipose tissue: Implications in dermatological diseases and beyond. Allergy 2024. [PMID: 39206504 DOI: 10.1111/all.16295] [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: 02/08/2024] [Revised: 07/19/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Subcutaneous adipose tissue (SAT) is the deepest component of the three-layered cutaneous integument. While mesenteric adipose tissue-based immune processes have gained recognition in the context of the metabolic syndrome, SAT has been traditionally considered primarily for energy storage, with less attention to its immune functions. SAT harbors a reservoir of immune and stromal cells that significantly impact metabolic and immunologic processes not only in the skin, but even on a systemic level. These processes include wound healing, cutaneous and systemic infections, immunometabolic, and autoimmune diseases, inflammatory skin diseases, as well as neoplastic conditions. A better understanding of SAT immune functions in different processes, could open avenues for novel therapeutic interventions. Targeting SAT may not only address SAT-specific diseases but also offer potential treatments for cutaneous or even systemic conditions. This review aims to provide a comprehensive overview on SAT's structure and functions, highlight recent advancements in understanding its role in both homeostatic and pathological conditions within and beyond the skin, and discuss the main questions for future research in the field.
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Affiliation(s)
- Reihane Ziadlou
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
| | - Ganesh N Pandian
- Institute for Integrated Cell-Material Science (WPI-iCeMS), Kyoto University, Kyoto, Japan
| | - Jürg Hafner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Cezmi A Akdis
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
| | - Georg Stingl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, California, USA
| | - Marie-Charlotte Brüggen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
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Meienberger N, Maul JT, Fröhlich F, Maul LV, Kündig T, Nordmann T, Anzengruber F. Atypical and Typical Presentation of Erythema Nodosum: Clinical Differences in Treatment and Outcome. Dermatology 2024; 240:226-232. [PMID: 38185114 PMCID: PMC10997255 DOI: 10.1159/000535617] [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: 04/23/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Erythema nodosum (EN) is the most common form of panniculitis that predominantly affects the shins. While EN in atypical sites has been described by many authors, there are currently only case studies published on this topic. This study aimed to evaluate clinical differences between patients suffering from EN on the shins, compared to patients with EN in atypical locations. METHODS We analyzed 105 patients in a retrospective, single-center study at a university hospital in Switzerland. Typical EN was defined as lesions, found only on the lower legs, while atypical EN as lesions on the upper legs, trunk, arms, or face, only or in addition to lesions on the lower legs. The patients were assessed for age, gender, dermatologic history, time until first medical consultation, time to diagnosis, and time until remission. Further, etiology, symptoms, and applied therapies were investigated. Findings were then compared between the typical and atypical EN cohorts. RESULTS Overall, we included 70 patients (37.99 ± 15.67 [3-81] years) with EN solely on the shins and 35 patients (41.27 ± 16.85 [9-76] years) with EN on other locations. Interestingly, time until diagnosis was significantly shorter in atypical EN (p = 0.034, 1.14 ± 4.68 vs. 0.46 ± 1.14 months). Time to remission was similar in both groups (3.61 ± 2.73 vs. 3.05 ± 2.86 months, respectively). Sarcoidosis was the only etiologic factor significantly more frequent in atypical EN compared to typical EN (23% vs. 9%, p = 0.042). Besides that, solely subtle differences were seen regarding etiology, gender, age at onset, course of the disease, and symptoms. CONCLUSIONS Our study suggests that only minor alterations between both study populations exist. Significant differences were found in time to diagnosis (shorter for atypical EN), as well as in sarcoidosis as an etiologic factor (more frequent in atypical EN). While adalimumab was only prescribed in atypical EN cases, prognosis seems to be similar for typical and atypical EN (similar time to remission, similar amount of reoccurring cases). Due to the limited sample size, however, our study population may have been too small to detect the relevant differences, and bigger studies may be needed.
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Affiliation(s)
- Nina Meienberger
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland,
- Faculty of Medicine, University of Zurich, Zurich, Switzerland,
| | - Julia-Tatjana Maul
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Fabienne Fröhlich
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Lara Valeska Maul
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Thomas Kündig
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Thierry Nordmann
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Florian Anzengruber
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, Cantonal Hospital of Chur, Chur, Switzerland
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Takeda T, Asaoka D, Ogiya S, Akashi K, Abe D, Suzuki M, Akazawa Y, Ueda K, Ueyama H, Shibuya T, Osada T, Hojo M, Hirai S, Ueki R, Nagahara A. A Case of Yersinia enterocolitica Enteritis Diagnosed with Erythema Nodosum. Intern Med 2022; 62:1479-1485. [PMID: 36198596 DOI: 10.2169/internalmedicine.0489-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
We herein report a rare case of Yersinia enterocolitica enteritis with a fever and abdominal pain followed by erythema nodosum (EN) a few days later. The diagnosis was confirmed based on characteristic colonoscopy and computed tomography findings, pathology, and mucosal culture. Yersinia enteritis is a curable disease provided a proper diagnosis and treatment are performed. Although EN is a rare clinical course, it should still be considered as a differential diagnosis.
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Affiliation(s)
- Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Sakiko Ogiya
- Department of Dermatology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Ken Akashi
- Department of Dermatology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Daiki Abe
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Maiko Suzuki
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Kumiko Ueda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Taro Osada
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Shu Hirai
- Department of Human Pathology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Rie Ueki
- Department of Dermatology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
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Velidedeoğlu M, Papila Kundaktepe B, Mete B, Uğurlu S. Idiopathic granulomatous mastitis associated with erythema nodosum may indicate a worse prognosis. Int J Rheum Dis 2021; 24:1370-1377. [PMID: 34514701 DOI: 10.1111/1756-185x.14218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease of unknown etiology, and erythema nodosum (EN) is a rare extramammary manifestation of this entity characterized by reddish, tender nodules of the lower legs. We aimed to investigate whether the association of IGM with EN has a role as a prognostic indicator. There are few case reports, and only 1 original article including 12 IGM patients with EN has been reported. METHODS We present 43 women with IGM coexisting with EN and 43 with a diagnosis of IGM only, who were randomly selected from 610 patients for a control group. To the best of our knowledge, this paper comprises the first comparative study of the coexistence of IGM and EN to be reported in the literature. RESULTS Our findings show that the association of IGM with EN indicates a more aggressive disease course. White blood cells, erythrocyte sedimentation rate, and C-reactive protein were significantly higher in the EN-positive group (P < .05). Arthralgia, breast feeding, fistula distribution and recurrence distributions were significantly higher in the EN-positive group (P < .05). CONCLUSION Since fistula distribution and recurrence rates were higher in EN-positive group, association of IGM with EN may be an indictor of a worse prognosis. The present study highlights the importance of dermatological care. All physicians should not neglect questioning breast complaints in patients with EN since EN may be caused by IGM.
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Affiliation(s)
- Mehmet Velidedeoğlu
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Berrin Papila Kundaktepe
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Serdal Uğurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
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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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Çetin K, Sıkar HE, Güllüoğlu BM. Idiopathic granulomatous mastitis with erythema nodosum: Is it a variant of clinical presentation indicating treatment resistance? A retrospective cohort study. Breast J 2020; 26:1645-1651. [DOI: 10.1111/tbj.13944] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Kenan Çetin
- Breast and Endocrine Surgery Unit University of Health SciencesKartal Dr. Lutfi Kirdar Training and Research Hospital Istanbul Turkey
| | - Hasan Ediz Sıkar
- Breast and Endocrine Surgery Unit University of Health SciencesKartal Dr. Lutfi Kirdar Training and Research Hospital Istanbul Turkey
| | - Bahadır M. Güllüoğlu
- Breast and Endocrine Surgery Unit SB Marmara University Pendik Training & Research Hospital Istanbul Turkey
- Department of Breast Surgery SENATURK Senology Academy of Turkey Istanbul Turkey
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Alia E, Varma A, Brody J, Keyzner A, Singh R, Levitt J. Use of etanercept in management of tyrosine kinase-inhibitor-induced erythema nodosum. JAAD Case Rep 2020; 6:567-568. [PMID: 32509950 PMCID: PMC7265067 DOI: 10.1016/j.jdcr.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Erisa Alia
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Aakaash Varma
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Joshua Brody
- Department of Hematology-Oncology, The Mount Sinai Hospital, New York, New York
| | - Alla Keyzner
- Department of Hematology-Oncology, The Mount Sinai Hospital, New York, New York
| | - Rajendra Singh
- Department of Dermatopathology, The Mount Sinai Hospital, New York, New York
| | - Jacob Levitt
- Department of Dermatology, The Mount Sinai Hospital, New York, New York
- Correspondence to: Jacob Levitt, MD, 5 E 98 St, 5 Floor, New York, NY, 10029.
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HAYRAN Y, ÖKTEM A, ŞAHİN B, İNCEL UYSAL P, ALLI N, YALÇIN B. Elevated neutrophil to lymphocyte ratio as an indicator of secondary erythema nodosum, a retrospective observational study. Turk J Med Sci 2019; 49:624-634. [PMID: 30997978 PMCID: PMC7018376 DOI: 10.3906/sag-1810-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim Erythema nodosum (EN) is an inflammatory disorder of subcutaneous tissue. Although etiopathogenesis of the disease is unknown, many predisposing factors such as infections, systemic disease, and drugs have been identified. Neutrophil to lymphocyte ratio (NLR) has been shown to be a novel inflammatory marker in many dermatological diseases. The aim of our study is to investigate NLR in EN patients and evaluate its relation to the underlying cause of the disease. Materials and methods Between 2014 and 2018, clinical and laboratory data of 395 patients diagnosed with EN and 395 controls were extracted from patient files. EN patients were grouped as idiopathic EN and secondary EN (EN with an identified underlying cause). Clinical and laboratory characteristics of the two groups were compared Results NLR was elevated in EN patients compared to controls (median of 2.38 vs. 1.55, P < 0.001). Among EN patients, NLR was also elevated in patients with secondary EN. In multivariate logistic regression model NLR (> 2.11), RDW-CV (> 13.65), and CRP (> 5.5) were identified as risk factors for secondary EN (relative risks were 17.16, 2.69, and 2, respectively). Conclusion Elevated NLR (> 2.11) may be used as a parameter to discriminate secondary EN from idiopathic EN.
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Affiliation(s)
- Yıldız HAYRAN
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Ayşe ÖKTEM
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Buket ŞAHİN
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Pınar İNCEL UYSAL
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Nuran ALLI
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Başak YALÇIN
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
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Sehrawat M, Dixit N, Sardana K, Malhotra P. Exploring the combination of SSKI and topical heparin in a case of erythema nodosum migrans. Dermatol Ther 2018; 31:e12610. [PMID: 29644775 DOI: 10.1111/dth.12610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/29/2017] [Accepted: 03/18/2018] [Indexed: 11/27/2022]
Abstract
Erythema nodosum migrans (subacute nodular migratory panniculitis) is an uncommon type of panniculitis characterized by migrating subcutaneous nodules or plaque on the lower extremity. There are a very few cases of Erythema nodosum migrans reported and thus its appropriate treatment modality is not defined. We describe a case of a 30-year-old male with idiopathic erythema nodosum migrans which was manifest centrifugally spreading, slightly morpheaform erythematous plaque on the lower left leg. The patient was diagnosed initially and treated as a case of furunculosis with poor clinical response. The skin biopsy showed features consistent with subacute nodular panniculitis. Saturated Solution of Potassium Iodide along with topical Heparin successfully treated the patient, when the conventional treatment modalities failed. In a morpheaform centrifugally expanded plaque, erythema nodosum migrans should be kept in mind in the differential diagnosis, especially in the lower extremities in cases of unknown etiology.
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Affiliation(s)
- Manu Sehrawat
- Department of Dermatology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Niharika Dixit
- Department of Dermatology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Kabir Sardana
- Department of Dermatology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Purnima Malhotra
- Department of Dermatology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
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Eugénio G, Tavares J, Ferreira JF, Malcata A. Unusual association between erythema nodosum and autoimmune atrophic gastritis. BMJ Case Rep 2018; 2018:bcr-2017-223638. [PMID: 29545439 DOI: 10.1136/bcr-2017-223638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We report a case of a 46-year-old woman with a history of autoimmune atrophic gastritis and recurrent erythema nodosum (EN). Laboratory results showed iron-deficiency anaemia, positive antiparietal cell antibodies and marginal deficiency of vitamin B12. Although EN was refractory to general measures (rest and non-steroidal anti-inflammatory drugs) and corticosteroid therapy, it was successfully treated with vitamin B12 supplementation.
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Affiliation(s)
- Gisela Eugénio
- Department of Rheumatology, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Joao Tavares
- Department of Internal Medicine, Hospital de Sao Teotonio, Viseu, Portugal
| | | | - Armando Malcata
- Department of Rheumatology, Hospitais da Universidade de Coimbra, Coimbra, Portugal
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De Simone C, Caldarola G, Scaldaferri F, Petito V, Perino F, Arena V, Papini M, Caproni M, Peris K. Clinical, histopathological, and immunological evaluation of a series of patients with erythema nodosum. Int J Dermatol 2016; 55:e289-94. [PMID: 26917228 DOI: 10.1111/ijd.13212] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/05/2015] [Accepted: 09/22/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The pathogenesis of erythema nodosum (EN) is still poorly understood, and studies evaluating the involvement of a cytokine network are very scarce. OBJECTIVES To investigate clinical and pathological features, the cytokine profiles, and the balance of T-regulatory (Treg) and T-helper (Th)17 cells in serum and lesional skin of patients with EN. METHODS Patients with a diagnosis of EN were consecutively enrolled, and their clinical and histopathological features were recorded. A panel of cytokines was evaluated in both serum and lesional skin using enzyme-linked immunosorbent assay. Real-time polymerase chain reaction was performed to evaluate the Treg/Th17 cell balance. RESULTS Histopathological examination of skin biopsy specimens from all patients (four women and one man) showed classical features of EN. The most widely expressed cytokines were innate immunity cytokines (mainly tumor necrosis factor alpha, interleukin-8 and -6) and growth factors (mainly granulocyte colony-stimulating factor and monocyte chemoattractant protein-1). The Treg/Th17 balance was highly different between patients. CONCLUSIONS The present study emphasizes the crucial role of neutrophils in the pathogenesis of EN, as high levels of cytokines and growth factors mainly involved in neutrophil recruitment and activation were detected.
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Affiliation(s)
- Clara De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giacomo Caldarola
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Franco Scaldaferri
- Gastroenterology Division, "Policlinico A. Gemelli" Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Valentina Petito
- Gastroenterology Division, "Policlinico A. Gemelli" Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Perino
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Vincenzo Arena
- Institute of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Manuela Papini
- Department of Surgical and Biomedical Sciences, Dermatologic Clinic of Terni, University of Perugia, Perugia, Italy
| | - Marzia Caproni
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - Ketty Peris
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
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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.
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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
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Yotsu R, Mii S, Hayashi R, Harada H, Furukawa K, Eto H. Erythema nodosum associated with Yersinia enterocolitica infection. J Dermatol 2010; 37:819-22. [PMID: 20883368 DOI: 10.1111/j.1346-8138.2010.00892.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: 11/28/2022]
Abstract
We report a 74-year-old woman who presented to hospital with fever, vomiting, diarrhea, and 2 weeks later developed erythema nodosum (EN) on the legs, and was diagnosed with Yersinia enterocolitica infection based on her clinical course and microbiological examination of the stool. She also had a complication of pancreatitis, which made the diagnosis challenging. We should suspect infection by Y. enterocolitica when diagnosing cases of EN with gastrointestinal symptoms. We assume EN is likely to appear 2 weeks after the onset of gastrointestinal symptoms from our case and other case reports.
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Affiliation(s)
- Rie Yotsu
- Department of Dermatology, St Luke's International Hospital, Chuo-ku, Tokyo, Japan.
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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]
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Gheith O, Al-Otaibi T, Tawab KA, Said T, Balaha MA, Halim MA, Nair MP, Nampoory MRN. Erythema nodosum in renal transplant recipients: multiple cases and review of literature. Transpl Infect Dis 2009; 12:164-8. [PMID: 20002354 DOI: 10.1111/j.1399-3062.2009.00474.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report 4 renal transplant recipients with erythema nodosum. Erythema nodosum is a cutaneous inflammatory reaction located on the anterior aspects of the lower extremities. It may be associated with a wide variety of diseases, including infections (as in Cases 1 and 2), sarcoidosis, rheumatologic diseases, inflammatory bowel diseases (as in Case 3), medications (as in Case 4), autoimmune disorders, pregnancy, and malignancies. Histopathologically, erythema nodosum is the stereotypical example of a mostly septal panniculitis with no vasculitis, and the inflammatory infiltrate in the septa varies with age of the lesion. In early lesions edema, hemorrhage, and neutrophils are responsible for the septal thickening, whereas fibrosis, peri-septal granulation tissue, lymphocytes, and multinucleated giant cells are the main findings in late stage. Etiological management - by anti-tuberculous therapy in Cases 1 and 2, by salazopyrin in Case 3, and by discontinuation of ciprofloxacin in Case 4 - was associated with regression. Erythema nodosum can develop in renal transplant patients who did not receive induction therapy, non-rejecters, and those with steroid-free protocols. Management of erythema nodosum should be directed to the underlying associated condition, which could be tuberculosis, inflammatory bowel disease, or drug related.
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Affiliation(s)
- O Gheith
- Hamed Al-Essa Organ Transplant Center, Ibn-Sina Hospital, Safat, Kuwait.
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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]
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Abstract
Erythema nodosum is the most frequent clinicopathologic variant of panniculitis. The process is a cutaneous reaction that may be associated with a wide variety of disorders, including infections, sarcoidosis, rheumatologic diseases, inflammatory bowel diseases, medications, autoimmune disorders, pregnancy, and malignancies. Erythema nodosum typically manifest by the sudden onset of symmetrical, tender, erythematous, warm nodules and raised plaques usually located on the lower limbs. Often the lesions are bilaterally distributed. At first, the nodules show a bright red color, but within a few days they become livid red or purplish and, finally, they exhibit a yellow or greenish appearance, taking on the look of a deep bruise. Ulceration is never seen, and the nodules heal without atrophy or scarring. Histopathologically, erythema nodosum is the stereotypical example of a mostly septal panniculitis with no vasculitis. The septa of subcutaneous fat are always thickened and variously infiltrated by inflammatory cells that extend to the periseptal areas of the fat lobules. The composition of the inflammatory infiltrate in the septa varies with age of the lesion. In early lesions edema, hemorrhage, and neutrophils are responsible for the septal thickening, whereas fibrosis, periseptal granulation tissue, lymphocytes, and multinucleated giant cells are the main findings in late stage lesions of erythema nodosum. A histopathologic hallmark of erythema nodosum is the presence of the so-called Miescher's radial granulomas, which consist of small, well-defined nodular aggregations of small histiocytes arranged radially around a central cleft of variable shape. Treatment of erythema nodosum should be directed to the underlying associated condition, if identified. Usually, nodules of erythema nodosum regress spontaneously within a few weeks, and bed rest is often sufficient treatment. Aspirin, nonsteroidal antiinflammatory drugs, such as oxyphenbutazone, indomethacin or naproxen, and potassium iodide may be helpful drugs to enhance analgesia and resolution. Systemic corticosteroids are rarely indicated in erythema nodosum and before these drugs are administered an underlying infection should be ruled out.
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Affiliation(s)
- Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
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Magro CM, Crowson AN. The spectrum of cutaneous lesions in rheumatoid arthritis: a clinical and pathological study of 43 patients. J Cutan Pathol 2003; 30:1-10. [PMID: 12534797 DOI: 10.1034/j.1600-0560.2003.300101.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is an idiopathic arthropathy syndrome that has a propensity to affect the small joints of the hands and feet with extra-articular manifestations comprising skin lesions, neuropathy, pericarditis, pleuritis, interstitial pulmonary fibrosis and a systemic polyarteritis nodosa (PAN)-like vasculitic syndrome. The most widely recognized skin lesion is the rheumatoid nodule. Other skin manifestations are poorly defined. MATERIALS AND METHODS Using a natural language search of the authors' outpatient dermatopathology databases, skin biopsies from 43 patients with RA were selected for retrospective analysis in an attempt to define the dermatopathological spectrum of RA and its clinical correlates. RESULTS The biopsies were categorized by the dominant histologic pattern, recognizing that in most cases there were additional minor reaction patterns. Palisading and/or diffuse interstitial granulomatous inflammation was the dominant pattern seen in 21 patients; the lesions included nodules, plaques and papules with a predilection to involve skin over joints. Besides interstitial histiocytic infiltrates and variable collagen necrobiosis, these cases also showed interstitial neutrophilia, vasculitis and pauci-inflammatory vascular thrombosis. The dominant morphology in 11 other patients was vasculopathic in nature: pauci-inflammatory vascular thrombosis, glomeruloid neovascularization, a neutrophilic vasculitis of pustular, folliculocentric, leukocytoclastic or benign cutaneous PAN types, granulomatous vasculitis, and lymphocytic vasculitis and finally occlusive intravascular histiocytic foci for which the designation of "RA-associated intravascular histiocytopathy" is proposed. Rheumatoid factor (RF) positivity and active arthritis were common in this group, with anti-Ro and anticardiolipin antibodies being co-factors contributing to vascular injury in some cases. Immunofluorescent testing in three patients revealed dominant vascular IgA deposition. In nine patients, the main pattern was one of neutrophilic dermal and/or subcuticular infiltrates manifested clinically as urticarial plaques, pyoderma gangrenosum and panniculitis. CONCLUSIONS The cutaneous manifestations of RA are varied and encompass a number of entities, some of which define the dominant clinical features, such as the rheumatoid papule or subcutaneous cords, while others allude to the histopathology, i.e. rheumatoid neutrophilic dermatosis. We propose a more simplified classification scheme using the adjectival modifiers of "rheumatoid-associated" and then further categorizing the lesion according to the dominant reaction pattern. Three principal reaction patterns are recognized, namely extravascular palisading granulomatous inflammation, interstitial and/or subcuticular neutrophilia and active vasculopathy encompassing lymphocyte-dominant, neutrophil-rich and granulomatous vasculitis. In most cases, an overlap of the three reaction patterns is seen. Co-factors for the vascular injury that we believe are integral to the skin lesions of RA include RF, anti-endothelial antibodies of IgA class, anti-Ro and anticardiolipin antibodies.
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Affiliation(s)
- C M Magro
- Department of Pathology, Ohio State University, Columbus, OH, USA
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Yang JJ, Preston GA, Pendergraft WF, Segelmark M, Heeringa P, Hogan SL, Jennette JC, Falk RJ. Internalization of proteinase 3 is concomitant with endothelial cell apoptosis and internalization of myeloperoxidase with generation of intracellular oxidants. THE AMERICAN JOURNAL OF PATHOLOGY 2001; 158:581-92. [PMID: 11159195 PMCID: PMC1850298 DOI: 10.1016/s0002-9440(10)64000-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The important issue addressed by the studies presented here is the mechanism of neutrophil-mediated damage to endothelial and epithelial cells during inflammation. Binding of neutrophil-released granule proteins to endothelial cells may be involved in vascular damage in patients with inflammatory vascular diseases. We have determined whether granule proteins proteinase 3(PR3) and/or myeloperoxidase (MPO) are internalized into endothelial cells, as examined by UV light, confocal, and electron microscopy. Coincident induction of apoptosis and/or the generation of intracellular oxidants were monitored. The results indicate that human endothelial cells (human umbilical vein endothelial cells, human umbilical arterial endothelial cells, human lung microvascular endothelial cells) internalize both PR3 and MPO, which are detected on the cell surface, in the cytoplasm, and possibly nuclear. Epithelial cells (small airway epithelial cells) internalized MPO but not PR3, implying that the mechanism of PR3 internalization may be cell-type specific and different from that of MPO. Internalization of PR3, but not MPO, correlated with activation of apoptosis. Internalization of MPO correlated with an increase in intracellular oxidant radicals. The requirement for the proteolytic activity of PR3 for the induction of apoptosis was examined by generating PR3-truncated fragments that did not contain the components of the catalytic triad. An apoptotic function was localized to the C-terminal portion of PR3. These studies reveal novel mechanisms by which the neutrophil granule proteins PR3 and MPO contribute to tissue injury at sites of inflammation.
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Affiliation(s)
- J J Yang
- Department of Medicine and Hypertension, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7155, USA.
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