|
July 2002
Case submitted by Stephen M. Schleicher,
MD, and Lawrence A. Schiffman, DO
|
|
|
CASE:
The patient is a 22-year-old female college student who has
had painful lesions on both legs for approximately six weeks.
She had a similar condition two years ago that resolved spontaneously.
Otherwise in good health, she takes birth control pills but
no other medications regularly. She denies malaise, fever,
and joint pain. Examination of both lower legs reveals scattered
dusk-colored to violaceous subcutaneous nodules that are tender
to light palpation. No lesions are noted elsewhere.
|
| What is your diagnosis? |
| |
|
|
|
Erythema nodosum, characterized by tender lesions
arising on the lower extremities, is more common in women. Fever
and arthralgias may precede the eruption of multiple discrete,
indurated, hyperpigmented nodules, defined histologically as
panniculitis. The etiology may be infectious—beta-hemolytic
streptococci are a common cause—or drug-related, including oral
contraceptives. The condition may also accompany sarcoid and
inflammatory bowel disease. The diagnostic workup therefore
should include a detailed history as well as throat culture
and radiologic examination of the lungs. |
Dr. Schleicher is director of the DermDx Centers for Dermatology
of Northeastern Pennsylvania and a clinical instructor of dermatology
at Graduate Hospital's City Line Campus in Philadelphia, Kings
College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Dr. Schiffman is a fellow at the DermDx Centers for Dermatology.
|
