new_n_lost
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A 25-year-old pregnant woman complains she has had painful nodules on her shins for over 2 weeks. She suffers from asthma, which is well controlled and is 32 weeks’ pregnant. Examination shows painful nodules over her shins.
What is the most likely diagnosis?
A. Erythema multiforme
B. Erythema nodosum
C. Cellulitis
D. Granuloma annulare
E. Drug eruption
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| keepgoing
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except b all seem not the case ,so b
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| usmle4me
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B Erythema Nodosum
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| rock
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B ?
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| werther
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Hi folks,
The lady probably fits into a Churg-Strauss syndrome. (just because they mention asthma which is associated)
On the other hand, here are causes of erythema nodosum.
Causes: Currently, the most common cause of EN is streptococcal infection in children and streptococcal infection and sarcoidosis in adults. Numerous other causes have been reported. The causes reported most often in the literature are as follows:
* Bacterial infections
o Streptococcal infections are one of the most common causes of EN.
o Tuberculosis was an important cause in the past, but it has decreased dramatically as a cause for EN; however, it still must be excluded, especially in developing countries.
o Yersinia enterocolitica is a gram-negative bacillus that causes acute diarrhea and abdominal pain; it is a common cause of EN in France and Finland.
o Mycoplasma pneumoniae infection may cause EN.
o EN leprosum clinically resembles EN, but the histologic picture is that of leukocytoclastic vasculitis.
o Lymphogranuloma venereum may cause EN.
o Salmonella infection may cause EN.
o Campylobacter infection may cause EN.
* Fungal infections
o Coccidioidomycosis (San Joaquin Valley fever) is the most common cause of EN in the American Southwest. In approximately 4% of males and 10% of females, the primary fungal infection (which may be asymptomatic or involve symptoms of upper respiratory infection) is followed by the development of EN. Lesions appear 3 days to 3 weeks after the end of the fever caused by the fungal infection.
o Histoplasmosis may cause EN.
o Blastomycosis may cause EN.
* Drugs: Sulfonamides and halide agents are an important cause of EN. Drugs more recently described to cause EN include gold and sulfonylureas. Oral contraceptive pills are implicated in an increasing number of reports.
* Enteropathies: Ulcerative colitis and Crohn disease may trigger EN. EN associated with enteropathies correlates with flares of the disease. The mean duration of chronic ulcerative colitis before the onset of EN is 5 years, and EN is controlled with adequate therapy of the colitis.
* Hodgkin disease and lymphoma: EN associated with non-Hodgkin lymphoma may precede the diagnosis of lymphoma by months. Reports of EN preceding the onset of acute myelogenous leukemia have been published.
* Sarcoidosis: The most common cutaneous manifestation of sarcoidosis is EN. A characteristic form of acute sarcoidosis involves the association of EN, hilar lymphadenopathy, fever, arthritis, and uveitis, which has been termed Lofgren syndrome. This presentation has a good prognosis with complete resolution within several months in most patients.
* Behçet disease (associated with EN)
* Pregnancy: Some patients develop EN during pregnancy, most frequently during the second trimester. Repeated episodes occur with subsequent pregnancies or with the use of oral contraceptives.
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| new_n_lost
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| new_n_lost
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Erythema nodosum is an acute panniculitis that produces painful nodules or plaques on the shin. It is commonly seen in sarcoidosis, inflammatory bowel diseases, streptococcal infections, tuberculosis, sulphonamide treatment and may be seen during pregnancy
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| werther
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AND...
ITS A TYPE IV HYPERSENSITIVITY REACTION.
Edited by new_n_lost on 06/28/07 - 12:59 AM. Reason: Spelling Chk
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| tompat
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never thought there s something called hypersensible!!
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| new_n_lost
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tompat wrote:
never thought there s something called hypersensible!!
Its Human To ERR 
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| tompat
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my bad,
meant only lil humor, no hurt.
i like every one in this forum
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| drduck
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i always get late......yes painful......its erythma nodosum...normal in pregnency....
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