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A 27y.o woman comes to ur office with painful erythematous papules that occured 1 day before her visit.She has no other complaints xcept joint swelling & pain occured 3 days ago.Physical exam. shows low grade fever,symmetric swelling of knees,PIP & MCP JOINTS, &weel demarcated,3 to 4 cm papules over the ant.aspect of her legs.
Wat wud be the next step in confirming the likely diagnosis in this pt.????


Erythema nodosum.....

Well..... I would go with throat culture for Group A beta hemolytic strept.
and then ASO....
meantime....shld go for a CXR for Features of Sarcoidosis.....

I mean this cld be the presentation of either of them even with the joint swelling.....

Am i even close to being correct....?? :?
Obviously if i had choices.....
Looking for Strept wld be priority
then Looking for Sarcoidosis.....


That's ABSOLUTELY CORRECT grin del!!!
This pt. has arthritis & erythema nodosum.......suggesting sarcoidosis.....
And yes, it's d/d cud be strep.........but the symmetric distribution of swelling of knees .PIP& MCP wud point more towards sarcoidosis...
And the next step wud be to do a biopsy of the suspected lesions(which wud show us noncaseating granulomas).........
And in these pt.s, sometimes an elevation of ACE can be seen(60%).........though nonspecific, can be used to follow the disease.

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