Erythema Nodosum
Characterized by red, painful nodules (histologically it is a panniculitis) most often seen on the lower extremities (shins, calves, thighs, ankles) and it generally flares when the inflammatory bowel disease flares. Erythema nodosum is also seen in TB, sarcoidosis, some strep infections, and as an allergic response to certain medications.
Patient 1:
This is a previously healthy young man with Löfgren’s syndrome. Note the inflammation around the ankles, which is highly characteristic of Löfgren’s syndrome.
Patient 2:
This is a previously healthy young man with Löfgren’s syndrome. Note the inflammation around the ankles, which is highly characteristic of Löfgren’s syndrome.
Patient 3:
This is a previously healthy young man with Löfgren’s syndrome. Note the inflammation around the ankles, which is highly characteristic of Löfgren’s syndrome.
Patient 4:
This is a young man who presented with several months of abdominal pain, weight loss, and blood diarrhea, and was found to have erythema nodosum on examination, and ultimately diagnosed with inflammatory bowel disease.
This is a highly reliable physical diagnostic sign in Crohn’s patients that often precipitates an IBD flare. I often see asymptomatic Crohn’s patients who have EN on physical exam (typically on the shins) which precipitated the flare by 1-3 weeks.
Awesome. Thanks for sharing that pearl, Amanda.
erythema nodosum leprosum {ENL] = Type 2 reaction in leprosy should be in the EN differential. Leprosy {Hansen’s Disease] can first present with ENL [or Type 1 reaction. In the USA, there is an average of 2 years between the onset of ANY of the symptoms/sign of leprosy that prompts a patient to see a clinician for diagnosis–and that actual correct leprosy diagnosis being made. Meantime there can be irreversible HEENT or nerve damage.
Thank you for sharing this, Ronald.