Type 2 reversal reactions (erythema nodosum leprosum, ENL) are a significant cause of morbidity in multibacillary leprosy. These reactions are commonly managed with long-term corticosteroids, which pose many risks. This case report highlights the use of methotrexate as a steroid-sparing treatment for ENL.

A 35-year-old female diagnosed with lepromatous leprosy in March 2020 developed painful erythematous nodules two months into multi-drug therapy. Biopsy revealed lobular panniculitis with vasculitis, consistent with ENL. She was started on prednisone (50 mg/day), which was tapered over the next 3.5 years, fluctuating between 5-55 mg/day depending on lesion recurrence.

In August 2023, the patient was diagnosed with pulmonary tuberculosis (PTB), necessitating PTB treatment. At this point, the decision was made to augment the patient’s prednisone (25 mg/day) with methotrexate (5 mg/week). Over a year, Methotrexate was increased to 10 mg/week while Prednisone was reduced to 10 mg/day. The patient reported a 60% improvement in lesion number and erythema. The goal is to continue to taper her Prednisone until it is discontinued.

The Philippines is a global priority country for leprosy, with over 90% of cases being classified as multibacillary (MB). Given that ENL is seen in up to half of all MB cases, accessible management options are necessary. Long-term corticosteroid use for ENL is unsustainable due to side effects. Methotrexate, a cost-effective alternative, showed promise in this case by reducing steroid dependence and improving clinical outcomes. Further research is needed to establish Methotrexate’s long-term efficacy and safety in managing ENL.

We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-old girl presented with EN as an initial manifestation of KD. At the initial visit, she showed high fever of 40℃, injection of the oropharynx, cervical lymphadenopathy, and red-purple cutaneous nodules, particularly on the lower limbs. She complained of severe pain in the neck and cutaneous lesions. Initially, the development of EN was attributed to Salmonella spp infection, which was detected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the Salmonella spp is sensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the left anterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should be considered in the differential diagnosis of refractory EN in pediatric patients.
Aneurysm ; Arteries ; Bacterial Infections ; Child, Preschool ; Coronary Vessels ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Erythema Nodosum ; Erythema ; Exanthema ; Female ; Fever ; Fever of Unknown Origin ; Humans ; Lower Extremity ; Lymphatic Diseases ; Masks ; Mass Screening ; Mucocutaneous Lymph Node Syndrome ; Neck ; Oropharynx ; Salmonella ; Skin ; Subcutaneous Tissue

No abstract available.
Erythema Nodosum ; Erythema ; Pancreatic Neoplasms

No abstract available.
Child, Preschool* ; Erythema Nodosum* ; Erythema* ; Granuloma Annulare* ; Granuloma* ; Humans ; Lower Extremity* ; Male*

A 39-year-old Caucasian man was referred to University Hospital Salamanca from a primary care unit due to the presence of an erythematous violaceous nodule at the superior portion of his nose. Physical examination indicated that the firm, fixed erythematous violaceous nodule measured approximately 2 cm in diameter and was located inferior to a scar on the nasal bridge. Cutaneous involvement in sarcoidosis occurs in 25% of cases. A wide range of clinical presentations of cutaneous sarcoidosis is recognized. Skin lesions are classified as either non-specific, of which erythema nodosum is the most representative and specific, or as granulomatous, which includes maculopapular nodules, plaques, infiltrated scars, lupus pernio, ulcerations, warty lesions and erythroderma. Scar sarcoidosis is a type of cutaneous sarcoidosis.
Adult ; Chilblains ; Cicatrix ; Dermatitis, Exfoliative ; Erythema Nodosum ; Humans ; Nose ; Physical Examination ; Primary Health Care ; Sarcoidosis* ; Skin ; Ulcer

Lepra reaction is an acute exacervational status occurring in the chronic course of leprosy. Type 2 lepra reaction occur from multibacillus leprosy (such as BL or LL), which mediated by antigen-antibody immune complex deposited vasculitis, involving multiple organs, and usually associated with constitutional symptoms such as fever, malaise, joint pains. The skin lesions is characterized by painful and tender red papules or nodules on the skin, which also refers to erythema nodosum leprosum (ENL). Different rare atypical skin lesions of ENL have been reported such as bullous, ulcerative, necrotic, pustular, sweet syndrome like lesions in literature. The 74 years old male patient with lepromatous leprosy presented as multiple crusted ulcers on the trunk and red edematous nodule on extremities and face. The histopathologic feature was typical for type 2 lepra lesion. Fite stain revealed large histiocytes containing well defined dense granular bacillus. This case was very rare and interesting because of unusual crusted ulcerative skin lesions combined with conventional ENL lesions and leprosy itself is rare in Korea these days.
Antigen-Antibody Complex ; Arthralgia ; Bacillus ; Erythema Nodosum ; Extremities ; Fever ; Histiocytes ; Humans ; Korea ; Leprosy ; Leprosy, Lepromatous* ; Male ; Skin* ; Sweet Syndrome ; Ulcer* ; Vasculitis

A case of a female patient with local and systemic complications of metallosis, following catastrophic wear of a revised hip arthroplasty, is presented. The patient had a history of a fractured ceramic-on-ceramic implant, exchanged with a metal-on-polyethylene prosthesis. Systemic complications included sarcoidosis-like reactions, presenting as granulomatous lung disease, along with chorioretinitis, erythema nodosum, and cardiomyopathy. High local and circulating cobalt and chromium levels established the diagnosis. The patient underwent extensive debridement and implant revision. One year postoperatively, she had no respiratory symptoms or functional impairment. Local and systemic complications of metallosis after hip arthroplasty should be promptly recognized and treated operatively.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Cardiomyopathies ; Ceramics ; Chorioretinitis ; Chromium ; Cobalt ; Debridement ; Diagnosis ; Erythema Nodosum ; Female ; Hip* ; Humans ; Lung Diseases* ; Lung* ; Prostheses and Implants ; Reoperation ; Sarcoidosis, Pulmonary

PURPOSE: The aim of this study was to investigate the clinical features and extraintestinal manifestations (EIMs) of Crohn disease (CD) in Korean pediatric patients. METHODS: The medical records of 73 children diagnosed with CD were retrospectively reviewed. Data regarding baseline demographic and clinical characteristics, including CD phenotype at diagnosis based on the Montreal classification, and clinical features and course of EIMs were investigated. RESULTS: Fifty-two (71.2%) of the patients were males. The mean age of the patients was 12.5 years. The mean follow-up period was 3.4 years. The disease location was ileal in 3 (4.1%) of the patients, colonic in 13 (17.8%), ileocolonic in 56 (76.7%). The clinical behavior was inflammatory in 62 (84.9%) of the patients, stricturing in 8 (11.0%), and penetrating in 3 (4.1%). Perianal abscesses or fistulas were found in 37 (50.7%) of the patients. EIMs observed during the study period were anal skin tag in 25 patients (34.2%), hypertransaminasemia in 20 (27.4%), peripheral arthritis in 2 (2.7%), erythema nodosum in 2 (2.7%), vulvitis in 1 (1.4%), uveitis in 1 (1.4%), and pulmonary thromboembolism in 1 (1.4%). CONCLUSION: Perianal diseases and manifestations were present in more than half of Korean pediatric CD patients at diagnosis. Inspection of the anus should be mandatory in Korean children with suspicious CD, as perianal fistulas, abscesses, and anal skin tags may be the first clue to the diagnosis of CD.
Abscess ; Anal Canal ; Arthritis ; Child* ; Classification ; Colon ; Crohn Disease* ; Diagnosis ; Erythema Nodosum ; Fistula ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Phenotype ; Pulmonary Embolism ; Retrospective Studies ; Skin ; Uveitis ; Vulvitis

Erythema nodosum (EN) is a painful skin disease characterized by erythematous tender nodules located predominantly over the extensor aspects of the legs. Various etiological factors, including infection, drug administration, and systemic illness have been implicated as causes of EN. Mycoplasma pneumoniae is one of rare infectious agents to cause EN in children. We report a case of a 7-year-old boy with context of respiratory illness and skin lesions with arthralgia. From stepwise approaches, IgM antibody against M. pneumoniae was positive with titers of 12.18, consistent with respiratory infection of M. pneumoniae and histopathology showed findings of septal and lobular inflammation without vasculitis consistent with EN. In addition, we reviewed the pathogenesis of this disease based on our case and the previous reports.
Arthralgia ; Child ; Erythema Nodosum* ; Erythema* ; Humans ; Hypersensitivity, Delayed ; Immunoglobulin M ; Inflammation ; Leg ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia ; Pneumonia, Mycoplasma* ; Skin ; Skin Diseases ; Vasculitis

No abstract available.
Erythema Nodosum* ; Erythema*