Erythema nodosum leads to the diagnosis of pulmonary tuberculosis
Theocharis Koufakis, Ioannis Gabranis
The Pan African Medical Journal. 2014;18:291. doi:10.11604/pamj.2014.18.291.5170

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Case report

Erythema nodosum leads to the diagnosis of pulmonary tuberculosis

Cite this: The Pan African Medical Journal. 2014;18:291. doi:10.11604/pamj.2014.18.291.5170

Received: 01/08/2014 - Accepted: 10/08/2014 - Published: 14/08/2014

Key words: Erythema nodosum, Tuberculosis, Hilar lymphadenopathy

© Theocharis Koufakis et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/18/291/full

Corresponding author: Theocharis Koufakis, 49 Ioustinianoustr. P.C. 41223 Larissa, Greece (thkoyfak@hotmail.com)


Erythema nodosum leads to the diagnosis of pulmonary tuberculosis

 

Theocharis Koufakis1,&, Ioannis Gabranis1

 

1Department of Internal Medicine, General Hospital of Larissa, Larissa, Greece

 

 

&Corresponding author
Theocharis Koufakis, 49 Ioustinianoustr. P.C. 41223 Larissa, Greece

 

 

Abstract

Erythema nodosum is a panniculitis which may have various causes, such as drugs, infections, sarcoidosis, inflammatory bowel disease, tuberculosis or can be idiopathic. We here report a case of a womandiagnosed with pulmonary tuberculosis whose first symptom was erythema nodosum. A thorough clinical and laboratory investigation of the patient presenting with erythema nodosum is always required, in order to assess a possible systemic, underlying condition.

 

 

Introduction

Erythema nodosum is a panniculitis, characterized by red, tender nodules usually located on the extensor surfaces of the legs. It may have various causes, such as drugs, infections, sarcoidosis, inflammatory bowel disease, tuberculosis or can be idiopathic [1].In up to 50% of cases, the underlying etiology remains unclear [2].

 

 

Patient and observation

We here report a case of a 78 year old woman, with free medical history, who presented to the Emergency Department of our Hospital with erythema nodosum on her both shins (Figure 1A). She also mentioned low grade fever since 15 days and a positive family history of tuberculosis (daughter). Her chest X-Ray revealed bilateralhilar lymphadenopathy, mainly at the right side (Figure1C). Further evaluation with High Resolution chest Computed Tomography confirmed the lymphadenopathy and demonstrated ground-glass opacities. The Mantoux skin test was strongly positive (22 mm) (Figure1B). Anti-TB treatment was started, based on the positive Mantoux test, the compatible imaging findings and mainly, the history of close and direct exposure. Sputum cultures proved to be positive for Mycobacterium tuberculosis.Patientís response to treatment was impressive and in her follow up visits, she remained free of symptoms and a define improvement of her imaging findings was observed.

 

 

Discussion

The commonest causes of erythema nodosum reported in the literature, are streptococcal infection in children and streptococcal infection and sarcoidosis in adults [3]. Its course is, in most cases, benign and self-limited.However, therapeutic options include, among others, NSAIDS, corticosteroids antimicrobial agents and colchicine.

 

 

Conclusion

In conclusion, a thorough clinical and laboratory investigation of the patient presenting with erythema nodosum is always required, in order to assess a possible systemic, underlying condition.

 

 

Competing interests

The authors declare that they have no competing interests

 

 

Authorsí contributions

Koufakis T: Patientís management and writing of the manuscript. Gabranis I: Patientís management and review of the literature. All the authors have read and approved the final version of the manuscript.

 

 

Figures

Figure 1: A) Erythema nodosun on the patientís left shin; B) Positive Mantoux test; C) Chest X-Ray demonstrating hilar lymphadenopathy, mainly at the right side

 

 

References

  1. Passarini B, Infusino SD. Erythema nodosum. G Ital Dermatol Venereol. 2013 Aug;148(4):413-7. PubMed | Google Scholar

  2. Acosta KA, Haver MC, Kelly B. Etiology and therapeutic management of erythema nodosum during pregnancy: an update. Am J Clin Dermatol. 2013; 14(3):215-2. PubMed | Google Scholar

  3. Hassink RI, Pasquinelli-Egli CE, Jacomella V, Laux-End R, Bianchetti MG. Conditions currently associated with erythema nodosum in Swiss children. Eur J Pediatr. Nov 1997; 156(11):851-3. PubMed | Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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