Erythema Nodosum in Children: A Study of 27 Patients

Abstract

Erythema nodosum (EN) seems to occur in children more rarely than in adults. It still remains the most frequent acute panniculitis, for which the diagnosis is almost always clinical. In a retrospective study of 27 pediatric patients, we have attempted to clarify the clinical spectrum and prognosis of this disease and discuss the differential diagnosis of nodular eruptions on the lower limbs of children. In almost half the patients of our series, the cause of EN remained undetermined. Streptococcal infections (usually of the pharynx) were the most common cause of EN in children (22% of patients in our series), followed by Yersinia infection in about 15% of patients. Tuberculosis, an important cause in the past, was never found, but must always be excluded. A benign course was noted in all patients. Erythema nodosum is easily recognized clinically, but other subcutaneous lesions, especially nodular vasculitis and Schönlein-Henoch purpura, have to be excluded by pathologic study, in cases of atypical presentation or long duration.

Unusual Eruptions Associated with <b><i>Mycoplasma pneumoniae</i></b> Respiratory Infections: Review of the Literature

“…Our review disclosed 11 erythema nodosum cases associated with M. pneumoniae infection [4,54,58,78,79,80,81,82,83]. No more than 1 case of erythema nodosum associated with M. pneumoniae respiratory infection was noted in 9 case series [4,79,84,85,86,87,88,89,90] including a total of 654 erythema nodosum cases not addressing this possible association. However, 4 cases were noted in 3 case series [79,80,91] addressing the mentioned association in a total of 77 erythema nodosum cases.…”

“…Using the described strategy, 94 reports were retained for the final analysis [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97]: 1 in German [23], 1 in Italian […”

Pediatric Autoimmune Hepatitis in a Patient Who Presented With Erythema Nodosum: A Case Report

“…Streptococcal infections are the most common identifiable cause of EN, especially in children. Other bacterial and viral infections, drugs, sarcoidosis, inflammatory bowel disease, and autoimmune disorders are the other common causes of EN (12,14). Sometimes, EN is the sign of an autoimmune disease such as ankylosing spondylitis, antiphospholipid antibody syndrome, Behçet's syndrome, Reiter's syndrome, rheumatoid arthritis, Sjögren's syndrome, systemic lupus erythematosus, Takayasu's arteritis, and Wegener's granulomatosis, which can be potentially relieved with immunosuppressive and supportive therapy (16,18).…”

“…Erythema nodosum (EN) is a skin lesion associated with some autoimmune diseases such as inflammatory bowel syndrome and Behçet syndrome, and some non-autoimmune disorders such as tuberculosis, bacterial or deep fungal infection, sarcoidosis, and cancer (11)(12)(13). EN seems to occur less frequently in children than in adults (14). Although AIH is an autoimmune disease and EN is not unusual in autoimmune disorder, there are few reports of an association between EN and AIH (15).…”

Erythema nodosum

“…Die 20 ± 40−Jährigen bilden die typische Altersgruppe für das EN, Kinder erkranken selten [10,15,20,25,32,46,62]. Die meisten Er− krankungen betreffen das weibliche Geschlecht, das Verhältnis männlich zu weiblich beträgt 1 : 3 (− 10), bei Kindern etwa 1 : 1.…”