Erythema nodosum–like lesions in treated Whipple's disease: Signs of immune reconstitution inflammatory syndrome

Successful treatment of immune reconstitution inflammatory syndrome in Whipple's disease using thalidomide

“…6 A paradoxical inflammatory syndrome, classified as an immune reconstitution inflammatory syndrome, has also been described in non-HIV-infected patients treated for lepromatous leprosy. 5,7 A parallel between the evolution of our patient and the erythema nodosum leprosum observed in leprosy can be drawn. The classic manifestations of erythema nodosum leprosum include crops of painful erythematous nodules in the skin and subcutaneous tissues.…”

“…However, aggravation of the clinical status of patients (mainly those patients with long-lasting fever) soon after the initiation of adequate antibiotic therapy for bacterial infections, such as lepromatous leprosy and mycobacteriosis, has been well described as an immune reconstitution inflammatory syndrome. 4,5 Recently, erythema nodosum-like lesions were reported in a patient treated for WD. 5 Five weeks after antibiotic therapy, erythematous nodules appeared on the trunk and the legs that were controlled by corticosteroid therapy.…”

“…4,5 Recently, erythema nodosum-like lesions were reported in a patient treated for WD. 5 Five weeks after antibiotic therapy, erythematous nodules appeared on the trunk and the legs that were controlled by corticosteroid therapy. In our patient, the skin lesions turned out not to be due to trimethoprim-sulfamethoxazole resistance but rather to an immune reconstitution inflammatory disease developed after initiation of antibiotic therapy for WD.…”

Whipple’s Disease: A Case Report and Review of Literature

“…Skin involvement apart from hyperpigmentation is very rare; it may be related to the malnutrition or an immune reaction to T. whipplei leading to conditions in the form of eczematous plaques, psoriasis and erythema nodosum [24].…”

“Immune reconstitution inflammatory syndrome”—a rare complication of Whipple’s disease

“…Skin manifestations usually comprise of erythema nodosum. For instance, Schaller et al [5] recently described the case of a 42-year-old who was diagnosed with IRIS after he started developing erythema nodosum-like lesions 5 weeks after commencement of antibiotic therapy for WPLD.…”