Highly suspected valsartan-induced chronic erythema nodosum migrans in a patient with hypertension: a case report

Abstract

Erythema nodosum migrans (ENM) is usually considered as a rare clinical variant of erythema nodosum and is characterized by unilateral, migratory, relatively painless, nodular lesions. ENM cases are rarely reported and most cases are idiopathic. Therefore, the appropriate treatment modality of ENM is unknown. We report a 72-year-old woman with highly suspected valsartan-induced ENM. She experienced painful, infiltrated, centrifugally spreading, slightly morpheaform, erythematous plaques on the flexor side of her left leg. Her symptoms were relieved after discontinuation of valsartan and temporary administration of oral prednisone once daily (20 mg for the first 7 days and 10 mg for the next 7 days).

Subacute nodular migratory panniculitis, a rare presentation of a rare disease: a case report

“…It has multiple triggering factors like infections such as hepatitis B, drugs (antibiotics containing sulfa or penicillin, oral contraceptives, anti-hypertensives like valsartan), thyroid disorder, pregnancy, and malignancies such as lymphoma or leukemia and rarely can be associated with Crohn's disease, carcinoid, colorectal and pancreatic cancer. [2][3][4] Clinically it presents as persistent nodular lesions and these nodules enlarge by confluence or peripheral extension (centrifugal extension with central clearing) to form plaques. The nodules do not ulcerate, and over weeks or months, they tend to migrate.…”

“…It may be triggered by infections like hepatitis B, drugs (antibiotics containing sulfa or penicillin, oral contraceptives, anti-hypertensives like valsartan), thyroid disorder, pregnancy, Crohn's disease or malignancies. [2][3][4] Though it may mimic erythema nodosum closely, lesions in this disease tend to be less tender and have a more chronic course. The histopathological examination shows greater septal thickening and more prominent granulomatous inflammation along the borders of widened subcutaneous septa.…”

Causes of Autoimmune Psoriasis and Associated Cardiovascular Disease: Roles of Human Endogenous Retroviruses and Antihypertensive Drugs—A Systematic Review and Meta-analysis

“…A flared psoriatic plaque manifestation, as a cutaneous ADR which is more commonly observed by ACE inhibitors, was also detected in a female patient receiving Telmisartan 75 , which in contrast can also significantly decrease the pro-inflammatory cytokines IL-6 and TNF-α levels 76 . In addition, a presumable association between some rare forms of PsD such as erythema nodosum migrans (ENM) and losartan administration was observed in another patient 77 . In contrast, losartan, exhibits a beneficial effect against imiquimod-induced psoriasis-like inflammatory response in vivo following topical administration (Losartan 1% ointment), more likely through the inhibition of IL17a-related inflammation mediated by suppression of the Ang II and Ang II receptor type 1 (AT1R) expression 78 .…”