Upper limb erythema nodosum: the first presentation of Crohn's disease

Abstract

Key Clinical MessageInflammatory bowel disease can present with extraintestinal features as the patient's only complaint. The erythema nodosum (EN) initially affected the upper limbs only, reminding us that signs do not always present in a classical fashion. The presence of EN should prompt the clinician to look for any underlying cause.

Erythema nodosum – review of the literature

“…In addition, there are suggestions that genetic factors also play a role in the pathogenesis of skin lesions in IBD – mainly variants of the TRAF3IP2 gene encoding a protein involved in inflammatory reactions by activating cytokines. The presence of ANCA and HLA-B27 antigen in patients with erythema nodosum and inflammatory bowel disease also argues in favour of the important role of genetic factors [ 22 ].…”

Dermatological changes associated with non-specific inflammatory bowel diseases – Crohn’s disease and ulcerative colitis

“…Erythema nodosum is the most common skin manifestation that occurs in the course of IBD, more often found in patients with Crohn's disease, especially in young women in the active phase of the disease [13,14]. The incidence of coexistence of this dermatosis with Crohn's disease ranges from 4% to 15%.…”

“…The association of this dermatosis has been demonstrated with the presence of HLA B27, Rs33980500 (in the case of Crohn's disease), Rs13190932, Rs13196377 (in the case of colitis ulcerosa) variants of the TRAF3IP2 allele and the -1031C polymorphism of the TNF-α gene in the population of people with IBD. The coexistence of both diseases is also related to the presence of ANCA antibodies (anti-neutrophil cytoplasmic antibodies) [2,13,15]. Erythema nodosum manifests itself as painful, inflammatory, subcutaneous tumors, several cm in diameter that resolve without leaving a scar.…”

“…The most common location of lesions is the surface of forearms, lower legs and thighs. It should also be noted that skin changes may be accompanied by general symptoms such as weakness, articular pain and fever [13,14,16]. The severity of skin symptoms usually correlates with the severity of the underlying disease, and is independent of it only in 10% of cases [11].…”

“…Rumień guzowaty jest najczęstszą manifestacją skórną pojawiającą się w przebiegu NZJ, stwierdzaną częściej u pacjentów z chorobą Leśniowskiego-Crohna, przede wszystkim młodych kobiet w aktywnej fazie choroby [13,14]. Częstość współwystępowania tej dermatozy z chorobą Leśniowskiego-Crohna waha się w zakresie 4-15%.…”