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Erythema Nodosum

Erythema Nodosum

A 40-year-old woman who said she had asthma was admitted to the hospital with worsening dyspnea and cough. A β-adrenergic agent was her only medication. The patient denied cigarette smoking and alcohol consumption. Except for an appendectomy 20 years earlier, her medical history was unremarkable. The patient was afebrile. Crackles were audible at the base of the lungs bilaterally. A chest radiograph revealed enlarged hilar lymph nodes bilaterally. Erythema nodosum and nodular lesions were present on both knees; a biopsy of the lesions was performed. Based on the patient’s presentation and the biopsy results, Drs N. K. Akritidis, C. Kanioglou, D. Eftaxias, and I. Takalou of Ioannina, Greece, diagnosed sarcoidosis. Sarcoidosis—a systemic disorder of unknown cause—often involves the mediastinal and peripheral lymph nodes, lungs, liver, spleen, skin, bones, eyes, and parotid glands. The most common cutaneous manifestation is erythema nodosum; lupus pernio often affects the face and may present as large nodules on the tip and bridge of the nose, cheeks, and earlobes. Other skin manifestations are subcutaneous nodules; circinate lesions; and purple-red nodules of scar sarcoidosis, which arise in old scars. Oral prednisone, 40 mg/d tapered over 2 months, resolved this patient’s lesions and improved respiratory function. No other treatment was given.

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