Patient Case: Erythema Nodosum
A 35-year-old woman presents to the clinic with a painful rash on her lower legs that started one week ago. She describes the lesions as tender, red bumps that initially felt like bruises but have gradually enlarged. She also reports fatigue, low-grade fever, and joint pain over the past few days.
She denies recent travel, insect bites, or new medications but mentions recovering from a sore throat two weeks ago. She has no history of inflammatory bowel disease or sarcoidosis.
On examination, she has multiple, warm, erythematous nodules on the anterior shins, measuring 2-5 cm in diameter. The overlying skin is intact, and there is no ulceration or discharge. Joint examination reveals mild swelling of the knees.
A clinical diagnosis of erythema nodosum (EN), likely triggered by a recent streptococcal infection, is made. The patient is prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, advised to rest and elevate her legs, and referred for a throat culture and ASO titer testing to confirm streptococcal infection.
- What is the most likely diagnosis for this patient’s condition?
a) Cellulitis
b) Erythema nodosum
c) Pyoderma gangrenosum
d) Deep vein thrombosis - Which of the following is the most likely trigger for this patient’s erythema nodosum?
a) Recent streptococcal infection
b) Sun exposure
c) Contact with an allergen
d) Fungal skin infection - What is the typical clinical presentation of erythema nodosum?
a) Painless, ulcerating nodules with necrosis
b) Tender, erythematous nodules on the anterior shins
c) Non-tender plaques with scaling
d) Vesicular rash involving the trunk - What is the best initial management for erythema nodosum?
a) High-dose systemic corticosteroids in all cases
b) NSAIDs, rest, and identifying the underlying cause
c) Immediate antibiotic therapy
d) Surgical excision of nodules
