Boyd Alan S
Department of Medicine (Dermatology) and Pathology, Vanderbilt University, Nashville, TN, USA.
Skinmed. 2007 Jul-Aug;6(4):197-9. doi: 10.1111/j.1540-9740.2007.05882.x.
A 22-year-old otherwise healthy woman presented to the Vanderbilt University Dermatology Clinics with a 5-year history of painful, red plaques and nodules on her shins and tops of her feet. She had initially been seen by a rheumatologist, who diagnosed her with erythema nodosum (EN) and prescribed oral prednisone. After 1 month of therapy, the condition had not improved and she discontinued the treatment. She had undertaken no additional therapy in the interim. At the onset of her condition, she was taking no medications, using only etonogestrel/ethinyl estradiol vaginal ring for contraception. Her condition did not change after beginning this hormonal contraception. Her lesions were constant, with variable waxing and waning and without any discernible precipitants. They were tender to palpation but were otherwise without symptoms. She denied any history of fever, joint pain, fatigue, cough, gastrointestinal symptoms, malaise, mucosal ulcerations, foreign travel, infectious exposures, or illicit drug use. Clinically, her anterior legs displayed moderately well demarcated patches and nodules with dusky erythema. The lesions were tender to palpation but were not present on the feet or above the knees. Darkened, bruise-like areas were also appreciated and corresponded to older, quiescent lesions. Results from a chest x-ray, complete blood cell count, and metabolic panel were normal. She declined a biopsy. She was treated with supersaturated solution of potassium iodide, indomethacin, methotrexate, and dapsone, all without benefit. She was then begun on etanercept 25 mg administered subcutaneously twice weekly. After 1 month she noticed the lesions beginning to fade with a concomitant decrease in their discomfort, and by 4 months she was clear of her disease. Results of all monitoring blood work were normal. At 6 months, her disease had resolved and her etanercept dose was reduced by half without any flare of her condition. She has continued 25 mg weekly for 12 months without developing any new lesions.
一名22岁的健康女性前往范德比尔特大学皮肤科诊所就诊，她的小腿和脚背出现疼痛性红色斑块和结节已有5年病史。她最初看过风湿病专家，被诊断为结节性红斑（EN），并开具了口服泼尼松。治疗1个月后，病情未见改善，她便停止了治疗。在此期间，她未接受其他治疗。发病时，她未服用任何药物，仅使用依托孕烯/炔雌醇阴道环避孕。开始这种激素避孕后，她的病情没有变化。她的皮损持续存在，有轻重变化，无明显诱因。触诊时疼痛，但无其他症状。她否认有发热、关节疼痛、疲劳、咳嗽、胃肠道症状、不适、黏膜溃疡、出国旅行、感染接触或吸毒史。临床上，她的小腿前部有边界较清晰的斑块和结节，伴有暗红色红斑。触诊时病变疼痛，但足部和膝盖以上未出现。还可见到颜色加深、类似瘀斑的区域，对应较陈旧、静止的病变。胸部X线、全血细胞计数和代谢指标检查结果均正常。她拒绝了活检。她接受了碘化钾饱和溶液、吲哚美辛、甲氨蝶呤和氨苯砜治疗，但均无效果。随后开始皮下注射依那西普，每周两次，每次25毫克。1个月后，她注意到皮损开始消退，不适感也随之减轻，4个月后疾病痊愈。所有监测血液检查结果均正常。6个月时，她的疾病已痊愈，依那西普剂量减半，病情未出现任何复发。她继续每周服用25毫克，持续12个月，未出现任何新的病变。
