Hanson Mitchell, Maloney McKenzie E, Kuchnir Louis
Medical College of Georgia, Augusta University, Augusta, GA.
Kuchnir Dermatology and Dermatologic Surgery, Marlborough, MA.
Dermatol Reports. 2024 Nov 21;16(4). doi: 10.4081/dr.2024.9866. Epub 2024 Feb 8.
Erythema nodosum (EN) is inflammation of subcutaneous fat. Etiologies include autoimmune diseases, drugs, infections, pregnancy, malignancy, and idiopathic origins. A 37-year-old female with a history of recurrent cellulitis and type II diabetes presented with worsening swollen lumps on upper extremities for four months during a Hurley Stage III hidradenitis suppurativa (HS) flare. Exam revealed multiple erythematous pustules and warm indurated nodules over diffuse edema on the upper extremities. Lesions were refractory to trimethoprim/sulfamethoxazole, cefalexin, clindamycin, and levofloxacin. Routine blood labs, ESR, and ANA were unremarkable. EN was diagnosed. Trimethoprim/sulfamethoxazole, saturated solution potassium iodide (SSKI), and ibuprofen were prescribed. At the three-week follow-up, EN completely resolved the issue except for one lesion. Literature review revealed one case of EN manifestation in association with HS but was complicated by Beçhet's syndrome. We propose HS as an underlying cause of EN and SSKI an effective treatment for EN and HS.
结节性红斑（EN）是皮下脂肪的炎症。病因包括自身免疫性疾病、药物、感染、妊娠、恶性肿瘤以及特发性病因。一名37岁女性，有复发性蜂窝织炎和II型糖尿病病史，在化脓性汗腺炎（HS）Hurley III期发作期间，上肢出现逐渐加重的肿块四个月。检查发现上肢弥漫性水肿上有多个红斑脓疱和温热硬结结节。病变对甲氧苄啶/磺胺甲恶唑、头孢氨苄、克林霉素和左氧氟沙星治疗无效。常规血液检查、血沉和抗核抗体均无异常。诊断为结节性红斑。处方了甲氧苄啶/磺胺甲恶唑、碘化钾饱和溶液（SSKI）和布洛芬。在三周的随访中，除一个病变外，结节性红斑完全解决了问题。文献回顾显示有一例结节性红斑与化脓性汗腺炎相关的表现，但并发白塞病。我们提出化脓性汗腺炎是结节性红斑的潜在病因，碘化钾饱和溶液是治疗结节性红斑和化脓性汗腺炎的有效药物。
