Eritema nodoso: Causas más prevalentes en pacientes que se hospitalizan para estudio, y recomendaciones para el diagnóstico

Febrero 2016

Art ículos de Investigaci ón 162 Rev Med Chile 2016; 144: 162-168 Eritema nodoso: Causas más prevalentes en pacientes que se hospitalizan para estudio, y recomendaciones para el diagnóstico Pablo Varas1, Andrea Antúnez-Laya, José Miguel Bernucci1, Laura Cossio2, Sergio González3, Gonzalo Eymin1 Erythema nodosum. Analysis of 91 hospitalized patients Background: Erythema Nodosum (EN) is an acute nodular erythematous cutaneous eruption. It is presumed to be a hypersensitivity reaction and it may be idiopathic, or occur in association with diverse diseases and medications. Aim: To identify the main etiologies of EN among patients admitted to a medicine service of a clinical hospital. Material and Methods: Analysis of medical records of patients discharged with the diagnosis of EN during a ten years period. Patients were considered to have secondary EN when an underlying condition was found, and to have idiopathic EN when no such condition was found. Results: One hundred twenty nine patients were identified, but 91, aged 38 ± 14 years (86% females) had available clinical information. The etiology was idiopathic in 32% and secondary in 68% of patients. The leading etiologies were post-Streptococcal in 32%, followed by sarcoidosis in 11%, primary tuberculosis in 7%, Mycoplasma infection in 3%, Bartonella infection in 3%, Behçet’s syndrome in 2%, inflammatory bowel disease in 2%, drugs in 1% and other etiologies in 8%. Secondary cases of EN had higher levels of C Reactive Protein and leucocytes than idiopathic cases. Conclusions: The distribution of causes in our study population were similar to those reported in the literature (With smaller proportion of idiopathic), as was the man/woman (1/6) ratio, and the preponderance of cases in winter and spring. Infectious diseases were the leading causes of EN in this group of patients, and a reasonable initial approach in the hospital should include a diligent medical history and physical examination, complete blood count, ESR, titles ASO, PPD tuberculin skin test, chest X-ray or CT scan and, where deemed appropriate, specific autoimmune and infectious serology. (Rev Med Chile 2016; 144: 162-168) Key words: Erythema nodosum; Inflammatory bowel diseases; Sarcoidosis; Streptococcal Infections; Tuberculosis. 1Departamento de Medicina. Escuela de Medicina de la Facultad de Medicina de la Pontificia Universidad Católica de Chile. 2Departamento de Dermatología. Escuela de Medicina, Facultad de Medicina de la Pontificia Universidad Católica de Chile. 3Departamento de Anatomía Patológica. Escuela de Medicina de la Facultad de Medicina de la Pontificia Universidad Católica de Chile. aInterna de Medicina. Escuela de Medicina, Facultad de Medicina de la Pontificia Universidad Católica de Chile. Recibido el 4 de mayo de 2015, aceptado el 11 de noviembre de 2015. Correspondencia a: Dr. Gonzalo Eymin Lago Hospital Clínico Red de Salud UC-Christus Marcoleta 367, 5º piso, Santiago, Chile. Teléfono: +562 23543152 El eritema nodoso (EN) es el tipo de paniculitis más frecuente. Se presenta como nódulos eritematosos violáceos de 1 a 5 cm, profundos, dolorosos, preferentemente en la cara anterior de las piernas, que evolucionan con apariencia de equimosis (coloración inicialmente violácea, luego amarillo-verdosa) sin dejar cicatriz, desapareciendo en un período de 2 a 8 semanas. Las lesiones también pueden aparecer en muslos, tronco y extremidades superiores, pero su ausencia en piernas es poco habitual (Figura 1). Además de dolor local es frecuente la asociación de fiebre,


Febrero 2016
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