Erythema nodosum

Objective. To study the etiology, demographic, clinical and laboratory features, and course of erythema nodosum (EN) among patients in the Rheumatology Service.
Materials and methods. A monocenter retrospective study including 85 patients hospitalized at the 11th City Clinical Hospital in Minsk from 01.09.2013 to 29.02.2024 was conducted. All patients were diagnosed with EN, based on the diagnostic criteria.
Results. The average age of the patients was 39 (29—54) years, the dominant majority were women — 70 (82.4 %). Infection was the leading cause of EN in 42 (49.4 %) of cases. The second most frequent was pulmonary-mediastinal form of sarcoidosis — 21 (24.7 %) of cases. EN was a manifestation of autoimmune and immunoinflammatory rheumatic diseases (IIRD) in 4 patients: autoimmune thyroiditis — 2 cases, Crohn’s disease — 1, nonspecific aortoarteritis — 1. There were 2 cases of pregnancy in the first and second trimester. A significant proportion was EN with unknown etiology — 16 (18.8 %). Acute course was observed in 72 (84.7 %) of patients, recurrent — in 13 (15.3 %). Symmetrical lesions were observed in 58 (68.2 %) of cases, and asymmetric lesions — in 27 (31.8 %). In the majority of patients localization of EN was limited to the shins, and in 35 (41.2 %) it spread to the thighs, feet, hands and even trunk. Some patients had concomitant joint involvement — 55 (64.7 %), more often ankles — 43 (50.6 %). Among the laboratory parameters, a significant number of patients had an increased both the erythrocyte sedimentation rate — 64 (79.0 %), and hs-CRP — 61 (80.3 %). Chest X-ray revealed intrathoracic lymphadenopathy in 14 cases, while chest CT — in 22 cases.
Conclusion. Among patients with erythema nodosum (EN) in the Rheumatology Service, women predominated — 82.4 %, the average age was 39 years. EN was associated with infection in 49.4 % of cases, with pulmonary-mediastinal form of sarcoidosis — in 24.7 %, other autoimmune diseases, IIRD and pregnancy were rare. A significant proportion was EN with unknown etiology — 18.8 %; in case of its relapse, further search for the cause of EN should be continued. In the algorithms of examination of patients with EN among women of childbearing age, the first priority is to exclude pregnancy.

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