: Clinical Image
Accepted Article
Article type
Clinical Image
Unilateral plantar erythema nodosum in sarcoidosis
Axel J Hueber, MD PhD; Georg Schett, MD; and Bernhard Manger, MD Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany Corresponding author: Axel Hueber, MD PhD; [email protected]; 0049-9131-8543036
A 32-year old male Caucasian patient presented with mild exertional dyspnea, pain and swelling of both ankles, and general malaise. On examination symmetrical arthritis of both ankles and a vivid nodular erythema with slight pain on pressure was detected on the sole of the right foot (A). A therapy with ibuprofen had not led to any improvement of symptoms. Erythrocyte sedimentation rate (73 mm/h) and C-reactive protein (30 mg/l) were elevated but all other parameters including angiotensin converting enzyme and soluble IL-2 receptor were within normal range. A CT scan of the chest demonstrated enlarged mediastinal lymph nodes (C) compatible with a diagnosis of Löfgren´s syndrome. With this working hypothesis a glucocorticosteroid therapy with starting dose of 40 mg was initiated, which resolved symptoms of arthritis, dyspnea, malaise, and inflammation markers in two weeks; the erythema nodosum improved and resolved after 2 months (B). A literature search revealed that unilateral plantar erythema nodosum is rare but can ocasionally be seen in children with an association to infections (dermatophytes, streptococci, Yersinia enterocolitica, or Mycoplasma). In adults only three cases have so far been reported. In one case plantar erythema nodosum is associated with Crohn’s disease (1), in another with granulomatous mastitis (2), and in one idiopathic (3). Here, we report the first case of sarcoidosis with unilateral plantar erythema nodosum. 1 Châtillon F, Chizzolini C, Kaya G, Borradori L, Hauser C. Plantar erythema nodosum in a patient with Crohn's disease. Dermatology. 1999;199(2):190. 2 Polat M, Kaya H. Plantar erythema nodosum associated with granulomatous mastitis. Indian J Dermatol Venereol Leprol. 2016 Mar-Apr;82(2):202-4. 3 Ohtake N, Kawamura T, Akiyama C, Furue M, Tamaki K. Unilateral plantar erythema nodosum. J Am Acad Dermatol. 1994 Apr;30(4):654-5.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/art.40341 This article is protected by copyright. All rights reserved.
Accepted Article This article is protected by copyright. All rights reserved.
Accepted Article
Article type
Clinical Image
Unilateral plantar erythema nodosum in sarcoidosis
Axel J Hueber, MD PhD; Georg Schett, MD; and Bernhard Manger, MD Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany Corresponding author: Axel Hueber, MD PhD; [email protected]; 0049-9131-8543036
A 32-year old male Caucasian patient presented with mild exertional dyspnea, pain and swelling of both ankles, and general malaise. On examination symmetrical arthritis of both ankles and a vivid nodular erythema with slight pain on pressure was detected on the sole of the right foot (A). A therapy with ibuprofen had not led to any improvement of symptoms. Erythrocyte sedimentation rate (73 mm/h) and C-reactive protein (30 mg/l) were elevated but all other parameters including angiotensin converting enzyme and soluble IL-2 receptor were within normal range. A CT scan of the chest demonstrated enlarged mediastinal lymph nodes (C) compatible with a diagnosis of Löfgren´s syndrome. With this working hypothesis a glucocorticosteroid therapy with starting dose of 40 mg was initiated, which resolved symptoms of arthritis, dyspnea, malaise, and inflammation markers in two weeks; the erythema nodosum improved and resolved after 2 months (B). A literature search revealed that unilateral plantar erythema nodosum is rare but can ocasionally be seen in children with an association to infections (dermatophytes, streptococci, Yersinia enterocolitica, or Mycoplasma). In adults only three cases have so far been reported. In one case plantar erythema nodosum is associated with Crohn’s disease (1), in another with granulomatous mastitis (2), and in one idiopathic (3). Here, we report the first case of sarcoidosis with unilateral plantar erythema nodosum. 1 Châtillon F, Chizzolini C, Kaya G, Borradori L, Hauser C. Plantar erythema nodosum in a patient with Crohn's disease. Dermatology. 1999;199(2):190. 2 Polat M, Kaya H. Plantar erythema nodosum associated with granulomatous mastitis. Indian J Dermatol Venereol Leprol. 2016 Mar-Apr;82(2):202-4. 3 Ohtake N, Kawamura T, Akiyama C, Furue M, Tamaki K. Unilateral plantar erythema nodosum. J Am Acad Dermatol. 1994 Apr;30(4):654-5.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/art.40341 This article is protected by copyright. All rights reserved.
Accepted Article This article is protected by copyright. All rights reserved.
