Evaluation of Pediatric Patients Diagnosed with Erythema Nodosum: A Six-year experience

Aim: To determine clinical symptoms, laboratory features, etiological causes and treatment of Erythema Nodosum (EN), to investigate predictive factors for the diagnosis of the idiopathic or secondary EN. Patients and Methods: Thirty - six pediatric patients, presented with painful erythematous nodosity on the shins, and diagnosed with EN between 2006 – 2012 in our hospital, were retrospectively investigated. Age, sex, presenting symptoms and history were noted. Complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein, ASO, ANA, stool microscopy, stool culture, throat culture, urinalysis were requested. PPD, Hepatitis serology, CMV serology, EBV serology, Parvovirus B19 IgM, Mycoplasma IgM, Brucella and Salmonella agglutination tests were also investigated. Eye examination was performed in patients thought to be Sarcoidosis, Beh？et’s Syndrome, Connective tissue disease. Results: 16 patients were female and 20 were male. 47 % percent of the patients were diagnosed as idiopathic. Post-streptococcal EN took first place in patients considered to be secondary. The diagnosis of Salmonella enteritis, Brucellosis, Hodgkin's disease, Familial Mediterranean fever, Connective tissue disease, Drug use, Granulomatous lymphadenitis were following etiologies, respectively. ESR and ASO levels were compared in patients with primary and secondary EN. Both parameters were higher in secondary cases and the difference was statistically significant. Conclusion: As a result, the course in the majority of EN cases, indicate a good prognosis. However, rarely, serious underlying diseases may be noted. Recurrent nodosity, the presence of lymphadenopathy, hepatosplenomegaly, the presence of systemic symptoms should be a warning, especially for the presence of malignancy