Question of the Week # 180

Q180) A 35 year old woman presents with a 3-week history of nodular lesions on her lower legs. She states that he had similar lesions that appeared few years ago and spontaneously resolved . She denies any recent infection except for an upper respiratory infection for which he was treated with antibiotics 2 weeks ago. She is currently not on any medications. He denies any weightloss or diarrhea or constipation. She has no cough or night sweats. Physical examination revealed erythematous nodular swellings on the anterior lower legs. The lesions are tender to palpation.

The most common etiology of these lesions world-wide:

A) Tuberculosis

B) Inflammatory bowel disease

C) Sarcoidosis

D) Diabetes Mellitus

E) Streptococcal infection

F) Herpes Simplex Virus

11 Responses

  1. eeeeeeeee EN

  2. Ans C.
    the most common cause of erythema nodosum is streptococcal infection in children and streptococcal infection and sarcoidosis in adults.

  3. Sarcoid is common with erythema nodosa.It could happen with TB and IBS. It can also happen with strep infection so with the pevious infection,,,,,,,Strep would be the answer

  4. sarcoid

  5. E

  6. TB

  7. This is a 35 year old elderly woman presenting with Erythema Nodosum. The thing to note in this case is this lesion has passed 3 weeks, you can see the bruises. It does not look like the first week of onset which is generally red and painful. The correct answer is “E”, even with the advent of penicillin for strep almost a century ago, the most common cause is still Strep world wide. In the american southwest, the most common cause is Coccidiomycosis.

    Among children in the states, the most common cause is strep. If they want you to pick Sarcoidosis, they have to give you some added clinical history. Exam tip: A vignette will never ask you to choose a different diagnosis if there’s no history of the disease. Here, URI was treated 2 weeks ago, but the EN has occurred 3 weeks ago, there’s a possibility of Sarcoidosis but the boards will give you clues!

    • Good reasoning. The vignette is asking the most common cause of these lesions worldwide not in this patient alone. Once you know that these lesions are Erythema Nodosum , the most common cause worldwide is strep infection irrespective of the patient’s history the vignette described in this case.

  8. Is the pt. female or male?

    • woman

  9. Sarcoidosis

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