Erythema nodosum in children: a cohort study from a tertiary pediatric hospital in Italy.
Children
Erythema nodosum
Infectious diseases
Work-up
Journal
European journal of pediatrics
ISSN: 1432-1076
Titre abrégé: Eur J Pediatr
Pays: Germany
ID NLM: 7603873
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
11
08
2022
accepted:
08
02
2023
revised:
06
02
2023
medline:
10
5
2023
pubmed:
16
2
2023
entrez:
15
2
2023
Statut:
ppublish
Résumé
Erythema nodosum (EN), although relatively uncommon in the pediatric population, is the most frequent type of panniculitis in children. The present study aimed to report all the cases of children admitted to our tertiary pediatric hospital with the diagnosis of EN to evaluate the epidemiology, clinical manifestations, etiology, treatment, and the course of this disease in the pediatric age. This observational study retrospectively considered all children evaluated to the emergency room (ER) of Meyer Children's University Hospital, Florence, Italy, discharged with a diagnosis of EN over a 12-year period (from January 2009 to December 2021). Clinical and laboratory data were recorded using a standardized report form. Sixty-eight patients with EN were included. The etiologic diagnosis of EN was made in 38 children (55.9%): 29 (42.6%) had infection-related EN (in particular EBV and β-hemolytic streptococcus), 6 (8.8%) had Crohn's disease, 1 celiac disease, 1 Sjogren syndrome, and 1 Hodgkin lymphoma. In 30 patients (45%), no definitive diagnosis was reached, and they were defined as having idiopathic EN. Most of the laboratory tests were nonspecific. No statistical differences were found in the demographic and clinical data, and the main diagnostic laboratory parameters between patients with idiopathic EN versus those with secondary EN. Conclusion: Since EN can be isolated or the first manifestation of heterogeneous underlying pathologies, some of which can be severe and life-threatening, it is important to recognize it and carry out all the necessary etiological diagnostic investigations to understand its etiology and start the specific treatment. What is Known: • Erythema nodosum (EN) is the most frequent type of panniculitis in children. • It has been associated with a wide spectrum of disorders, such as different types of infection, malignancies, chronic inflammations, and drugs. What is New: • No statistical differences can be found in clinical features as well as laboratory data, between patients with idiopathic EN versus those with secondary EN. • A broad spectrum of investigations and a proper follow-up should be taken into account in order to prevent a delayed or missed secondary EN diagnosis.
Identifiants
pubmed: 36790486
doi: 10.1007/s00431-023-04872-x
pii: 10.1007/s00431-023-04872-x
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1803-1810Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Garty BZ, Poznanski O (2014) Erythema nodosum in Israeli children. Isr Med Assoc J 2:145–146
Blake T, Manahan M, Rodins K (2014) Erythema nodosum – a review of an uncommon panniculitis. Dermatol Online J 20:22376
doi: 10.5070/D3204022376
pubmed: 24746312
Calista D, Schianchi S, Morri M (2001) Erythema nodosum induced by kerion celsi of the scalp. Pediatr Dermatol 18:114–116. https://doi.org/10.1046/j.1525-1470.2001.018002114.x
doi: 10.1046/j.1525-1470.2001.018002114.x
pubmed: 11358549
Hassink RI, Pasquinelli-Egli CE, Jacomella V, Laux-End R, Bianchetti MG (1997) Conditions currently associated with erythema nodosum in Swiss children. Eur J Pediatr 156:851–853. https://doi.org/10.1007/s004310050728
doi: 10.1007/s004310050728
pubmed: 9392398
Trapani S, Rubino C, Lodi L, Resti M, Indolfi G (2022) Erythema nodosum in children: a narrative review and a practical approach. Children 9:511. https://doi.org/10.3390/children9040511
doi: 10.3390/children9040511
pubmed: 35455555
Porges T, Shafat T, Sagy I et al (2018) Clinical, epidemiological, and etiological changes in erythema nodosum. Isr Med Assoc J 20:770–772
pubmed: 30550008
Mana J, Marcoval J (2007) Erythema nodosum. Clin Dermat 25:288–294. https://doi.org/10.1016/j.clindermatol.2007.03.006
doi: 10.1016/j.clindermatol.2007.03.006
Arnold J, Leung AKC, Lam JM (2020) Violaceous tender nodules symmetrically distributed over the pretibial area. Paediatr Child Health 25:201–202. https://doi.org/10.1093/pch/pxz030
doi: 10.1093/pch/pxz030
pubmed: 32549732
Litwin L, Machura E (2014) The etiology and clinical manifestation of erythema nodosum in hospitalized children – analysis of 12 cases. Preliminary report Dev Period Med 18:506–512
pubmed: 25874791
Polcari IC, Stein SL (2010) Panniculitis in childhood. Dermatol Ther 23:356–367. https://doi.org/10.1111/j.1529-8019.2010.01336.x
doi: 10.1111/j.1529-8019.2010.01336.x
pubmed: 20666823
Labbe L, Perel Y, Maleville J, Taieb A (1996) Erythema nodosum in children: a study of 27 patients. Pediatr Dermatol 13:447–450. https://doi.org/10.1111/j.1525-1470.1996.tb00722.x
doi: 10.1111/j.1525-1470.1996.tb00722.x
pubmed: 8987051
Picco P, Gattorno M, Vignola S et al (1999) Clinical and biological characteristics of immunopathological disease-related erythema nodosum in children. Scand J Rheumatol 28:27–32
pubmed: 10092161
Bartyik K, Varkonyi A, Kirschner A, Endreffy E, Turi S, King E (2004) Erythema nodosum in association with celiac disease. Pediatr Dermatol 21:227–230. https://doi.org/10.1111/j.0736-8046.2004.21307.x
doi: 10.1111/j.0736-8046.2004.21307.x
pubmed: 15165200
Leung AKC, Leong KF, Lam JM (2018) Erythema nodosum. World J Pediatr 14:548–554. https://doi.org/10.1007/s12519-018-0191-1
doi: 10.1007/s12519-018-0191-1
pubmed: 30269303
Kakourou T, Drosatou P, Psychou F, Aroni K, Nicolaidou P (2001) Erythema nodosum in children: a prospective study. J Am Acad Dermatol 44:17–21. https://doi.org/10.1067/mjd.2001.110877
doi: 10.1067/mjd.2001.110877
pubmed: 11148471
Wallis P, Starr M, Phillips RJ (2016) An uncommon cause of erythema nodosum. J Paediatr Child Health 52:961–963. https://doi.org/10.1111/jpc.13267
doi: 10.1111/jpc.13267
pubmed: 27500685
Schwartz RA, Nervi SJ (2007) Erythema nodosum: a sign of systemic disease. Am Fam Physician 75:695–700
pubmed: 17375516
Aydin-Teke T, Tanir G, Bayhan GI, Metin O, Oz N (2014) Erythema nodosum in children: evaluation of 39 patients. Turk J Pediatr 56:144–149
pubmed: 24911847
Mert A, Kumbasar H, Ozaras R et al (2007) Erythema nodosum: an evaluation of 100 cases. Clin Exp Rheumatol 25:563–570
pubmed: 17888212
Lins K, Drummond M, Velho PE (2019) Cutaneous manifestations of bartonellosis. An Bras Dermatol 94:594–602. https://doi.org/10.1016/j.abd.2019.09.024
doi: 10.1016/j.abd.2019.09.024
pubmed: 31780437
pmcid: 6857551
Carithers HA (1985) Cat-scratch disease. an overview based on a study of 1,200 patients. Am J Dis Child 139:1124–1133. https://doi.org/10.1001/archpedi.1985.02140130062031
doi: 10.1001/archpedi.1985.02140130062031
pubmed: 4061408
Laborada J, Cohen PR (2021) Tuberculosis-associated erythema nodosum. Cureus 13:e20184. https://doi.org/10.7759/cureus.20184
Mantadakis E, Arvanitidou V, Tsalkidis A, Thomaidis S, Chatzimichael A (2010) Erythema nodosum associated with Salmonella enteritidis. Hippokratia 14:51–53
pubmed: 20411062
pmcid: 2843573
Su CG, Judge TA, Lichtenstein GR (2002) Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Clin North Am 31:307–327. https://doi.org/10.1016/s0889-8553(01)00019-x
doi: 10.1016/s0889-8553(01)00019-x
pubmed: 12122740
He S, Zhen X, Hu Y (2021) Juvenile primary Sjogren’s syndrome with cutaneous involvement. Clin Rheumatol 40:3687–3694. https://doi.org/10.1007/s10067-021-05656-0
doi: 10.1007/s10067-021-05656-0
pubmed: 33712889
Bonci A, Di Lernia V, Merli F, Lo Scocco G (2001) Erythema nodosum and Hodgkin’s disease. Clin Exp Dermatol 26:408–411. https://doi.org/10.1046/j.1365-2230.2001.00847.x
doi: 10.1046/j.1365-2230.2001.00847.x
pubmed: 11488828
La Spina M, Russo G (2007) Presentation of childhood acute myeloid leukemia with erythema nodosum. J Clin Oncol 25:4011–4012. https://doi.org/10.1200/JCO.2007.12.0022
doi: 10.1200/JCO.2007.12.0022
pubmed: 17761986
Lin JT, Chen PM, Huang DF, Kwang WK, Lo K, Wang WS (2004) Erythema nodosum associated with carcinoid tumour. Clin Exp Dermatol 29:426–427. https://doi.org/10.1111/j.1365-2230.2004.01544.x
doi: 10.1111/j.1365-2230.2004.01544.x
pubmed: 15245549
Perez NB, Bernad B, Narváez J, Valverde J (2006) Erythema nodosum and lung cancer. Joint Bone Spine 73:336–337. https://doi.org/10.1016/j.jbspin.2005.10.009
doi: 10.1016/j.jbspin.2005.10.009
pubmed: 16495102
Alvarez-Lario B, Piney E, Rodriguez-Valverde V, Pena-Sagredo JL, Peiro-Callizo E (1987) Erythema nodosum: study of 103 cases. Med Clin (Barc) 88:5–8
pubmed: 3821255