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This article reports a case of erythema nodosum (EN) after receiving the COVID-19 vaccine, potentially associated with the reactivation of the varicella-zoster virus (VZV). The patient, a 39-year-old woman, developed painful rashes on her lower legs and knee joint pain four days after receiving the mRNA-1273 COVID-19 vaccine. Histopathological findings showed septal panniculitis with multinucleated giant cells, consistent with EN. EN has been observed in other cases following COVID-19 vaccination, with a mean onset of 7.5 days after vaccination. Reactivation of herpesviruses, including VZV, has been reported after COVID-19 vaccination, suggesting a potential association between cutaneous manifestations and herpesvirus reactivation. Further research is needed to understand the underlying mechanisms. [Extracted from the article]

A 29-year-old, otherwise healthy Indian male, presented to us with a 2-year history of repeated episodes of painful erythematous nodules associated with high-grade fever. Equal rates of drug resistance in leprosy cases with relapse and recurrent/chronic Type 2 reaction: time to revise the guidelines for drug-resistance testing in leprosy?. [Extracted from the article]

This article discusses a case of a 34-year-old woman with lepromatous leprosy and uncontrolled type 2 diabetes who developed rhino-orbito-cerebral mucormycosis, a fungal infection. The patient had been treated with steroids for necrotic erythema nodosum leprosum, a complication of leprosy, and subsequently developed mucormycosis. The article highlights the increased susceptibility to mucormycosis in patients with chronic leprosy reactions and diabetes who undergo prolonged corticosteroid therapy. It also emphasizes the need for novel immunomodulatory agents to manage these cases and mitigate the risk of complications. [Extracted from the article]

Background: Corticosteroids remain the main therapy in erythema nodosum leprosum (ENL), and long‐term usage in chronic or recurrent ENL is a cause of significant morbidity and mortality. Thalidomide exerts dramatic effect in controlling ENL and helps reduce the dose of steroids, but the cost is a hindrance to its usage. Methods: Patients of ENL (steroid naïve and steroid‐dependent) were recruited over a 1‐year period. An escalating dose of low‐dose thalidomide with a reducing dose of prednisolone was titrated depending on the control of disease activity. The primary aim was to reduce the dose of steroids to the lowest effective dose, and the secondary aim was to stop. Results: Sixteen patients of ENL were studied (mean duration of ENL 22.1 months, 15 severe ENL), and a majority (11/16, 68%) were on steroids with a mean duration of 11.27 months. All patients had steroid‐related side effects (cushingoid habitus 81.8%, weight gain 54.5%, diabetes mellitus 9%, hyperlipidemia 18.18%, cataract 18.1%, osteoporosis 36.3%, striae 36.3%, acneiform eruptions 18.1%, and myopathy 9%). Steroids could be tapered in a majority of patients (n = 9) within 3 months (mean 2.44 months) with a low dose of thalidomide (25–150 mg/day, mean 78.3 mg) achieving a significant reduction in prednisolone dose (33.16 mg at baseline; 4.28 mg at 3 months, P < 0.05). Steroids could be stopped in 92% of patients by 3.03 months, and both drugs could be stopped in 80% of cases by 5.83 months. Conclusion: The rapid and effective control of ENL with low‐dose thalidomide in our series is comparable to the historical efficacy of high‐dose thalidomide regimens, making it an affordable therapy in resource‐constrained settings and an excellent steroid‐sparing agent. The rapid onset of disease control is likely attributable to its action via neutrophils. [ABSTRACT FROM AUTHOR]

A full-body CT scan revealed multiple pulmonary nodules and paravertebral involvement, leading to the diagnosis of systemic I S. apiospermum i infection. Infective panniculitis represents a small percentage of the broad spectrum of panniculitis, and the subgroup of fungal panniculitis is even more rare.[1] Fungal panniculitis may be divided into two groups depending on the origin of fungal invasion: (1) subcutaneous mycoses where the infective agent is introduced into the panniculus by direct inoculation from the skin and (2) disseminate fungal infection where the invasion of the panniculus by the fungus originates from vascular or lymphatic vessels. [Extracted from the article]

Clinically and histopathologically, the lesions raised differential diagnoses between erythema nodosum (EN), Behçet disease (BD)-associated erythema nodosum-like lesions, and polyarteritis nodosa (PAN). Dear Editor, Nodular cutaneous lesions are relatively frequently encountered in the context of Behçet disease and may present a diagnostic challenge. The utility of orcein and elastic Verhoeff-Van Gieson stain to demonstrate phlebitis in nodular cutaneous lesions of Behçet disease. [Extracted from the article]

Background: Panniculitides are a heterogeneous group of inflammatory dermatoses involving the subcutaneous fatty tissue. Histologically, they are classified into septal and lobular panniculitis, according to the predominant localization of the inflammatory infiltrate. Neutrophils are frequently found in panniculitis, mainly at the early stages. Here, we investigated whether neutrophils contribute to various types of cutaneous panniculitis by releasing neutrophil extracellular traps (NETs). Materials and Methods: Formalin‐fixed paraffin‐embedded skin biopsies from 25 patients with panniculitis were included in the study. Our cohort was divided into n = 10 erythema nodosum (septal panniculitis) and n = 15 lobular panniculitis, including n = 7 lupus panniculitis, n = 1 pancreatic panniculitis, n = 1 Weber‐Christian disease, n = 1 deep fungal infection, n = 2 lipodermatosclerosis, and three cases did not have an identified etiology. The presence of neutrophils and NETs was assessed by double immunofluorescence using antibodies against elastase, a neutrophilic marker, and citrullinated histone 3, a marker of NETs. Results: The mean percentages (±SEM) of elastase‐positive neutrophils showing NETs were 44% ± 3% in erythema nodosum and 43% ± 7% in lobular panniculitis. The difference was not statistically significant and reflects the implication of NETs not only in severe scarring lobular panniculitis but also in benign non‐scarring self‐remitting reactive inflammation such as erythema nodosum. In tissues, NETs were located in the interlobular septa in erythema nodosum and in the inflamed fat lobules in lobular panniculitis. Conclusions: NETs are massively present in septal and lobular subtypes of panniculitides, suggesting their involvement in tissue damage. [ABSTRACT FROM AUTHOR]

Late leprosy reaction presenting as erythema multiforme-like erythema nodosum leprosum with underlying rifampicin resistance and its potential implications. Drug resistance to rifampicin in a case of steroid-dependent erythema nodosum leprosum and the therapeutic implications of resistance and reactions in leprosy Dear Editor, A 30-year-old male, who was a treated case of lepromatous leprosy (LL), presented with recurrent severe episodes of erythema nodosum leprosum (ENL) for 5 months, 15 months after completing a 2-year course of multibacillary multidrug therapy (MBMDT). [Extracted from the article]

Background: Leprosy can cause acute reactions, which may be type 1 (reverse reaction) or type 2 (erythema nodosum leprosum – ENL). ENL has been classified as mild, moderate, or severe. In order to standardize the classification, the Erythema Nodosum Leprosum International Study (ENLIST) Group has developed an objective scale, the ENLIST ENL Severity Scale (EESS), which was the first validated severity scale of ENL in the world. The goal of the study was to describe the sociodemographic and clinical characteristics of patients with ENL attending a tertiary hospital in Piauí, Brazil, classifying them according to the EESS. Methods: A descriptive cross‐sectional observational study was conducted on 26 patients recruited sequentially from May 2017 to February 2018. Their data were statistically analyzed and compared against each other through a structured questionnaire. Results: According to the score obtained in the scale, the patients were divided into two groups: mild ENL and moderate/severe ENL. The extent and number of nodules were related to the severity of the cases, and these data were statistically significant. The majority of the patients were male, between the ages of 31 and 49 years old, with low educational level, and residents in the urban area. Conclusions: This was the first study to use EESS in Brazil. This scale is easy to apply and allows for the enhancement of treatment protocols. The study also showed a correlation between the number and extension of nodules and the severity of the condition. [ABSTRACT FROM AUTHOR]

Erythema nodosum leprosum (ENL) is a severe inflammatory complication of multibacillary leprosy with cutaneous and systemic involvement, usually occurring in a recurrent or chronic manner. Treatment of ENL is difficult and requires the use of systemic immunosuppressant with significant side effects, such as corticosteroids and thalidomide. [Extracted from the article]

Dear Editor, We describe a rare case of erythema nodosum (EN) in a patient with diagnosis of gonorrhea. Gonorrhea is the second most common sexually transmitted disease (STD), only after chlamydia in bacterial STD prevalence with the highest incidence in patients ranging in age from 15 to 24.1 I Neisseria gonorrhoeae i is a gram-negative intracellular aerobic diplococcus that mainly colonizes genitourinary, rectal, and pharyngeal mucosa. Sonck concluded that EN probably occurs when gonorrhea is accompanied by some other infection.4 In our case, the patient tested positive only for I N. gonorrhoeae i , thus representing a particular coexistence of EN and this disease. [Extracted from the article]

Skin biopsies were taken from a noduloplaque lesion on the face and edge of ulcer on the thigh. The biopsy from the edge of the ulcer in addition demonstrated epidermal ulceration and apoptotic keratinocytes. GLO:DIF/01feb20:ijd14643-fig-0001.jpg PHOTO (COLOR): Lesions at presentation: Multiple, coalescing, sharply angulated ulcers with jagged margins and necrotic center overlying erythematous noduloplaques on the extremities (a, b) and trunk (c). [Extracted from the article]

A letter to the editor is presented on facial annular bullous erythema nodosum leprosum reaction in a 17-year-old male.

Background The pathogenesis of erythema nodosum ( EN) is still poorly understood, and studies evaluating the involvement of a cytokine network are very scarce. Objectives To investigate clinical and pathological features, the cytokine profiles, and the balance of T-regulatory (Treg) and T-helper (Th)17 cells in serum and lesional skin of patients with EN. Methods Patients with a diagnosis of EN were consecutively enrolled, and their clinical and histopathological features were recorded. A panel of cytokines was evaluated in both serum and lesional skin using enzyme-linked immunosorbent assay. Real-time polymerase chain reaction was performed to evaluate the Treg/Th17 cell balance. Results Histopathological examination of skin biopsy specimens from all patients (four women and one man) showed classical features of EN. The most widely expressed cytokines were innate immunity cytokines (mainly tumor necrosis factor alpha, interleukin-8 and -6) and growth factors (mainly granulocyte colony-stimulating factor and monocyte chemoattractant protein-1). The Treg/Th17 balance was highly different between patients. Conclusions The present study emphasizes the crucial role of neutrophils in the pathogenesis of EN, as high levels of cytokines and growth factors mainly involved in neutrophil recruitment and activation were detected. [ABSTRACT FROM AUTHOR]

Background Erythema nodosum leprosum ( ENL) classically presents as tender evanescent skin nodules involving extremities, trunk, and face but may appear at any site. Mucosal involvement in ENL is uncommon, and its occurrence over glans is extremely rare. Method We describe two interesting cases of ENL involving the glans penis and prepuce with different presentations. Result The first case had lepromatous leprosy with ENL with involvement of the glans penis in the form of a painful ulcer with necrotic slough. The second case had borderline lepromatous leprosy with ENL with involvement of glans in the form of a single painful nodule. Histopathology showed features of ENL, and Ziehl-Neelsen staining showed numerous acid fast bacilli. Conclusion We should be aware of genital involvement of ENL, which is a rare presentation and needs to be differentiated from other conditions requiring a different management approach. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 53-year-old man who has a ten-year history of non-tender subcutaneous erythematous nodules and cords without ulceration on lower extremity. The man was diagnosed with superficial migratory thrombophlebitis with acute deep vein thrombosis which was misdiagnosed for erythema nodosum (EN). The treatment plan aims to relieve symptomatic pain and prevent the thrombus from entering the deep venous system.

The article presents a case study of a 45-year-old farmer presented with painful nodules on the face and back. Topics discussed include lepromatous leprosy (LL) and completed World Health Organization multibacillary, multidrug therapy usage in the treatment; complications of lepromatous leprosy with type 2 reaction, lymphadenitis, iridocyclitis, glomerulonephritis, synovitis; and information on forming of annular plaque.