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Objective: Patients with sarcoidosis may present with cutaneous lesions or other systemic involvement, particularly pulmonary. In this study, we investigated our hypothesis that the clinical course of sarcoidosis patients who present with skin involvement be different. Methods: Fifty-two sarcoidosis patients who applied to our rheumatology outpatient clinic were included in the study. Data on demographics, smoking status, angiotensin converting enzyme (ACE) level at the time of diagnosis, other organ involvement and lung involvement stages were collected. We then compared the clinical and demographic characteristics of patients with and without skin involvement and patients with skin involvement at first presentation, and others separately. Results: While the initial involvement was lung involvement in 28 (53.5%) patients, 19 (36.5%) patients applied to the clinic with skin involvement as a presenting feature. In 23 (44.2%) patients, skin involvement was present at any time during the disease. In our study, the most common skin involvement was erythema nodosum observed in 9 patients (17.3%). Demographic and clinical findings of patients presenting with skin findings did not differ significantly from other patients. High ACE levels were more common in patients without skin involvement than in patients with skin involvement. Conclusion: Even if the clinical course does not differ in sarcoidosis patients presenting with cutaneous involvement, it is important to recognize the cutaneous manifestations of sarcoidosis. We would like to emphasize that detailed physical examination is important, as easily overlooked, small and asymptomatic lesions are the most appropriate site for histopathological diagnosis of sarcoidosis. [ABSTRACT FROM AUTHOR]

Background: The primary aim of the study is to investigate the frequency of pathergy positivity in active BD patients at the time of the first diagnosis. Its secondary aim is to compare the status of pathergy with sociodemographic, clinical and laboratory characteristics. Materials and Methods: In this study, 110 BHs were analyzed retrospectively. Sociodemographic characteristics (age, gender), clinical findings, PT status, sedimentation (mm/hr) and C-reactive protein (CRP) (mg/L) values of the patients at the time of initial diagnosis were recorded. Age of onset of disease symptoms <40 were accepted as classical onset, patients ≥40 as late-onset BD. Krause Behçet's Disease Clinical Activity Score was used for disease activity. Results: S PT was found to be positive in 36 (32.7%) of 110 patients with Behçet's disease. In PT positive patients; there was genital ulcer in 31 (86.1%), arthritis in 9(25.0%), uveitis in 7 (19.4%), deep vein thrombosis in 10 (27.8%), papulopustular lesion in 10 (27.8%), erythema nodosum in 6 (16.7%), neuropenchymal involvement in 1 (2.8%) and neurovascular involvement in 1 (2.8%). In PT negative patients, these frequencies were 66 (89.2%), 19 (25.7%), 22 (29.7%), 19 (25.7%), 12 (16.2%), 7 (9.5%), 2 (2.7%) and 1 (1.4%), respectively. The positivity of PT and the frequency of clinical findings were not statistically different (p>0.05). Median value of sedimentation (mm/h) was 16 (2-98), while the median value of CRP (mg/L) was 3.78 (0-126) in PT positive Behçet patients. In PT negative patients, these values were 17.5 (1-108) and 4.5 (0-121), respectively. When the positivity of PT and the median values of sedimentation (mm/hr) and CRP (mg/L) were compared, no significant difference was found (p>0.05). Median value of disease activity total score was 3 (1-6) in PT positive patients, while this median value was 3 (1-7) in PT negative patients. When PT positive and negative patients were compared in terms of disease activity total scores, there was no significant difference (p=0.494). While there were 34 (33.3%) patients with positive PT among classical age-onset patients, there were 2 (25.0%) among those with late onset. When classical and late-onset patients were compared in terms of PT positivity, no significant difference was found (p=1.000). Conclusions: The benefit of PT positivity in predicting the clinical severity of the disease and regulating treatment for BD is still controversial and requires further research. Perhaps new, standardized test methods that will increase the sensitivity of PT will resolve this uncertainty and make the test more valuable for clinicians. [ABSTRACT FROM AUTHOR]

Tularemia is a zoonotic disease which emerges as epidemics or sporadic cases and maintains its importance for public health. It can be confused with infectious and non-infectious diseases because of its clinical diversity, and invasive tests and unnecessary treatments can be applied to patients, especially in nonendemic areas, if it was not considered in differential diagnosis. The first case was referred to the outpatient clinic of infectious diseases and clinical microbiology to investigate the etiology of cervical lymphadenopathy; tularemia was considered based on the negative results of other tests, development of erythema nodosum lesions on follow-up and epidemiological history, and her diagnosis was confirmed serologically by microagglutination test. Serum samples of the second and third cases were sent for tularemia testing on their first admissions based on their epidemiological history. It is remarkable that tularemia was diagnosed about three months after the onset of the symptoms. [ABSTRACT FROM AUTHOR]

Tularemia is a zoonotic diseases which is reported 500,000 new case every year in globally and over 500 number case comes from Turkey. Responsible agent is a Francisella tularensis which is coccobacillus shaped and gram negative bacteria. Clinical features can be changeable and depends on host immun response, inoculation dosage, entrance and virulence of bacteria. Tularemia can be emergent in various manifestation like as a subclinic mild situation or severe sepsis. Globally most observed form in human is ulceroglandular tularemia which mostly can be seen in North America, Asia and Europe. In our country oropharyngeal tularemia is most detected form and case reports has been send nearly form all regions notably Black sea and Marmara. Making diagnose is late because tularemia can be miscible with a lot of diseases especially other infections and because of delay of medical treatment, lymph node suppuration would be progressed. In despite of rare mentioned disease about differential diagnose of head and neck mass, it must come to minds especially with the case cervical lymphadenitis and erythema nodosum. Risky groups are people live in rural areas, farmers, hunters, butchers, cooks, nature lovers. Diagnostic titers are considered to be >1:160 in tube agglutination and >1:128 in microagglutination. First option in the treatment is aminoglycosides and it must be provided for at least 10 days. In this article, we try to evaluate tularemia with clinical approach of the case who admit to the clinic presenting with polyarthralgia, erythema nodosum and lymphadenopathy in the Uşak city from Aegean region in Turkey. [ABSTRACT FROM AUTHOR]

Aim: Sarcoidosis is known as the 'great imitator' for its versatile manifestations which differ among genders. The objective of this study is to investigate the signs and symptoms and differences in respect to gender and phases of disease. Material and Methods: This cohort study includes patients with sarcoidosis classified as asymptomatic, with pulmonary symptoms only, extrapulmonary symptoms only and those with both together. The frequency, prevalence, and severity of the signs and symptoms were compared between gender identities. Results: This study enrolled 338 patients, of which 71% were female, and mean age was 42.5±11.6. Most patients (86%) were symptomatic on presentation, and pulmonary symptoms were noted in 31%, extrapulmonary symptoms in 23% and both in 32%. There were no significant differences between genders regarding cough (45% in women, 42% in men, p=0.620), sputum (9%, 11%, respectively, p=0.535), hemoptysis (2%, 1%, respectively, p=0.678), fever (4%, 4%, respectively, p=0.999). Dyspnea was reported significantly more common in women (33% and 22%, respectively, p=0.048) whilst chest pain was more common in men (7%, and %20 respectively, p=0.001). Excessive perspiration was significantly more common in men, and erythema nodosum in women (p=0.004 and p=0.003, respectively). Frequencies of constitutional symptoms other than perspiration did not differ between sexes. Conclusion: Women with sarcoidosis were older than men and dyspnea and erythema nodosum were seen more commonly in women. Frequencies of other symptoms were similar between sexes. [ABSTRACT FROM AUTHOR]

Erythema nodosum is a septal panniculitis defined as a delayed‐type of hypersensitivity reaction, in which particularly infections, systemic diseases, malignancies and drugs play a role in the etiology. We present here a 36 years‐old female patient admitted to our internal outpatient clinic with significant painful swelling on the upper extremities and whose lesions were diagnosed as erythema nodosum and then we found tuberculosis lymphadenitis with more detailed research. Tuberculosis is still an important factor in developing countries in the erythema nodosum etiology. We want to emphasize that; despite good socio‐cultural situations and no typical clinical symptoms for tuberculosis, extrapulmonary tuberculosis infection should be kept in mind while exploring the etiology of erythema nodosum. [ABSTRACT FROM AUTHOR]

Pernio, or chilblain, is a localized inflammatory disease of the skin resulting from an abnormal response to cold. Pernio presents as tender, erythematous-to-violaceous papules, nodules, or plaques that are usually located on the dorsal aspect of the fingers and toes and the lesions are less commonly found on the ears, nose, and lateral region of the thighs and buttocks. Differential diagnosis include such as Raynaud phenomenon, erythema nodosum, lupus erythematosus. A 32-year-old man was presented with painful papular lesions on his hands for the last 11 years. The lesions worsened with exposure to the cold and improved when his hands were warmed. A punch biopsy sample was taken from papule on the hands. Histopathological examination revealed perivascular infiltrate of lymphocytes in the dermis. The patient was diagnosed with pernio via these findings. Herein we reported a case with pernio. We discussed clinical and histopathological features of pernio and reviewed of differential diagnosis. [ABSTRACT FROM AUTHOR]

Tularemia is zoonotic infection diseases that caused by Francisella tularensis. Oropharyngeal tularemia has been seen the most frequently in our country. Oropharyngeal tularemia may be presented with fever, exudative tonsillitis/pharyngitis, lymphadenopathy, and ulcers in the oral mucosa. Secondary skin rashes may be seen in tularemia. Our cases were presented with fever, headache and sore throat. Physical examination of the patients demonstrated exudative tonsillitis, erythema nodosum and papular rash. Patients' complaints and clinical findings decreased with initiation of early and appropriate treatment. Tularemia should be remembered in the differential diagnosis of exudative tonsillitis, especially in endemic areas. It should be noted that, secondary skin manifestations can be seen in the course of tularemia. [ABSTRACT FROM AUTHOR]

Objective: In this study our aim was to determine demographic and clinical features, etiological factors, laboratory findings and treatment regimens of patients who were diagnosed and treated with erythema nodosum. Methods: Thirty-three patients who were clinical and histopathological diagnosed as erythema nodosum in dermatology clinic of our university, dated between 2008 and 2014, were evaluated retrospectively. Results: The study population consisted of 29 (87.9%) female and 4 (12.1%) male, with a mean age of 40.57±13.98 years (range, 11-69 years). Most patients were found in the 30-39 age range. The most frequent localization of lesions was found in the lower extremities (54.5%). Infections (30.3%) were the most common identified etiologic factors followed by drugs (12.1%), pregnancy (6.1%), Behcet's disease (6.1%) and sarcoidosis (3.1%). The mean duration of disease was 12.60 days. 72.7% of patients were admitted as the first episode. The mean hospitalization time was 8.93 days. Conclusion: The etiology of erythema nodosum varies from country to country. The most common etiological factor was found idiopathic (42.4%) in our study. However, etiologic factors are similar in all studies, only showed differences in the rankings. No showed significant difference between clinical, laboratory, histopathological findings and treatment. [ABSTRACT FROM AUTHOR]

Recurrent oral aphthous ulcerations, genital ulcerations and cutaneous manifestations including erythema nodosum like lesions, superficial thrombophlebitis and papulopustular lesions are the most common manifestations of Behcet's disease. The pathergy reaction reflects skin hypersensitivity to trauma in Behcet's disease. Pathergy test which is characterized by the formation of a sterile pustule 24-48 h after intradermal needle prick has a high diagnostic value especially in Middle East and Mediterranean countries. Due to their high sensitivity, mucocutaneous lesions and pathergy test constitute four out of the five criteria in the International Behcet's Disease study group classification criteria. Behcet's disease has a wide clinical spectrum and since there are no specific diagnostic laboratory tests, diagnosis depends on clinical acumen of the physician. In the majority of patients with systemic findings, mucocutaneous lesions precede the onset of systemic involvement and therefore prompt recognition of mucocutaneous manifestations is of utmost importance in the early diagnosis and the outcome of the disease. [ABSTRACT FROM AUTHOR]

Background and Design: Erythema nodosum (EN) is the most common type of inflammatory nodules. Etiologic factors that lead to EN show a wide spectrum including drugs, infections, malignant and inflammatory diseases. The aim of our study was to investigate frequency of etiologic factors, clinical and laboratory findings of EN patients treated in our clinic, and to identify whether these findings were predictive for a specific etiology in these patients or not. Material and Method: A total of 72 patients diagnosed with EN in our clinic during the period 2003-2007 were included. Results: Patients were divided into two groups with regard to their etiologies. Group I was consisting of 30 cases (41.6%) in whom no underlying disease or precipitating factor were found and Group II was consisting of 42 cases (58.4%) in whom an etiologic factor was identified. Infections (n=24) were the most common identified etiologic factors followed by Behcet's disease (BD), drugs, pregnancy, and sarcoidosis. Statistical analysis revealed no difference according to age and sex characteristics, localization of disease, and the presence of fever and arthralgia as accompanying findings between the groups (p>0.05). The duration of disease was longer in Group II and patients in Group II were found to have more frequently >1 attack of EN, culture positivity and elevated ASO level when compared with that of Group I (p<0.05). However, a statistically significant difference was not found between the two groups regarding presence of leukocytosis, anemia, elevated CRP level and accelerated ESR (p>0.05). Conclusion: Infections, BD and drugs were the most frequently detected etiologic factors in our study. Our results revealed that the localization of lesions and laboratory findings like elevated ESR and CRP, leukocytosis, and anemia were not predictors of secondary EN, and that a further search for an underlying disease is necessary in patients having relapsing EN with a long disease duration. [ABSTRACT FROM AUTHOR]

Background and Design: Erythema nodosum (EN) is the most common type of inflammatory nodules. Etiologic factors that lead to EN show a wide spectrum including drugs, infections, malignant and inflammatory diseases. The aim of our study was to investigate frequency of etiologic factors, clinical and laboratory findings of EN patients treated in our clinic, and to identify whether these findings were predictive for a specific etiology in these patients or not. Material and Method:A total of 72 patients diagnosed with EN in our clinic during the period 2003-2007 were included. Results: Patients were divided into two groups with regard to their etiologies. Group I was consisting of 30 cases (41.6%) in whom no underlying disease or precipitating factor were found and Group II was consisting of 42 cases (58.4%) in whom an etiologic factor was identified. Infections (n=24) were the most common identified etiologic factors followed by Behcet's disease (BD), drugs, pregnancy, and sarcoidosis. Statistical analysis revealed no difference according to age and sex characteristics, localization of disease, and the presence of fever and arthralgia as accompanying findings between the groups (p>0.05). The duration of disease was longer in Group II and patients in Group II were found to have more frequently >1 attack of EN, culture positivity and elevated ASO level when compared with that of Group I (p<0.05). However, a statistically significant difference was not found between the two groups regarding presence of leukocytosis, anemia, elevated CRP level and accelerated ESR (p>0.05). Conclusion: Infections, BD and drugs were the most frequently detected etiologic factors in our study. Our results revealed that the localization of lesions and laboratory findings like elevated ESR and CRP, leukocytosis, and anemia were not predictors of secondary EN, and that a further search for an underlying disease is necessary in patients having relapsing EN with a long disease duration. (Turkderm 2008; 42: 113-7). [ABSTRACT FROM AUTHOR]

Objective: A retrospective analysis of etiology, clinical features, diagnostic approach, and treatment options was carried out on patients who were hospitalized with a diagnosis of subcutaneous painful nodules. Methods: Sixty-two patients who were treated for subcutaneous painful nodules in our clinic between 2006 and 2012 were included in the study. The patients were identified using a keyword and disease code search of the hospital information management system database. The 62 patient admission files were identified and examined in order to record the patients' demographic profiles, clinical symptoms, laboratory findings, and treatments for the study. Results: The majority of the patients were female (80.7%). The etiologic factors were identified as: upper respiratory tract infection (20.9%), Behcet's disease (14.5%), sarcoidosis (11.2%), tuberculosis (9.6%), other infections (4.8%), pregnancy (3.2%), post-traumatic (1.6%), Crohn's disease (1.6%), and Wegener's granulomatosis (1.6%). The etiologic factors for 19 patients (30.6%) could not be determined and were evaluated as idiopathic. The biopsy findings of 11 patients with subcutaneous painful nodules indicated septal panniculitis. Six patients with lobular panniculitis and 6 with septolobular panniculitis were detected. Conclusion: The major cause of painful subcutaneous nodules is the group of diseases known as panniculitis. Subcutaneous nodules can be caused by many different diseases. In order to make a correct diagnosis and begin treatment, it is important to investigate the underlying disease. However, the majority of etiologic factors for panniculitis are unidentifiable, and the increasing occurrence of those cases that are termed idiopathic is beginning to draw attention. [ABSTRACT FROM AUTHOR]