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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]

Granulomatous mastitis (GM) is a chronic inflammatory disease of the breast that usually occurs in women of reproductive age. However, GM during pregnancy is unusual and only one case of GM in the accessory breast has been reported so far. Here, we report an extremely rare case of GM in the accessory axillary breast of a pregnant woman. A 24-year-old pregnant woman had persistent pain and swelling in the right axilla that did not improve with antibiotic administration. Despite incision and drainage for subcutaneous abscess, the incised skin gradually became ulcerated, exposing the subcutaneous granulomatous tissue. Corynebacterium species were isolated in the bacterial culture of drained pus. Lower back pain, pain in several joints, and erythema nodosum on the lower legs appeared later. Based on the result of bacterial culture and the above disease course, the patient was clinically suspected of having GM. The axillary mass was surgically removed after childbirth, and the excised mass was histopathologically confirmed as GM. Treatment for GM should be considered individually and carefully in accordance with the patients' condition. Unnecessary surgery should be avoided. However, early addition of surgical interventions may yield good outcomes, especially for pregnant women because of limited treatment options. [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]

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with in-drawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones. [ABSTRACT FROM AUTHOR]

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with in-drawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones. [ABSTRACT FROM AUTHOR]

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with in-drawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones. [ABSTRACT FROM AUTHOR]

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with in-drawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones. [ABSTRACT FROM AUTHOR]

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with indrawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrastenhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones. [ABSTRACT FROM AUTHOR]

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with in-drawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones. [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]