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Objectives To characterize joint involvement (JI) in sarcoidosis, a systematic search of MEDLINE, EMBASE and Cochrane Library was conducted from inception to July 2022 for publications reporting its prevalence, pattern, treatment and outcome. Methods The pooled prevalence estimates (PPE) with 95% CI were calculated using binomial distribution and random effects. Meta-regression method was used to examine factors affecting heterogeneity between studies. Results Forty-nine articles were identified comprising a total of 8574 sarcoidosis patients, where 12% presented with JI (95% CI 10, 14; I 2 = 0%). The PPE for sarcoid arthritis (SA) was 19% (95% CI 14, 24; I 2 = 95%), and 32% (95% CI 13, 51; I 2 = 99%) for arthralgia. Heterogeneity was due to higher JI prevalence reported in Western Asia and the Middle East, in rheumatology clinics and via surveys. Sample size of SA varied from 12 to 117 cases. Ankles were most frequently affected (PPE 80%) followed by knees and wrists. Monoarthritis was uncommon (PPE 1%; 95% CI 0, 2; I 2 = 55%). Acute SA prevailed (PPE 79%; 95% CI 72, 88; I 2 = 69%) with an equal proportion of oligo and polyarthritis and was frequently accompanied by erythema nodosum (PPE 62%; 95% CI 52, 71; I 2 = 16%). Chronic SA was predominantly polyarticular with a higher frequency of the upper extremity joints affected. Most common non-articular manifestations with SA included fever (52%), erythema nodosum (41%), hilar adenopathy (86%) and interstitial lung disease (23%) of which one-third required corticosteroids and/or immunosuppressants. Conclusion SA occurred early in the disease with a PPE of 19% and most frequent pattern of acute oligo- or polyarthritis predominantly affecting the lower extremity large joints. [ABSTRACT FROM AUTHOR]

Leprosy is a chronic infectious disease caused by the bacillus Mycobacterium leprae. The disease may evolve for inflammatory reactions, reversal reaction (RR) and erythema nodosum leprosum (ENL), the major cause of irreversible neuropathy in leprosy, which occur in 1 in 3 people with leprosy, even with effective treatment of M. leprae. Leprosy remains persistently endemic in our region where it predominantly affects lowest socioeconomic conditions people, as Toxoplasma gondii infection in the municipality studied. Previously, we have shown T. gondii coinfection as a risk marker for leprosy, mainly in its severe form. This present study assessed whether T. gondii infection is also a risk factor for leprosy reactions and the predictive value of immunoglobulin production prior to development of leprosy reactions. Patients with leprosy (n = 180), co-infected or not with T. gondii, had their serum investigated for levels of IgA, IgE, IgG1, IgG2, IgG3 and IgG4 anti-PGL-1 by ELISA prior to development of leprosy reactions. The serologic prevalence for T. gondii infection was 87.7% in leprosy reaction patients reaching 90.9% in those with ENL. The leprosy reaction risk increased in T. gondii seropositive individuals was two-fold ([OR] = 2.366; 95% confidence interval [CI 95%]: 1.024–5.469) higher than those seronegative, and considering the risk of ENL, this increase was even more evident (OR = 6.753; 95% CI: 1.050–72.85) in coinfected individuals. When evaluated the prediction of anti-PGL-1 immunoglobulin levels for development of leprosy reactions in patients coinfected or not with T. gondii, only the increase IgE levels were associated to occurrence of reactional episodes of leprosy, specifically ENL type, in patients coinfected with T. gondii, compared to those not coinfected or no reaction. Thus, the immunomodulation in co-parasitism T. gondii–M. leprae suggest increased levels of IgE as a biomarker for early detection of these acute inflammatory episodes and thereby help prevent permanent neuropathy and disability in leprosy patients. [ABSTRACT FROM AUTHOR]

Coccidioidomycosis occurs after inhalation of airborne spores of the endemic, dimorphic fungus, Coccidioides. While the majority of individuals resolve the infection without coming to medical attention, the fungus is a major cause of community-acquired pneumonia in the endemic region, and chronic pulmonary and extrapulmonary disease poses significant personal and economic burdens. This review explores the literature surrounding human susceptibility to coccidioidomycosis, including chronic pulmonary and extrapulmonary dissemination. Over the past century of study, themes have emerged surrounding factors impacting human susceptibility to severe disease or dissemination, including immune suppression, genetic susceptibility, sex, pregnancy, and genetic ancestry. Early studies were observational, frequently with small numbers of cases; several of these early studies are highly cited in review papers, becoming part of the coccidioidomycosis "canon". Specific genetic variants, sex, and immune suppression by TNF inhibitors have been validated in later cohort studies, confirming the original hypotheses. By contrast, some risk factors, such as ABO blood group, Filipino ancestry, or lack of erythema nodosum among black individuals, are repeated in the literature despite the lack of supporting studies or biologic plausibility. Using examination of historical reports coupled with recent cohort and epidemiology studies, evidence for commonly reported risk factors is discussed. [ABSTRACT FROM AUTHOR]

Late-onset Adamantiades-Behçet's disease (ABD) is a rare inflammatory condition that primarily affects males and has similar clinical features to early-onset ABD. This study compared the prevalence and characteristics of late-onset ABD with early-onset ABD through a systematic review and meta-analysis. The findings showed that late-onset ABD is less common and associated with milder symptoms, such as recurrent oral and genital ulcers, ocular lesions, and a positive pathergy test. Late-onset ABD also has lower rates of vessel involvement. Overall, late-onset ABD may occur predominantly in males and have a milder course compared to early-onset ABD. [Extracted from the article]

Introduction: Behcet's disease (BD) is classified among inflammatory vascular diseases, affecting vessels of all kinds and sizes thus affecting every tissue and organ, with unknown aetiology. Considering low frequency with which this condition occurs, variation with the signs of symptoms, lack of specific test for diagnosis, this study was done to understand the clinical behaviour of patients with BD, which will aid in diagnosing and managing patients with BD and also relapses and other associated conditions. Methodology: A hospital-based study was done in 50 adult patients of either sex, diagnosed with BD in a tertiary care hospital after obtaining ethical committee clearance during February 2020 to January 2023. The diagnosis was based on the diagnostic criteria laid down by the International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). Results of laboratory tests, including HLA-B5, HLA-B51, and HLA-B27, were recorded. NSAIDS, steroids and immunomodulating drugs were prescribed, either individually or in combination, to treat the disease. Data analysis was done using SPSS 20. Data represented as frequency percentage and bar diagrams. Results: Majority of the patients with BD belong to age group of 41 - 60 years (84%) with mean age of the patients being 42.3±8.4. BD was seen more in males (68%). Oral apthous (94%) ulcers were the most common manifestations followed by skin lesions (52% includes erythema nodosum, pseudo folliculitis and others) and ocular involvement (50% includes anterior uveitis, posterior uveitis, pan uveitis and retinal vasculitis). Pathergy test was positive in 62% of patients. Out of 50 patients 62% had positive HLA B5, followed by HLA B51 (40%) and HLA B27 (8%). Conclusion: BD is more common in younger age group with mean age 42.3 years and in males. Most of the patients were positive for HLAB5. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated the coexistence of erythema nodosum (EN) and inflammatory bowel disease (IBD), while the exact etiology of the co‐occurrence of the two disorders remains uncertain. Methods: A bidirectional two‐sample Mendelian randomization (MR) design was employed to determine the causal link between EN and IBD. Genetic variations associated with Crohn's disease (CD) and ulcerative colitis (UC) were derived from accessible genome‐wide association studies pertaining to European ancestry. The FinnGen database was used to find the genetic variations containing EN. In the forward model, IBD was identified as the exposure, whereas in the reverse model, EN was identified as the exposure. The causal link between IBD and EN was examined using a range of different analysis techniques, the primary one being the inverse variance weighted (IVW) method, including inverse variance weighted‐fixed effects (IVW‐FE) and inverse‐variance weighted‐multiplicative random effects (IVW‐MRE). To strengthen the results, assessments of sensitivity, heterogeneity, and pleiotropy were also conducted. Results: MR results showed that IBD increased the risk of EN (IVW‐MRE: OR = 1.242, 95% CI = 1.068–1.443, p = 0.005). Furthermore, there was a strong correlation found between CD and a higher risk of EN (IVW‐FE: OR = 1.250, 95% CI = 1.119–1.396, p = 8.036 × 10−5). However, UC did not appear to be linked to EN (IVW‐FE: OR = 1.104, 95% CI = 0.868–1.405, p = 0.421). The reverse MR analysis findings did not imply that EN was linked to IBD. Horizontal pleiotropy did not appear to exist, and the robustness of these findings was confirmed. Conclusion: The current investigation found that in European populations, IBD and its subtype CD could raise the incidence of EN. [ABSTRACT FROM AUTHOR]

The article describes the case of a healthy 13-month-old Indian boy with erythema nodosum (EN) after receiving his 12-month routine vaccine. Topics discussed include tender erythematous nodules on the boy's legs that appeared 24 hours after vaccination, most common etiological factors for EN in children, and differential diagnoses for EN.

Background: Leprosy is the most ancient and widely spread global disease and was described in various articles of ancient civilizations. In 1990, the goal of eliminating leprosy by the end of the 20th century was proposed by the World Health Organization but still leprosy is highly prevalent in India. Leprosy is categorized in various types depending upon clinical features, histopathological findings and the host immunity. Various clinical features and acid fast bacilli demonstration in slit skin smears can help in diagnosis of leprosy but histopathological examination can help to classify and aid in the definitive diagnosis of leprosy and also prognosis of the disease and assessment of regression of the disease in patient undergoing treatment. Aim: To classify all skin biopsies having clinical diagnosis of leprosy in to various types according to the Ridley Jopling's classification of leprosy, also to find out the correlation between histopathological diagnosis of skin biopsies with clinical diagnosis of leprosy and to study various clinical presentations of leprosy with respect histopathological diagnosis. Materials and Methods: It was a prospective study done in the Department of Pathology, Shri Bhausaheb Hire Government Medical College Dhule over a period of 24 months i.e. from 1st January 2022 to 31st December 2023. Skin punch biopsies from 288 clinically diagnosed patients of leprosy were subjected for routine processing and routine staining with Haematoxyline & Eosin stain as well as Fite-Faraco staining. The lesions were classified using the Ridley-Jopling's classification into Tuberculoid Leprosy, Borderline Tuberculoid, Mid Borderline, Borderline Lepromatous and Lepromatous Leprosy. Few of the lesions were categorized as Histioid leprosy and Erythema Nodosum Leprosum Result: There was a male predominance (59.02%) seen in our study. Most common age group affected was 21to 30yrs followed by 31to 40yrs. Most common histopathological diagnosis was Borderline Tuberculoid leprosy followed by Indeterminate leprosy. Most common clinical presentation was hypopigmented patches, hypoasthetic patches, erythematous patches and tingling and numbness. 100% Fite-Faraco stain positivity was noted in Lepromatous and Histioid leprosy. Clinicohistopathological concordance was 100% in Erythema Nodosum Leprosum, followed by Tuberculoid (94%) and Borderline Tuberculoid (90%). The concordance was minimum in Mid Borderline leprosy(33%). Conclusion: Despite of implementation several government projects to control leprosy, leprosy still remains to be highly prevalent disease in India, also seen in this study, as we got 188 cases of leprosy over a period of 24 months. In our study we got high clinicohistopathological concordance in the diagnosis of Tuberculoid, Borderline Tuberculoid and Erythema Nodosum Leprosum cases. But it is low in the diagnosis of Midborderline and Indeterminate leprosy. There is overlapping of clinical features in various types of leprosy, so histopathological examination should be strongly recommended and considered as Gold standard for the diagnosis of leprosy. [ABSTRACT FROM AUTHOR]

The article discusses the presence of neutrophilic skin diseases and autoinflammatory skin diseases, which are examples of innate immune diseases in human skin. Neutrophilic dermatoses, characterized by neutrophils invading affected skin, include various skin disorders such as acneiform papules, pustular lesions, and neutrophilic plaques. Autoinflammatory diseases, on the other hand, are clinical cases with genetic abnormalities and systemic inflammation. Cutaneous manifestations in these diseases often include pustules, acne, and other epidermal and follicular alterations. The article highlights the role of neutrophilic microabscesses in these diseases and the potential involvement of keratinocytes and follicular epithelial cells in immune responses. [Extracted from the article]

Erythema nodosum leprosum (ENL) is an immunological complication of leprosy characterized by acute inflammation of the skin, nerves, and other organs. Identifying laboratory parameters is important for early diagnosis of leprosy reactions. Various cytokine biomarkers have been examined and only a few studies have reported on angiogenesis in leprosy. This study aims to understand the pathomechanism of ENL by examining IL-7 and plateletderived growth factor (PDGF)-BB mRNA expression that can be the development and consideration of new effective therapies to prevent reactions, recurrences, and defects in leprosy. The study used a cross-sectional analytic design. Sampling was done by peripheral blood from the patient and measuring mRNA expression with specific primers RT-PCR. The expression of mRNA IL-7 and PDGF-BB was significantly different between multibasilar patients without reaction and with ENL reaction, where there was an increased expression in ENL patients. This could be used as the development of potential biomarkers in ENL and development of new therapeutic intervention pathways in ENL. [ABSTRACT FROM AUTHOR]

Introduction: Azathioprine hypersensitivity can occasionally present as Sweet‐like syndrome, a dose‐independent side effect characterized by the unanticipated onset of macules, papules, and pustules. Case presentation: A 35‐year‐old woman with systemic lupus erythematosus presented with complaints of generalized maculopapular rash, facial swelling, and bilateral lower extremity edema with a duration of 4 days and a 2‐day history of constitutional symptoms within 2 weeks of the beginning of azathioprine therapy to treat existing lupus nephritis (class 2/3). Discussion: Patients who experience azathioprine hypersensitivity syndrome can present with erythema nodosum, small‐vessel vasculitis, acute generalized exanthematous pustulosis, Sweet syndrome, and nonspecific dermatosis. The following signs and symptoms are used as criteria to diagnose drug‐induced Sweet syndrome: (a) abrupt onset of painful erythematous plaques, (b) histopathological evidence of dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis, (c) temperature higher than 39.7°C, (d) temporal relationship between drug ingestion and clinical presentation, and (e) temporal resolution of lesions after drug withdrawal. Our patient met three out of five criteria and was diagnosed with Sweet‐like syndrome. Conclusion: Our case highlights the uncommonly presented azathioprine‐induced Sweet‐like syndrome that occurs abruptly after the commencement of the offending drug. This diagnosis can be established through basic laboratory workup and skin biopsy findings. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is an important and topical problem at global level, so it remains a challenge for public health policies. According to the World Health Organization (WHO), in 2018, about 10 million new TB cases worldwide were estimated. Of these, 11% are children under the age of 15. In addition to these alarming data, TB is responsible for 130,000 deaths per year in children and it is estimated that there are approximately 1 million TB-cases in the global population of children, being one of the top 10 causes of death in children worldwide. According to the WHO, there are economic, social, cultural, ethnic/racial, psychological and behavioral factors that interfere with the occurrence of diseases, and these factors are attributed to the persistence of infectious diseases such as TB in the population, even today. Numerous specialized studies strengthen the hypothesis of associating social vulnerability with TB emergence and distribution in the community. Therefore, the development of more accurate estimates of pediatric TB cases is an urgent need for public policy scheduling and resource allocation and, consequently, for reducing morbidity and mortality from TB among children. [ABSTRACT FROM AUTHOR]

Background: Cutaneous tuberculosis is an important infectious public health problem in India. The incidence has dropped from 2% to 0.1%, making it a rare finding in clinical settings. Due to paucibacillary character of this illness and its resemblance to other dermatoses, making it challenging to diagnose. The present study was done to report the various clinical types of cutaneous tuberculosis. Material and Methods: All the clinically suspected cases of cutaneous tuberculosis attending the dermatology OPD of our tertiary care hospital during a period of one year (May 2022 to May 2023) were enrolled in the study. They were subjected to routine blood tests, Chest X-ray, HIV, Mantoux test and skin biopsy done for confirmation. Results: During a study period of 12 months, a total of 25 patients were diagnosed as cutaneous tuberculosis. Male to Female ratio was 1.3:1. Commonest type was Lupus vulgaris (48%) followed by Scrofuloderma (20%), Tuberculosis verrucosa cutis (8%), Erythema nodosum (8%), Papulonecrotic tuberculid (8%), Erythema induratum of Bazin (4%), Lichen scrofulosorum (4%). In this study most cases are middle aged adults, the youngest was 13-year-old girl, oldest was 70-year-old male. Commonest site were limbs followed by trunk. One patient had pulmonary tuberculosis. All patients were responded to standard antitubercular treatment. Conclusion: Cutaneous tuberculosis remains an important medical problem despite the development of extremely potent anti-tuberculous medications. This case study demonstrates the importance of diagnosing a case of cutaneous tuberculosis in patients presenting with a suspicious skin lesion. [ABSTRACT FROM AUTHOR]

Introduction: Lupus erythematosus tumidus (LET) is a rare photosensitive dermatosis that is categorized as intermittent cutaneous lupus erythematosus. It shares clinical similarities and histopathological features with other skin disorders, such as erythema nodosum, lymphocytic infiltrate of Jessner, and reticular erythematous mucinosis, thus making diagnosis quite challenging. We present a patient with LET whose diagnosis was confirmed after seeing several doctors. Case Presentation: A 52-year-old Hispanic female presented with tender erythematous nodules on her thighs for approximately 1 month. She was suspected of having erythema nodosum secondary to coccidioidomycosis and was prescribed fluconazole 200 mg for 30 days but showed no improvement. However, histopathological and direct immunofluorescence tests later confirmed a diagnosis of LET. The patient was treated with hydroxychloroquine, and the lesions improved remarkably after 2 weeks. Conclusion: LET is a rare dermatosis that closely resembles other dermatologic conditions such as erythema nodosum, lymphocytic infiltrate of Jessner, and reticular erythematous mucinosis. Diagnosis based on clinical features alone should be avoided, and ideally, treatment should only be initiated after confirmatory histopathological testing. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a Th1-mediated chronic inflammatory disease characterized by non-caseating granulomas. Its pathogenesis is not yet clear, but the possible role of various proinflammatory cytokines is being discussed. This study aims to determine serum cytokine (IL-6, IL-12, IL-17, and IL-23) levels in patients with sarcoidosis, and to determine a possible correlation with clinical and laboratory findings of the disease. Forty-four biopsy-proven sarcoidosis patients followed up at a single centre and 41 healthy volunteers were included in the study. Demographic, clinical, laboratory, and radiological data of all patients were recorded. Serum samples from the patients and the control group were taken and IL-6, IL-12, IL-17, IL-23 were measured by ELISA method. Of the 44 sarcoidosis patients, 13(29.5%) were male and 31(70.5%) were female. Average patient age was 47.4 years, mean disease duration was 3.2 years. Twenty-one (47.7%) patients had erythema nodosum, three (6.8%) had uveitis, 40(90.9%) had arthralgia, 23(52.3%) had ankle arthritis, 15(34.1%) had enthesitis. Laboratory evaluation showed increased serum ACE levels in 24(54.5%) patients, increased serum calcium levels in 11 (25%) patients, increased serum D3 levels in 5(11.4%) patients, increased ESR and CRP levels in 22(50%) and 23(52.3%) patients, respectively. Compared with the control group higher serum IL-23 levels were found in the patients with sarcoidosis (p =.01). Serum IL-23 was associated with ankle arthritis (p =.02). Serum IL-6, IL-12, and IL-17 levels were similar in the sarcoidosis patients and the control group (p =.128, p =.212, p =.521 respectively). In our study, we found increased serum IL-23 in patients with sarcoidosis, while serum IL-6, IL-12, and IL-17 were detected as normal. Although our results are somewhat contradictory to other studies in the literature, the question should still be whether sarcoidosis is a Th1/Th17 disease. Multicentre studies are needed in this regard. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Erythema nodosum (EN) is a type of panniculitis occurring due to various conditions. It can be associated with certain malignancies or manifest as a side effect of drugs. This article presents a unique case of EN in a patient with chronic myeloid leukemia (CML‐blast phase) following dasatinib and chemotherapy. Timely recognition and appropriate management are crucial to alleviate symptoms and consider potential drug‐induced etiology. [ABSTRACT FROM AUTHOR]

The objectives are to describe the demographic and clinical properties of Behçet's disease (BD) and investigate their relationship with the use of biological agents. Four hundred-eighty-eight patients, (299 (61.3%) males, 189 (38.7%) females), who fulfilled the ISG classification criteria for BD were included, retrospectively. The patient's demographics, disease onset age (DOA), clinical findings of the disease, and the drugs were determined and analyzed statistically. The means of patient age and DOA were 40.7 ± 9.9 and 30.8 ± 8.8 years, respectively. The most common initial findings were oral ulcer (OU)s (30.1%), genital ulcer (GU) (27.5%), ocular involvement (OI) (12.5%), and papulopustular lesion (PPL)s (10.1%). The most common clinical manifestations were OUs (96.9%), PPLs (70.2%), HLA-B51 (64.4%), positive pathergy reaction (26.4%), GU (58.8%), OI (44.7%), erythema nodosum (29.8%), and vascular involvement (VSI) (27.3%). Although, the frequency of GU was higher in females (p = 0.01), PPLs (p = 0.001) and VSI (p = 0.001) were higher in males. Sixty-three (8.9%) patients used a biological agent. Its frequency was higher in younger patients (< 40 years) (p = 0.006), males (p = 0.012) and patients with OI (p = 0.001). Besides, the DOA (p = 0.012) and the current age (p = 0.001) were lower in biological agent users. The possibility of using biological agent was increased in males (OR = 2.2), patients with OI (OR = 2.7) and young patients (OR = 0.9). Mucocutaneous lesions are distinctive features of BD, especially OUs precede other findings. GU was more common in females and PPLs and VSI were in males. The probability of using biologics is higher in males, patients with OI, and young patients. [ABSTRACT FROM AUTHOR]

This article discusses the case of a teenage girl in Mayotte, France, who was diagnosed with lepromatous leprosy and developed severe erythema nodosum leprosum (ENL). ENL is a rare immunological reaction that can complicate leprosy. The patient's condition worsened despite treatment with conventional therapies, such as corticosteroids and thalidomide. The article explores the use of alternative treatments, including ustekinumab and apremilast, which resulted in a favorable outcome for the patient. The authors highlight the need for alternative therapies for ENL and discuss the potential of biological therapies in managing severe cases. [Extracted from the article]

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]

Goserelin acetate is a gonadotropin‐releasing hormone analog that is commonly used in patients with prostate cancer, endometriosis, and precocious puberty. The side effects of the drug include allergic rash, flushing, excessive sweating, skin swelling at the injection site, sexual dysfunction, erectile dysfunction, and menopausal symptoms. However, erythema nodosum has so far not been reported. In this paper, we have presented the case of erythema nodosum caused by goserelin acetate and a review of the literature on its adverse effects, thus providing useful insights into clinical management and medication safety. [ABSTRACT FROM AUTHOR]

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]

Morbus Adamantiades–Behçet (MAB) is an inflammatory disease typically manifesting with oral and genital aphthosis, erythema nodosum, and vasculopathy, and in only around 2%, cardiac involvement. Its prevalence is usually higher along the historic Silk Road, but rarer in Scandinavia where 0.64–4.9 in 100,000 people are affected. We herein present two Swedish patients with cardiac manifestations of Morbus Adamantiades–Behçet. Along with the intracardial thrombi, which both patients presented with, one patient also had cerebrovascular insults leading to visual field deficits as well as involvement of peripheral nerves. Being of Scandinavian origin and showing uncommon symptoms as their initial manifestations of MAB, the 62- and 35-year-old patients presenting herein constitute rare cases. [ABSTRACT FROM AUTHOR]

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is associated with a hyperergic response of the immune system. The spectrum of clinical changes in ASIA is extensive and difficult to diagnose. Panniculitis is a heterogeneous group of diseases characterized by lesions of the adipose tissue. Panniculitis may become one of the signs of ASIA progress. To describe the clinical signs and morphological changes in the subcutaneous fat as a manifestation of ASIA, developing after osteosynthesis with metal structures. In this case-based review, were searched for all articles published in PubMed and Scopus databases until March, 2021 using the following keywords "panniculitis", "erythema nodosum", "Weber-Christian Disease", "idiopathic lobular panniculitis", "Autoimmune/inflammatory syndrome induced by adjuvants", "Shoenfeld's syndrome", "metal allergy" "metal implants", "metal hypersensitivity" and reviewed them. Irrelevant items and duplicates were excluded. We report a case of an adult female patient presenting with a non-healing uninfected surgical wound following implantation of metal osteosynthesis construction and panniculitis developed after surgery. A comprehensive examination of the patient to check for ASIA was conducted. Considering the medical history of exposure to metals, tissue lesions, arthralgia, myalgia, low-grade fever, the disappearance of symptoms on the background of immunosuppressive therapy suggested the diagnosis of ASIA. Report affords clinicians and pathologists additional insight into the clinical and morphological picture of ASIA-associated panniculitis which, if remain unidentified, may cause severe complications. We recommend the removal of constructions with adjuvant activity in patients with suspected ASIA-associated manifestations. [ABSTRACT FROM AUTHOR]

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: Increasing evidence has suggested that Corynebacterium kroppenstedtii is associated with some cases of granulomatous mastitis, mostly based on pathology or microbiology. We aimed to identify the clinical characteristics and treatment regimens for granulomatous mastitis with Corynebacterium kroppenstedtii infection. Understanding these clinical features is essential for patient care. Methods: We retrospectively collected data on 201 patients who were pathologically diagnosed with granulomatous mastitis and had microbiological results of either Corynebacterium kroppenstedtii or no bacterial growth and recorded and analysed their demographics, clinical characteristics, and clinical outcomes. Results: There were 107 patients in the CK group and 94 patients in the negative group. Sinus formation (x2 = 13.028, p = 0.000), time to complete remission at the first treatment period (Z = -3.027, p = 0.002), diameter of breast mass at first-time medical consultancy (Z = -2.539, p = 0.011) and recurrence (x2 = 4.953, p = 0.026) were statistically significant. Age (Z = -1.046, p = 0.295), laterality (x2 = 4.217, p = 0.121), time to presentation since the last delivery (x2 = 0.028, p = 0.868), BMI (Z = -0.947, p = 0.344), lactation time (Z = -1.378, p = 0.168), parity (x2 = 1.799, p = 0.180), gravida (Z = -0.144, p = 0.885), history of lactational mastitis or abscess (x2 = 0.115, p = 0.734), local trauma (x2 = 0.982, p = 0.322), hyperprolactinemia (x2 = 0.706, p = 0.401), erythema nodosum (x2 = 0.292, p = 0.589), and nipple discharge (x2 = 0.281, p = 0.596) did not demonstrate statistical significance. Regarding recurrence related to therapeutic strategy, except for surgery combined with immunosuppressants (x2 = 9.110, p = 0.003), which was statistically significant, none of the other treatment regimens reached statistical significance. The recurrence rate of patients in the CK group using rifampicin in their treatment course was 22.0% (x2 = 4.892, p = 0.027). Conclusions: Granulomatous mastitis accompanied by Corynebacterium kroppenstedtii more easily forms sinuses and has a higher recurrence rate. Both of the clinical characteristics may indicate that Corynebacterium kroppenstedtii plays an important role in the development and progression of granulomatous mastitis. Lipophilic antibiotics may be essential for granulomatous mastitis with Corynebacterium kroppenstedtii infection. [ABSTRACT FROM AUTHOR]

Background: Primary immunodeficiencies are immunological disorders caused by gene mutations involved in immune system development and activation. Recently, activated phosphoinositide 3-kinase delta syndrome (APDS) due to mutations in the phosphoinositide 3-kinase (PI3K), phosphatidylinositol-4, 5-bisphosphate 3-kinase, catalytic subunit delta gene (PIK3CD), and phosphoinositide 3-kinase regulatory subunit 1 (PIK3R1) genes have been reported to induce a combined immunodeficiency syndrome leading to senescent T cells, lymphadenopathy, and immunodeficiency. The exact diagnosis of these deficiencies is essential for treatment and prognosis. In recent years, targeted treatment with selective PI3Kd inhibitors has had a significant effect on controlling the symptoms of these patients. Case presentation: In this case report, we represent a 27-month-old girl with recurrent fever, an increased level of inflammatory markers, and erythema nodosum, who was referred to the rheumatology clinic. In the course of evaluations, because of the lack of clinical improvement with usual treatments, and a history of frequent respiratory infections, combined immunodeficiency was diagnosed in the immunological investigations. Moreover, whole-exome sequencing was performed for her. Conclusion: The genetic analysis found a novel variant of PIK3CD (c.1429 G > A) in the patient. Following daily antibiotic prophylaxis and monthly IV therapy, the patient's frequent infections and fevers were controlled. [ABSTRACT FROM AUTHOR]

With the introduction of large‐scale COVID‐19 vaccination programs, a variety of cutaneous manifestations have been described. We present two girls (ages 12 and 5 years) who developed erythema nodosum (EN) 3 and 14 days after Pfizer‐BioNTech COVID‐19 vaccination, respectively. While EN after COVID‐19 vaccination has been reported in adults, it is can also occur in children. [ABSTRACT FROM AUTHOR]

Erythema nodosum (EN) is acute nodular septal panniculitis characterized by firm nodule or erythematous plaque which is pain on palpation and commonly localized on lower extremities. EN cases related to various vaccinations have been reported with the onset of <24 hours to 30 days of first or following dose. Some studies have reported EN case after COVID-19 vaccination in adult. We reported a case of 25 years old male presented with tender, erythematous nodules on the bilateral lower extremities that started one day after receiving second dose of COVID-19 vaccination. Based on patient history, physical examination, laboratory, and histopathologic investigation all pointed to EN related to vaccination. The patient was given nonsteroidal antiinflammatory agent and clinical improvement was noticed. [ABSTRACT FROM AUTHOR]

The article offers information on a 9-year-old girl initially presenting to the emergency department with painful "spider bites," leading to a diagnosis of insect bites and discharge. Topics include the patient's subsequent re-presentation with worsening symptoms, including fever, abdominal pain, and lymphadenopathy, prompting a differential diagnosis that considered urinary tract infection, septic joint, and erythema nodosum.

Aim: The aim of this retrospective study is to examine the frequency and clinical features of skin lesions in patients with sarcoidosis and to compare them with the literature. Materials and Methods: The files of patients diagnosed with sarcoidosis in the last 10 years in our hospital were reviewed retrospectively. Age, gender, age at diagnosis, dermatology consultation or dermatological examination findings were recorded for all patients. Results: Thirty (69.8%) of the patients diagnosed with sarcoidosis were female and 13 (30.2%) were male. The mean age was 49.7 ± 12.2. When the patients are grouped according to the age ranges at which they are diagnosed, there are 1 (%2.3) patient between the ages of 10-19, 4 (%9.3) patients between the ages of 20-29, 6 (%13.9) patients between the ages of 30-39, 16 (%37.2) patients between the ages of 40-49, 8 (%18.6) patients between the ages of 50-59 and 8 (%18.6) patients over the age of 60. The mean age at which female patients were diagnosed with sarcoidosis was 47.56±12.85, and the mean age at which male patients were diagnosed with sarcoidosis was 41.86±13.81 years. The mean follow-up period of the patients was 4.0±3.1 years. Thirty-one (72.1%) of all patients were examined in dermatology. Dermatological findings including erythema nodosum were detected in 8 (18.6%) patients. Conclusion: Sarcoidosis is a multisystemic disease that can progress with various clinical findings and should be considered in the differential diagnosis with its frequent or rare findings. In this study, in which the data of patients diagnosed with sarcoidosis in the last 10 years in our hospital were evaluated, our findings were generally similar to the literature data. [ABSTRACT FROM AUTHOR]

Tuberculids are a group of dermatoses with tuberculoid histology and the absence of tubercle bacilli. They are considered to be hypersensitivity reactions to circulating Mycobacterium tuberculosis (M. tb) or its antigens in individuals with good immunity. The objective of the review is to provide a detailed literature review of all available articles on tuberculids in the past 10 years and provide an update on epidemiology, etiopathogenetic mechanisms, clinical manifestations, and treatment. A search was performed on PubMed using the keywords lichen scrofulosorum, papulonecrotic tuberculid, erythema induratum, and erythema nodosum tuberculosis for all articles, with no restrictions on age, gender, or nationalities. An update on tuberculids, including some new concepts in pathogenesis, atypical presentations, new investigative modalities, and treatments are reviewed. [ABSTRACT FROM AUTHOR]

Introduction: Leprosy reactions (LRs) are inflammatory responses observed in 30%-50% of people with leprosy. First-line treatment is glucocorticoids (GCs), often administered at high doses with prolonged courses, resulting in high morbi-mortality. Methotrexate (MTX) is an immunomodulating agent used to treat inflammatory diseases and has an excellent safety profile and worldwide availability. In this study, we describe the efficacy, GCs-sparing effect and safety of MTX in LRs. Methods: We conducted a retrospective multicentric study in France consisting of leprosy patients receiving MTX for a reversal reaction (RR) and/or erythema nodosum leprosum (ENL) since 2016. The primary endpoint was the rate of good response (GR) defined as the complete disappearance of inflammatory cutaneous or neurological symptoms without recurrence during MTX treatment. The secondary endpoint was the GCs-sparing effect, safety and clinical relapse after MTX discontinuation. Results: Our study included 13 patients with LRs (8 men, 5 women): 6 had ENL and 7 had RR. All patients had had at least one previous course of GCs and 2 previous treatment lines before starting MTX. Overall, 8/13 (61.5%) patients had GR, allowing for GCs-sparing and even GCs withdrawal in 6/11 (54.5%). No severe adverse effects were observed. Relapse after MTX discontinuation was substantial (42%): the median relapse time was 5.5 months (range 3–14) after stopping treatment. Conclusion: MTX seems to be an effective alternative treatment in LRs, allowing for GCs-sparing with a good safety profile. Furthermore, early introduction during LRs may lead to a better therapeutic response. However, its efficacy seems to suggest prolonged therapy to prevent recurrence. Author summary: Leprosy reactions (LRs) are acute inflammatory episodes that complicate 30% to 50% of Mycobacterium leprae infections. Type 1 is known as reversal reaction (RR), and type 2 is known as erythema nodosum leprosum (ENL). The two types have relatively distinct pathogenesis and clinical features; furthermore, they can advance to become severe and progress to irreversible nerve damage and deformities. Beyond leprosy infection, LR can bring about neurological burden, poor quality of life, and risk of further descent into poverty for often young patients. Despite effective standardized treatment of leprosy infection with multidrug therapy (MDT) since 1981, treating LRs prove to be challenging. First-line treatment of LR is based on prolonged systemic glucocorticoids (GCs) therapy. The current challenge in leprosy is now to develop and evaluate new therapeutic alternatives to reduce not only the sequelae and morbidity of LR but also the lasting side effects of GCs. Thalidomide is an effective alternative in moderate to severe ENL, but its use is limited given its numerous adverse effects. Methotrexate (MTX) is an immunomodulating agent used to treat inflammatory diseases and has an excellent safety profile and worldwide availability. Here, we describe the efficacy, GCs-sparing effect, and safety of MTX in LR. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a chronic granulomatous disease of unknown etiology involving multiple organs of body. Cutaneous sarcoidosis varied in morphology with follicular, papular, nodular plaque, lupus pernio and erythema nodosum are the commonest forms. We herein present a case of a middle age male who presented with micropapular lesion on photo exposed areas which turn out to be cutaneous sarcoidosis on histopathology. There was no systemic involvement. Multidisciplinary and comprehensive management approach is required in such cases. Patients' clinical features improved considerably after treatment with topical and systemic corticosteroids. [ABSTRACT FROM AUTHOR]

Erythema Nodosum (EN) is the most common panniculitis, presented as acutely eruptive painful erythematous nodules on lower extremities symmetrically, with a wide spectrum etiology from infection to malignancy. The aim of this case report is to comprehend the diagnosis and the underlying treatable origin of EN. A 24-year-old female presented with painful red bumps on both legs a week after an episode of fever and sore throath. She also noted tenderness on both ankle joints. She was diagnosed with vasculitis by the internist and was treated with Methylprednisolone (MP) 16mg/day for 2 weeks. The symptomps were resolved but re-emmerged 1 week after the MP was stopped. Physical examination revealed erythematous nodules on both legs with tenderness on palpation. ASTO test was positive. Septal panniculitis and Miescher's granuloma was identified through histopathology examination. Exclusion of inflammatory subcutaneous differential diagnosis such as EN, nodular vasculitis (NV), and cutaneous polyarteritis nodosa (CPAN) require clinical and histopathologic consideration. Etiology identification of EN was done through a relevant supporting examination based on epidemiology, history, and physical examination. Poststreptococcal EN possibly related to molecular mimicry and immune complex deposition leading to reactive inflammation. Hereby we reported one case of post-streptococcal EN that was confirmed by laboratory examination and skin biopsy. The clinical response was good towards the etiologybased treatment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Behçet disease may be confused with sarcoidosis because they are both multisystem inflammatory disorders presenting with uveitis, polyarthritis, cardiovascular disease, erythema nodosum, and other cutaneous lesions. The coexistence of Behçet disease and sarcoidosis is extremely rare but not impossible. Vascular involvement is a significant pathological finding in Behçet disease, and arterial aneurysm formation is more common than occlusion. However, large-vessel vasculitis associated with sarcoidosis is extremely rare. Case Report: A 23-year-old man was admitted to the hospital because of swelling and pain in the right groin. The patient, who had predominant Behçet disease, was also diagnosed with sarcoidosis during the examination. He had inguinal distention associated with femoral artery aneurysm and underwent successful surgery without complication. Conclusion: Assessment of the coexistence of Behçet disease and sarcoidosis is critical because of their potentially fatal effects by triggering systemic inflammation. Furthermore, arterial diseases, especially those developing at young ages, can be a sign of immunoinflammatory disease. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency is endemic in India. Hypovitaminosis D not only results in musculoskeletal disorders but also affects extraskeletal systems. In this article, we describe three interesting patients suffering from hypovitaminosis D with dermatologic manifestations of erythema nodosum, heel fissures, and palmar hyperhidrosis. All the three cases responded well to treatment with vitamin D. Similar cases have not been reported earlier. [ABSTRACT FROM AUTHOR]

Erythema nodosum (EN), the most common form of panniculitis, is a reactive inflammation of the subcutaneous fat clinically presented with a sudden onset of painful, erythematous, nodular, subcutaneous lesions, typically localized to the pretibial area. EN is commonly caused by numerous infections (especially beta‐haemolytic streptococcal infections), autoimmune diseases (sarcoidosis), inflammatory bowel conditions and drugs. EN induced by Covid‐19 vaccines is rarely reported. We describe an original clinical observation of a 75‐year‐old woman who presented with EN after receiving the second dose of BNT162b2, an mRNA vaccine. [ABSTRACT FROM AUTHOR]

Intraocular tuberculosis should always be deemed as a differential diagnosis due to its high importance, in addition to the high morbidity of systemic infection. This condition may be associated with extraocular manifestations that are not prevalent in tuberculosis. The author reported a case of ocular tuberculosis vasculitis associated with erythema nodosum and Poncet’s disease, with resolution of the medical findings and symptoms after the standard treatment for tuberculosis. [ABSTRACT FROM AUTHOR]

Background Only 0.2% of coccidioidomycosis (CM) diagnoses were made in patients (pts) with pneumonia (PNA) in urgent care (UC), because they were not being tested for CM. Our objective in this study was to improve CM testing rates. Methods This was a time series of clinician practice before and after an intervention that occurred at UC clinics in Phoenix and Tucson Arizona. All patients in UC were >18 years old. We included information about CM in periodic educational activities for clinicians. Coccidioidal serologic testing (CST), CST results, and their relation to International Classification of Diseases, Tenth Revision (ICD-10) codes were extracted from medical records. Results Urgent care received 2.1 million visits from 1.5 million patients. The CST orders per 104 visits increased from 5.5 to 19.8 (P <.0001). Percentage positive CSTs were highest for August, November, and December (17.0%) versus other months (10.6%). Positive CSTs were associated with PNA ICD-10 codes, and, independently, for Erythema nodosum (EN) which had the highest positivity rate (61.4%). Testing of PNA pts increased on first visits and on second visits when the first CST was negative. Yearly rates of PNA due to CM ranged from 17.3% to 26.0%. Despite this improvement, CST was still not done for over three quarters of pts with PNA. This was a noncomparative study. Conclusions Routine quality improvement activities have significantly but only partially improved rates of testing pts with PNA for CM in UC clinics located in a highly endemic area. Innovative strategies may be needed to improve current practice. Also in our region, EN, independent of PNA, is a strong predictor of CM. [ABSTRACT FROM AUTHOR]

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]

Erythema nodosum (EN) is a common panniculitis characterized by tender erythematous nodules predominantly on the pretibial area and represents a hypersensitivity reaction to multiple triggers. COVID19 infection and vaccination have been associated with EN in the adult population. We report a pediatric case of EN following COVID19 infection and review the literature on COVID19 infection and COVID19 immunization‐related EN. [ABSTRACT FROM AUTHOR]

Granulomatous lobular mastitis (GLM) is a benign inflammatory disease of the mammary gland with unknown etiology. Erythema nodosum (EN) is a rare, extramammary symptom of GLM. The purpose of this article was to investigate the clinical features of EN associated with GLM. We recruited 102 GLM patients diagnosed between December 2018 and December 2021 at Renmin Hospital of Wuhan University. The clinical characteristics and laboratory indices of the EN group (n = 12) and the non-EN group (n = 90) were compared. The proportion of GLM patients with lesions involving ≥2 quadrants and high peripheral white blood cell count, absolute neutrophil count and neutrophil-to-lymphocyte ratio (NLR) was larger in the EN group than in the non-EN group (p = 0.002, 0.025, 0.014, 0.002, respectively). The duration of EN was longer in GLM patients with EN than in GLM patients without EN (p = 0.005). GLM patients with EN had more abscesses and sinus tracts than those without EN (p = 0.003, 0.038). Lesions involving ≥2 quadrants and the NLR were positively associated with the occurrence of EN (R = 0.304, 0.0302, p = 0.002, 0.002). Receiver operating characteristic curve analysis revealed that the area under the curve of the NLR was 0.770. When NLR > 5.73, the sensitivity and specificity of predicting EN were 66.67% and 87.78%, respectively. Our findings suggest that GLM concomitant with EN suggests the presence of a more severe condition and extensive lesions. [ABSTRACT FROM AUTHOR]

Introduction: Nodular skin lesions in patients with acute myeloid leukemia (AML) raise clinical suspicion for leukemia cutis versus fungal infections. Here, we report a rare case of treatment-related erythema nodosum (EN) in a patient with AML. Case Report: Approximately 5 weeks after the initiation of sorafenib and one week after azacitidine initiation, a 32-year-old man with primary refractory AML presented with several painful red nodules on the lower extremities. Histological examination established a diagnosis of EN. Management and Outcome: Treatment with topical and oral steroids led to complete resolution of the nodules. However, once the dose of steroids was reduced, the lesions rapidly recurred. Higher dose steroids were reinitiated, again with a resolution of the nodules, confirming steroid responsiveness of the underlying process. Discussion: Given the onset of lesions one week after the initiation of azacitidine and 5 weeks after the initiation of sorafenib, azacitidine was considered the more likely culprit. Only 2 cases of EN-like eruption after azacitidine and 1 case after sorafenib have been reported. Although fungal infections and leukemia cutis are the top differentials considered for skin nodules in a patient with AML, EN should be considered as an alternative diagnosis. Correct diagnosis is critical because it will guide treatment. [ABSTRACT FROM AUTHOR]

Background: Erythema nodosum leprosum (ENL) is a reactional state observed in the lepromatous spectrum of leprosy. Currently, systemic steroids and thalidomide constitute the backbone of ENL therapy. Aim: The aim of this study was to evaluate the efficacy of apremilast as a standalone steroid-sparing drug for ENL and its combination with aspirin for selected cases. Materials and Methods: This was a pilot study on 10 patients having recrudescence of ENL following reduction of prednisolone dose to 20mg. Apremilast (30 mg twice daily) was administered to these patients as prednisolone was gradually tapered. The severity of ENL was evaluated based on the 16-item ENLIST ENL Severity Scale (EESS). If the EESS score reduced to zero with 20 mg of prednisolone following apremilast addition, patients were considered apremilast responsive. In case the EESS score reduced by> 50% then low-dose aspirin was added to the therapeutic regimen with gradual taper of steroids, and patients were accordingly evaluated. Those patients not responding to apremilast were labeled non-responders and were switched to thalidomide after appropriate investigations. Results: Out of 10 patients, 1 demonstrated complete clinical response with apremilast. In 5 patients the EESS score with apremilast had reduced by 50% or more; and following the addition of low-dose aspirin complete clinical cure was obtained. The remaining 4 patients were apremilast unresponsive. Conclusion: Apremilast may not be an effective standalone steroid-sparing drug for ENL in all patients. EESS scoring is a valuable tool in assessing treatment responses in all patients with ENL. Low-dose aspirin shows efficacy in those ENL patients demonstrating partial response to apremilast. [ABSTRACT FROM AUTHOR]

Background Erythema Nodosum leprosum (ENL) is a type 2 hypersensitive reaction mostly affecting multibacillary leprosy types. Understanding the risk factors of ENL progression is necessary to prevent complications and further damage. Methods A case-control descriptive study on leprosy patients visiting the Dermatovenereology outpatient clinic of Dr. Moewardi Hospital, Surakarta, Indonesia from January 2016 to December 2020. The data taken from medical records of patients were sex, age, education, job, type of leprosy based on WHO or Ridley-Jopling, ENL onset, the length of being on multidrug therapy (MDT), and bacterial index. We analyzed the data statistically with the Chi-Square test and Logistic regression analysis, and the significance was determined with P <0.05. Results We obtained 98 subjects who were dominated by males (69.4%). Leprosy mostly occurred in subjects aged between 26 and 45 years old (41.8%). Most of our subjects were primary school graduates (47%). Farmers predominated our subjects. Bivariate analysis showed no significant relationship between sex as well as age and ENL (p=0.738 and p=0.244, respectively). ENL significantly related to WHO-based leprosy type, LL as well as BL type, onset of ENL, length of MDT consumption, and bacterial index (p=0.000,p=0.000,p=0.013,p=0.009, and p=0.014, respectively). Conclusion There was a significant correlation between the occurrence of ENL and WHO type of leprosy, Ridley-Jopling type of leprosy, the onset of ENL, duration of MDT, and Bacterial Index. The most significant relationship was between Ridley-Jopling type of leprosy and the occurrence of leprosy. [ABSTRACT FROM AUTHOR]

This 38‐year‐old man has a familial BRCA2 mutation. He presented with skin erythema, polyarthritis, dactylitis, and febrile erythema nodosum; a biopsy of a liver metastase revealed acinar cell carcinoma of the pancreas. After FOLFIRINOX, olaparib was initiated, and 24 months after, the patient was PS 0 and asymptomatic. [ABSTRACT FROM AUTHOR]

Sarcoidosis is an inflammatory and granulomatous disorder, developed due to dysregulation between immune response and certain environmental antigens. We hereby report an interesting case of sarcoidosis following COVID‐19 vaccination (COVIran Barekat), which presented with inflammation of previous tattoo sites as well as the development of erythema nodosum and systemic lymphadenopathy, suggested a possible link between the COVID vaccination and dysregulation of the inflammatory process and served as a reminder for clinicians to have enough vigilance before proposing a vaccine booster to these patients. [ABSTRACT FROM AUTHOR]

Erythema nodosum (EN) is a poly-etiological disease with an acute flow that is characterized by symmetric emergence of painful nodules often in pretibial areas. A twenty-month-old male child was admitted to hospital for evaluation of the eruptive skin changes in the lower extremities and forearms. The disease began 10 days before getting febricity and loose stools. The laboratory analysis showed an elevated erythrocyte sedimentation rate and leukocytosis. Blood cultures demonstrated the presence of coagulase-negative Staphylococcus, while Proteus vulgaris was isolated in urine cultures. After initiation of the empiric antibiotic therapy and then, the targeted antibiotic therapy according to the antibiogram, there was a significant improvement in a general condition and regression of cutaneous lesions. Erythema nodosum in the present case, is the result of staphylococcal bacteremia although Proteus vulgaris cannot be excluded as a cause. [ABSTRACT FROM AUTHOR]