Monday, June 04, 2007

Case for Diagnosis

The patient is a 54 yo woman with a 2 week history of a rash on the arms and chest. Two months ago, she had erythema nodosum with atypical features (on her legs). The work-up eventually discovered Crohn's disease. She was started on Asacol around a month ago and around 2 weeks ago developed erythematous papules on arms and anterior chest.

0/E: The new lesions are 6 - 8 mm in diameter erythematous papules with the suggestion of central punctae. The E.N. has resolved.

Lab: Representative lesions were biopied.

Question: What are your thoughts? We will post pathology in around a week.


  1. AnonymousJune 04, 2007

    The picture reminds me of a patient that I once had with Sweet's syndrome, which I understand can be associated with IBD. Does this patient have any systemic symptoms?

    - Ken Fowler

  2. AnonymousJune 05, 2007

    Sweet's fits well - presumably the plaques are tender, and patient perhaps febrile? - Ben Barankin

  3. Target lesions may arise in erythema multiforme (wrong distribution), bullous pemphigoid (too young), Sweet's (best bet in this case I think).

    Mesalazine skin adverse reactions are listed as "Alopecia, psoriasis (rare), pyoderma gangrenosum (rare), dry skin, erythema nodosum, urticaria."

    Amanda Oakley

  4. AnonymousJune 07, 2007

    Crohns ds might present with EN and erythema multiforme which can take atypical picture.Still diarrhea,EN,EM,Sweets ds could be a presenation of Behcets ds.So please ask about other features of Behcets like orogenital ulcerations,eye problems.Also perform PATHERGY TEST.
    khalifa sharquie


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