Quiz
Leg rashes and unwell – 10 cases

Each of these patients is unwell and presented with a rash on their legs.

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

Case 4

A pregnant woman complained of painful lumps on her shins, and aching knees and ankles. On examination, she had several erythematous subcutaneous nodules on each leg. A careful history and extensive investigations failed to reveal underlying systemic disease. She was treated with paracetamol. The nodules persisted for a couple of months before resolving spontaneously.

What is the name of the skin condition?

Erythema nodosum

What underlying systemic disease(s) or condition is it caused by?

This is erythema nodosum. Inflammatory subcutaneous nodules are caused by panniculitis, or inflammation of the subcutaneous fat. Panniculitis may acute or chronic; lobular, septal or both; and associated or not associated with vasculitis – so biopsy is useful to distinguish these. Erythema nodosum is the clinical manifestation of an acute septal panniculitis without vasculitis. It is considered a reaction to an underlying systemic event. It is associated with infections (most often streptococcal infection), sarcoidosis, rheumatological diseases, inflammatory bowel diseases, autoimmune disorders, medications and malignancy. An association with pregnancy is well established, but the pathogenesis is not understood.

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