The Significance of the Radiological Manifestations of Erythema Nodosum

Abstract

Erythema nodosum is described as an acute febrile illness characterised by a painful, nodular, erythematous rash on the shins and forearms and by joint pains and malaise. Occasionally there is a moderate polymorph leucocytosis; the erythrocyte sedimentation rate may be as high as 100 mm. in one hour during the acute stage and rapidly falls to normal when the fever subsides. The usual duration of the illness is ten to fourteen days, but severer forms occur in which high fever may be prolonged for some weeks. Relapses with recurrence of fever and a second crop of nodes are not uncommon. The etiology of erythema nodosum has been the subject of much speculation during the last twenty years. Prior to the 1914–1918 war it was commonly believed to be a manifestation of tuberculosis, but owing to the absence of tubercle bacilli and of typical tuberculous lesions, the rash was classified as a “tuberculide” or para-tuberculous phenomenon. The rash and fever certainly did occur in cases of proven tuberculosis, but an increasing number of reports showed that a similar rash also occurred in streptococcal, gonococcal, and meningococcal fevers. There are a few reported examples of “erythema nodosum” as a complication of syphilis, lympho-granuloma inguinale and leprosy, and many more in association with coccidioido-mycosis.