Ambulatory Report – 5.17.17 – Shin Nodules…Erythema Nodosum!

Thanks to Grant Smith for presenting a case of a 62 yo M h/o questionable SLE presenting with subcutaneous nodules on the shins thought to be Erythema Nodosum with unclear etiology!
  • Turns out this isn’t LT’s first deep dive into EN!  He was already ahead of the curve in 1984.
    • DDC6576B-C1A7-4A62-AE17-199E0C7D8E72
  • As promised, here’s the document to get a FREE version of Visual Dx!  (It’s great for dermatology and more!)
    • Note: you have to be physically present at the VA when doing this, or on the VA VPN.
    • Getting VisualDx
  • We talked a bunch about the Common etiologies of EN vs. the More Uncommon.  Here’s a list of a bunch of those dx’s (Missing from the list below – Pregnancy!)
    • 173C44D6-960C-4DA6-A6C5-0F8FC74233DF
  • When you find a diagnosis of EN, you should send an initial work up (per UpToDate)
    • CBC (to assess for infxn & malig)
    • ESR +/- CRP (elevation sign of systemic dz & widespread inflam)
    • Antistreptolysin O (ASO) titers (repeated 2-4 wks later)
    • CXR (assess for sarcoid, TB, pulm infxn, lymphoma)
    • PPD or Quantiferon

Evernote Link: https://www.evernote.com/l/ADWRkMKZe3xCCaISL1vIWweJR_Flkg-O-_U

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