Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

548 Erythema Multiforme Major Erythema Nodosum

■Secondary infection, due to breakdown of skin barrier

■Dehydration and malnutrition, due to pain from oral involvement

■Ocular sequelae in severe cases – symblepharon, ectropion, corneal

scarring, rarely blindness

■Strictures of mucosal surfaces – esophagus, urethral, anal

■Cutaneous dyspigmentation

■Permanent scarring of skin uncommon

Prognosis

■Estimates of mortality vary widely in published studies

➣SJS 5–15% mortality

➣TEN up to 50% mortality

■Sepsis is most common cause of death.

Erythema Nodosum..................................

JAMES SEWARD, MD and JEFFREY P. CALLEN, MD

REVISED BY JEFFREY P. CALLEN, MD

history & physical

History

■An acute, inflammatory reaction pattern triggered by wide range of

disease processes

■Commonly associated with streptococcal infections

■Other etiologic associations:

➣Yersinia, salmonella, shigella, systemic fungal infections (coc-

cidioidomycosis, histoplasmosis, and blastomycosis), sporotri-

chosis, toxoplasmosis, tuberculosis, inflammatory bowel dis-

ease, pregnancy, drugs (bromides, iodides, sulfonamides, and

oral contraceptives)

■Also seen with sarcoidosis (the combination of anterior uveitis,

arthritis, bilateral hilar lymphadenopathy, and EN is known as Lof-

gren’s syndrome. These patients may also have fever and malaise.

This process is a self-limited form of sarcoidosis.)

■Inflammatory bowel disease – EN reflects activity of the bowel dis-

ease

■Frequently no underlying disease is found (40%)

■Most commonly seen in young women

■Peak incidence 20–30 years old