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PATHOGENESIS OF ERYTHEMA NODOSUM: WITH SPECIAL REFERENCE TO TUBERCULOSIS, STREPTOCOCCIC INFECTION AND RHEUMATIC FEVER

PATHOGENESIS OF ERYTHEMA NODOSUM: WITH SPECIAL REFERENCE TO TUBERCULOSIS, STREPTOCOCCIC INFECTION... Abstract Considerable attention has been directed in recent years to the etiology of erythema nodosum. Various explanations for this cutaneous eruption have been given and include the following: (1) It is a manifestation of tuberculosis; (2) it occurs as part of the symptom complex of rheumatic fever; (3) it has its origin in streptococcic infection; (4) it is a specific infectious disease the etiology of which is not known, and (5) it may occur during the course of various infections, and any one of a number of toxic and bacterial agents may be the cause, including the tubercle bacillus and the hemolytic streptococcus. While most writers appear to accept the tuberculous concept of erythema nodosum, my colleagues and I have been impressed by the close association which the appearance of this eruption has with streptococcic infections. Because of the apparent confusion in the literature and our own previous observations, the following References 1. Drs. Henry J. Bakst, J. A. Foley and M. E. Lamb ( Gonorrheal Septicemia and Erythema Nodosum , Ann. Int. Med. 9:790, 1935).Crossref 2. Landouzy, L.: Érythème noueux et septicémies à bacilles de Koch , Bull. Acad. de méd., Paris 70:400, 1913. 3. Arena, A. A.: Existence du Myobacterium tuberculosis dans les nodules de l'érythème noueux , Compt. rend. Soc. de biol. 115:340, 1934. 4. Gutman, R. A.: Un cas de érythème noueux avec présence de bacilles de Koch dans le sang circulant , Paris méd. 21:416, 1917. 5. Brian, O.: Untersuchungen über die Aetiologie des Erythema nodosum , Deutsches Arch. f. klin. Med. 104:272, 1911. 6. Hildebrandt, W.: Zur Aetiologie des Erythema nodosum , München. med. Wchnschr. 54:310, 1907. 7. Ernberg, H.: Erythema nodosum and Tuberculosis , Am. J. Dis. Child. 46:1297 ( (Dec.) ) 1933 8. Erythema Nodosum , Nord. med. tidskr. 4:230, 1932. 9. Wallgren, A.: Paratuberkulöse Krankheitserscheinungen , in Engel, S., and von Pirquet, C.: Handbuch der Kindertuberkulose , Leipzig, Georg Thieme, 1930, vol. 1, p. 809 10. Tubercle Bacilli in Children with Erythema Nodosum: Demonstration by Gastric Lavage , Am. J. Dis. Child. 41:816 ( (April) ) 1931.Crossref 11. Dickey, L. B.: Erythema Nodosum and Tuberculosis in Children , Am. Rev. Tuberc. 26:614, 1932. 12. Hess, J. H., and Berman, S. L.: Erythema Nodosum in Childhood , M. Clin. North America 12:49, 1928. 13. Holmes, E. M.: Some Aspect of Dermatological Work in Denmark , Brit. J. Dermat. 46:84, 1934.Crossref 14. Symes, J. O.: Significance of Erythema Nodosum , Brit. J. Dermat. 44: 181, 1932.Crossref 15. Foerster, O. H.: The Association of Erythema Nodosum and Tuberculosis , J. A. M. A. 63:1266 ( (Oct. 10) ) 1914.Crossref 16. Stokes, J. H.: Erythema Nodosum and Tuberculosis: Report of a Case Terminating in Tuberculous Meningitis, with Necropsy , Arch. Dermat. & Syph. 3:29 ( (Jan.) ) 1921. 17. Meara, F. S., and Goodridge, M.: The Relationship Between Erythema Nodosum and Tuberculosis, with the Report of a Case , Am. J. M. Sc. 143:393, 1912. 18. Howe, J. Duncan: Erythema Nodosum and Tuberculous Meningitis , Brit. M. J. 2:864, 1921. 19. Giertsen, C.: Ninety-Three Cases of Erythema Nodosum , Acta med. Scandinav. 82:87, 1934. 20. Ustvedt, H. J., and Johannessen, A. S.: Érythème noueux tuberculose ultérieure , Acta med. Scandinav. 80:262, 1933. 21. Engelsgaard, H. d'U. A., cited in Erythema Nodosum and Tuberculosis , Lancet 1:597, 1931. 22. Mogensen, E.: Reinvestigations in Erythema Nodosum , Acta med. Scandinav. 80:480, 1933.Crossref 23. Forman, L., and Whitwell, G. P. B.: Preliminary Observations on Erythema Nodosum , Guy's Hosp. Rep. 84:213, 1934. 24. Arena.2b 25. Landau, A.: Multiple Cases of Erythema Nodosum in a Class of School Children , Arch. Dis. Childhood 7:77, 1932.Crossref 26. Rotnes, P. L.: Eine Familien-Endemie von Erythema nodosum , Dermat. Ztschr. 67:259, 1933.Crossref 27. Brian.3a 28. Gamstedt, E.: Ueber die Tuberkulinempfindlichkeit bei Erythema nodosum vor der Eruption , Monatschr. f. Kinderh. 59:111, 1933 29. Laurinsich, A.: Eritema nodoso e tubercolosi , Pediatria 40:1309, 1932. 30. Heimbeck, J., quoted from Giertsen.11a 31. Chaufford, A., and Troisier, J.: Érythème noueux expérimentale par injection intradermique de tuberculine , Bull. et mém. Soc. méd. d. hôp. de Paris 27:7, 1909. 32. Ernberg, H.: Erythema nodosum: Natur und Bedeutung , Jahrb. f. Kinderh. 95:1, 1921. 33. Hoyer, W. A.: Untersuchungen über das Blutbild bei Erythema nodosum mit Hinblick auf die Aetiologie , Acta med. Scandinav. 57:587, 1923.Crossref 34. Móritz, D. U., and Dóra, A.: Das lokale Blutbild bei Erythema nodosum , Arch. f. Kinderh. 104:65, 1935. 35. Nobécourt, P., and Ducas, P.: Érythème noueux et conjonctivite phlycténulaire , Presse méd. 42:1241, 1934. 36. Rist, E., and Rolland, J.: Étude sur la réinfection tuberculeuse , Ann. de méd. 2:13, 1914. 37. Collis, W. R. F.: A New Conception of the Aetiology of Erythema Nodosum , Quart. J. Med. 1:141, 1932. 38. Collis, W. R. F.: Erythema Nodosum , Lancet 2:732, 1934. 39. Pilot, I.: Focal Infection and Erythema Nodosum , J. A. M. A. 101:2145 ( (Dec. 30) ) 1933. 40. Pilot, I., and Davis, D. J.: Sporadic Septic Sore Throat , J. A. M. A. 97:1691 ( (Dec. 5) ) 1931.Crossref 41. Goldstein H. I.: Erythema Multiforme and Erythema Nodosum with Streptococcic Sore Throat , M. J. & Rec. 134:266, 1931. 42. Stone, W. R.: Erythema Nodosum Associated with Streptococcic Faucitis , New York M. J. 118:673, 1923. 43. Shepheard, E.: Septic Sore Throat Complicated by Erythema Nodosum , Brit. M. J. 1:902, 1926. 44. Gaub, W. H.: Erythema Nodosum , J. A. M. A. 100:601 ( (Feb. 25) ) 1933. 45. Traut, E. F.: Hypersensitivity in Rheumatic Disease , M. Clin. North America 18:1237, 1935. 46. Coglievina, B.: Aetiologie des Erythema nodosum , Wien. klin. Wchnschr. 37:413, 1924. 47. Móritz, D. V.: Erythema nodosum und Scharlach , Arch. f. Kinderh. 103: 227, 1934. 48. Slot, G.: Erythema Nodosum Treated with Antistreptococcal Serum , Lancet 2:600, 1934.Crossref 49. Mackenzie, S.: On Erythema Nodosum, Especially Dealing with Its Connection with Rheumatism , Tr. Clin. Soc. London 19:215, 1886. 50. Holmes, A. H.: Erythema Nodosum , Lancet 2:784, 1934. 51. Markson, A.: Antistreptococcal Serum for "Rheumatic" Affections , Brit. M. J. 1:129, 1935.Crossref 52. Claman, I. A.: Erythema Nodosum: A Link in a Rheumatic Syndrome , Am. J. Dis. Child. 48:1448 ( (Dec.) ) 1934. 53. Symes, J. O.: Erythema Nodosum: An Acute Specific Fever , Brit. M. J. 2:741, 1921.Crossref 54. Comby, J.: Érythème noueux chez les enfants , Arch. de méd. d'enf. 26:329, 1923. 55. Woringer, P.: Érythème noueux familial , J. de méd. de Paris 42:241, 1923. 56. Lendon, A. A.: Nodal Fever , London, Baillière, Tindall & Cox, 1905. 57. Goldberg-Curth, A.: Zur Pathogenese des Erythema nodosum , Monatschr. f. Kinderh. 61:249, 1935. 58. Fornara, P.: Le problème de l'érythème noueux , Rev. franç. de pédiat. 6:723, 1930. 59. Rosenow, E. C.: The Etiology and Experimental Production of Erythema Nodosum , J. Infect. Dis. 16:367, 1915.Crossref 60. Moon, V. H., and Strauss, A.: Erythema Nodosum; Character and Etiology , Arch. Dermat. & Syph. 26:78 ( (July) ) 1932. 61. Blumer, G.: The Febrile Types of Erythema Multiforme and Erythema Nodosum , New England J. Med. 195:515, 1926. 62. Josephsen, G.: Erythema Nodosum , Ugesk. f. læger 95:423, 1933. 63. Amtman, L., and Pilot, I.: Lymphogranuloma Inguinale , Arch. Dermat. & Syph. 26:868 ( (Nov.) ) 1932. 64. Hellerström, S.: A Contribution to the Knowledge of Lymphogranuloma Inguinale , Acta dermat-venereol. ( (supp.) ) 1:5, 1929. 65. Elwell, L. B.: Erythema Nodosum and Focal Infection , Brit. M. J. 1:974, 1935. 66. Montgomery, L. C.: Chronic Meningococcal Septicemia , Canad. M. A. J. 20:266, 1929. 67. Master, A. M.: Meningococcemia with Endocarditis , J. A. M. A. 96:164 ( (Jan. 17) ) 1931.Crossref 68. Netter, A.: Fièvre intermittente par septicémie méningococcique , Bull. et mém. Soc. méd. d. hôp. de Paris 41:1018, 1917. 69. Morgan, J. H.: Chronic Meningococcus Septicemia , Bull. Johns Hopkins Hosp. 32:245, 1921. 70. Leviseur, F. J.: Erythema Nodosum Syphiliticum (Mauriac's Disease) , J. Cutan. Dis. 29:579, 1911. 71. Stillians, A. W., and Senear, F. E.: Erythema Nodosum Syphiliticum , Arch. Dermat. & Syph. 1:607 ( (May) ) 1920. 72. Fischl, F.: Erythema nodosum lueticum; Spirochätenbefund und Histologie , Arch. f. Dermat. u. Syph. 129:361, 1921. 73. Boganovitch, V.: Five Cases of Post-Influenzal Erythema Nodosum , Arch. Dis. Childhood 5:56, 1930. 74. Brooke, P. A.: Erythema Nodosum-Like Lesions in Chronic Ulcerative Colitis , New England J. Med. 209:233, 1933. 75. Rankin, F. W.; Bargen, J. A., and Buie, L. A.: The Colon, Rectum and Anus , Philadelphia, W. B. Saunders Company, 1932, p. 238. 76. Weber, F. P.: Erythema Nodosum with Tuberculous Bacillaemia and Meningitis , Brit. J. Child. Dis. 21:119, 1924. 77. Perrin, L.: Un cas d'érythème noueux dû à l'iodure de potassium , Marseille-méd. 29:567, 1892. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

PATHOGENESIS OF ERYTHEMA NODOSUM: WITH SPECIAL REFERENCE TO TUBERCULOSIS, STREPTOCOCCIC INFECTION AND RHEUMATIC FEVER

SPINK, WESLEY W.
Archives of Internal Medicine , Volume 59 (1) – Jan 1, 1937
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Publisher
American Medical Association
Copyright
Copyright © 1937 American Medical Association. All Rights Reserved.
ISSN
0730-188X
DOI
10.1001/archinte.1937.00170170071005
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Abstract

Abstract Considerable attention has been directed in recent years to the etiology of erythema nodosum. Various explanations for this cutaneous eruption have been given and include the following: (1) It is a manifestation of tuberculosis; (2) it occurs as part of the symptom complex of rheumatic fever; (3) it has its origin in streptococcic infection; (4) it is a specific infectious disease the etiology of which is not known, and (5) it may occur during the course of various infections, and any one of a number of toxic and bacterial agents may be the cause, including the tubercle bacillus and the hemolytic streptococcus. While most writers appear to accept the tuberculous concept of erythema nodosum, my colleagues and I have been impressed by the close association which the appearance of this eruption has with streptococcic infections. Because of the apparent confusion in the literature and our own previous observations, the following References 1. Drs. Henry J. Bakst, J. A. Foley and M. E. Lamb ( Gonorrheal Septicemia and Erythema Nodosum , Ann. Int. Med. 9:790, 1935).Crossref 2. Landouzy, L.: Érythème noueux et septicémies à bacilles de Koch , Bull. Acad. de méd., Paris 70:400, 1913. 3. Arena, A. A.: Existence du Myobacterium tuberculosis dans les nodules de l'érythème noueux , Compt. rend. Soc. de biol. 115:340, 1934. 4. Gutman, R. A.: Un cas de érythème noueux avec présence de bacilles de Koch dans le sang circulant , Paris méd. 21:416, 1917. 5. Brian, O.: Untersuchungen über die Aetiologie des Erythema nodosum , Deutsches Arch. f. klin. Med. 104:272, 1911. 6. Hildebrandt, W.: Zur Aetiologie des Erythema nodosum , München. med. Wchnschr. 54:310, 1907. 7. Ernberg, H.: Erythema nodosum and Tuberculosis , Am. J. Dis. Child. 46:1297 ( (Dec.) ) 1933 8. Erythema Nodosum , Nord. med. tidskr. 4:230, 1932. 9. Wallgren, A.: Paratuberkulöse Krankheitserscheinungen , in Engel, S., and von Pirquet, C.: Handbuch der Kindertuberkulose , Leipzig, Georg Thieme, 1930, vol. 1, p. 809 10. Tubercle Bacilli in Children with Erythema Nodosum: Demonstration by Gastric Lavage , Am. J. Dis. Child. 41:816 ( (April) ) 1931.Crossref 11. Dickey, L. B.: Erythema Nodosum and Tuberculosis in Children , Am. Rev. Tuberc. 26:614, 1932. 12. Hess, J. H., and Berman, S. L.: Erythema Nodosum in Childhood , M. Clin. North America 12:49, 1928. 13. Holmes, E. M.: Some Aspect of Dermatological Work in Denmark , Brit. J. Dermat. 46:84, 1934.Crossref 14. Symes, J. O.: Significance of Erythema Nodosum , Brit. J. Dermat. 44: 181, 1932.Crossref 15. Foerster, O. H.: The Association of Erythema Nodosum and Tuberculosis , J. A. M. A. 63:1266 ( (Oct. 10) ) 1914.Crossref 16. Stokes, J. H.: Erythema Nodosum and Tuberculosis: Report of a Case Terminating in Tuberculous Meningitis, with Necropsy , Arch. Dermat. & Syph. 3:29 ( (Jan.) ) 1921. 17. Meara, F. S., and Goodridge, M.: The Relationship Between Erythema Nodosum and Tuberculosis, with the Report of a Case , Am. J. M. Sc. 143:393, 1912. 18. Howe, J. Duncan: Erythema Nodosum and Tuberculous Meningitis , Brit. M. J. 2:864, 1921. 19. Giertsen, C.: Ninety-Three Cases of Erythema Nodosum , Acta med. Scandinav. 82:87, 1934. 20. Ustvedt, H. J., and Johannessen, A. S.: Érythème noueux tuberculose ultérieure , Acta med. Scandinav. 80:262, 1933. 21. Engelsgaard, H. d'U. A., cited in Erythema Nodosum and Tuberculosis , Lancet 1:597, 1931. 22. Mogensen, E.: Reinvestigations in Erythema Nodosum , Acta med. Scandinav. 80:480, 1933.Crossref 23. Forman, L., and Whitwell, G. P. B.: Preliminary Observations on Erythema Nodosum , Guy's Hosp. Rep. 84:213, 1934. 24. Arena.2b 25. Landau, A.: Multiple Cases of Erythema Nodosum in a Class of School Children , Arch. Dis. Childhood 7:77, 1932.Crossref 26. Rotnes, P. L.: Eine Familien-Endemie von Erythema nodosum , Dermat. Ztschr. 67:259, 1933.Crossref 27. Brian.3a 28. Gamstedt, E.: Ueber die Tuberkulinempfindlichkeit bei Erythema nodosum vor der Eruption , Monatschr. f. Kinderh. 59:111, 1933 29. Laurinsich, A.: Eritema nodoso e tubercolosi , Pediatria 40:1309, 1932. 30. Heimbeck, J., quoted from Giertsen.11a 31. Chaufford, A., and Troisier, J.: Érythème noueux expérimentale par injection intradermique de tuberculine , Bull. et mém. Soc. méd. d. hôp. de Paris 27:7, 1909. 32. Ernberg, H.: Erythema nodosum: Natur und Bedeutung , Jahrb. f. Kinderh. 95:1, 1921. 33. Hoyer, W. A.: Untersuchungen über das Blutbild bei Erythema nodosum mit Hinblick auf die Aetiologie , Acta med. Scandinav. 57:587, 1923.Crossref 34. Móritz, D. U., and Dóra, A.: Das lokale Blutbild bei Erythema nodosum , Arch. f. Kinderh. 104:65, 1935. 35. Nobécourt, P., and Ducas, P.: Érythème noueux et conjonctivite phlycténulaire , Presse méd. 42:1241, 1934. 36. Rist, E., and Rolland, J.: Étude sur la réinfection tuberculeuse , Ann. de méd. 2:13, 1914. 37. Collis, W. R. F.: A New Conception of the Aetiology of Erythema Nodosum , Quart. J. Med. 1:141, 1932. 38. Collis, W. R. F.: Erythema Nodosum , Lancet 2:732, 1934. 39. Pilot, I.: Focal Infection and Erythema Nodosum , J. A. M. A. 101:2145 ( (Dec. 30) ) 1933. 40. Pilot, I., and Davis, D. J.: Sporadic Septic Sore Throat , J. A. M. A. 97:1691 ( (Dec. 5) ) 1931.Crossref 41. Goldstein H. I.: Erythema Multiforme and Erythema Nodosum with Streptococcic Sore Throat , M. J. & Rec. 134:266, 1931. 42. Stone, W. R.: Erythema Nodosum Associated with Streptococcic Faucitis , New York M. J. 118:673, 1923. 43. Shepheard, E.: Septic Sore Throat Complicated by Erythema Nodosum , Brit. M. J. 1:902, 1926. 44. Gaub, W. H.: Erythema Nodosum , J. A. M. A. 100:601 ( (Feb. 25) ) 1933. 45. Traut, E. F.: Hypersensitivity in Rheumatic Disease , M. Clin. North America 18:1237, 1935. 46. Coglievina, B.: Aetiologie des Erythema nodosum , Wien. klin. Wchnschr. 37:413, 1924. 47. Móritz, D. V.: Erythema nodosum und Scharlach , Arch. f. Kinderh. 103: 227, 1934. 48. Slot, G.: Erythema Nodosum Treated with Antistreptococcal Serum , Lancet 2:600, 1934.Crossref 49. Mackenzie, S.: On Erythema Nodosum, Especially Dealing with Its Connection with Rheumatism , Tr. Clin. Soc. London 19:215, 1886. 50. Holmes, A. H.: Erythema Nodosum , Lancet 2:784, 1934. 51. Markson, A.: Antistreptococcal Serum for "Rheumatic" Affections , Brit. M. J. 1:129, 1935.Crossref 52. Claman, I. A.: Erythema Nodosum: A Link in a Rheumatic Syndrome , Am. J. Dis. Child. 48:1448 ( (Dec.) ) 1934. 53. Symes, J. O.: Erythema Nodosum: An Acute Specific Fever , Brit. M. J. 2:741, 1921.Crossref 54. Comby, J.: Érythème noueux chez les enfants , Arch. de méd. d'enf. 26:329, 1923. 55. Woringer, P.: Érythème noueux familial , J. de méd. de Paris 42:241, 1923. 56. Lendon, A. A.: Nodal Fever , London, Baillière, Tindall & Cox, 1905. 57. Goldberg-Curth, A.: Zur Pathogenese des Erythema nodosum , Monatschr. f. Kinderh. 61:249, 1935. 58. Fornara, P.: Le problème de l'érythème noueux , Rev. franç. de pédiat. 6:723, 1930. 59. Rosenow, E. C.: The Etiology and Experimental Production of Erythema Nodosum , J. Infect. Dis. 16:367, 1915.Crossref 60. Moon, V. H., and Strauss, A.: Erythema Nodosum; Character and Etiology , Arch. Dermat. & Syph. 26:78 ( (July) ) 1932. 61. Blumer, G.: The Febrile Types of Erythema Multiforme and Erythema Nodosum , New England J. Med. 195:515, 1926. 62. Josephsen, G.: Erythema Nodosum , Ugesk. f. læger 95:423, 1933. 63. Amtman, L., and Pilot, I.: Lymphogranuloma Inguinale , Arch. Dermat. & Syph. 26:868 ( (Nov.) ) 1932. 64. Hellerström, S.: A Contribution to the Knowledge of Lymphogranuloma Inguinale , Acta dermat-venereol. ( (supp.) ) 1:5, 1929. 65. Elwell, L. B.: Erythema Nodosum and Focal Infection , Brit. M. J. 1:974, 1935. 66. Montgomery, L. C.: Chronic Meningococcal Septicemia , Canad. M. A. J. 20:266, 1929. 67. Master, A. M.: Meningococcemia with Endocarditis , J. A. M. A. 96:164 ( (Jan. 17) ) 1931.Crossref 68. Netter, A.: Fièvre intermittente par septicémie méningococcique , Bull. et mém. Soc. méd. d. hôp. de Paris 41:1018, 1917. 69. Morgan, J. H.: Chronic Meningococcus Septicemia , Bull. Johns Hopkins Hosp. 32:245, 1921. 70. Leviseur, F. J.: Erythema Nodosum Syphiliticum (Mauriac's Disease) , J. Cutan. Dis. 29:579, 1911. 71. Stillians, A. W., and Senear, F. E.: Erythema Nodosum Syphiliticum , Arch. Dermat. & Syph. 1:607 ( (May) ) 1920. 72. Fischl, F.: Erythema nodosum lueticum; Spirochätenbefund und Histologie , Arch. f. Dermat. u. Syph. 129:361, 1921. 73. Boganovitch, V.: Five Cases of Post-Influenzal Erythema Nodosum , Arch. Dis. Childhood 5:56, 1930. 74. Brooke, P. A.: Erythema Nodosum-Like Lesions in Chronic Ulcerative Colitis , New England J. Med. 209:233, 1933. 75. Rankin, F. W.; Bargen, J. A., and Buie, L. A.: The Colon, Rectum and Anus , Philadelphia, W. B. Saunders Company, 1932, p. 238. 76. Weber, F. P.: Erythema Nodosum with Tuberculous Bacillaemia and Meningitis , Brit. J. Child. Dis. 21:119, 1924. 77. Perrin, L.: Un cas d'érythème noueux dû à l'iodure de potassium , Marseille-méd. 29:567, 1892.

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Archives of Internal Medicine – American Medical Association

Published: Jan 1, 1937

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