| Background: Erythema nodosum(EN)is an inflammatory disease involving in the subcutaneous fat septum.The disease is classically an acute eruption,running a self-limiting course lasting several weeks.Chronic erythema nodosum(CEN),also known as subacute nodular migratory panniculitis or migratory erythema nodosum,is a relatively rare disease.It is distinguished by its prolonged course which may continue for months to years.The etiology of CEN is unknown.There is no consensus on the diagnosis and treatment.Objective: This study retrospectively analyzed the clinicopathologic feature and treatment of CEN,combined with literature review,to summarize the experience of diagnosis and treatment of CEN.Methods:(1)The cases in this study had previously diagnosed with CEN from January 2018 to December 2020 in the Qingdao municipal hospital.The patients’ clinical and histopathology records were reviewed.(2)Literature retrieval was conducted on CNKI,Wanfang,VIP,Pub Med and other Chinese and English databases from 1995 to 2020 using keywords such as"慢性结节性红斑,迁移性结节性红斑,游走性结节性红斑,亚急性结节性游走性脂膜炎,chronic erythema nodosum,subacute nodular migratory panniculitis,erythema nodosum migrans".To summarize the clinicopathological features,the treatment methods and effects of CEN.Results:(1)General information of this study: A total of 7 cases were enrolled,including 1 male and 6 females,male: female =1:6,aged 19 to 76 years,duration ranged from 3 months to 3 years.Clinical manifestations: all patients presented red and dark red nodules and plaques,with wandering tendency in 1 case.Lesions mostly attended to lower extremities(7/7),followed by trunk(1/7)and upper extremities(1/7),4 cases showed single lesions(4/7),3 cases showed multiple lesions(3/7),3 cases showed symmetry(3/7),4 case showed unilateral(4/7).Accompanying symptoms: mild pian(6/7),moderate pain(1/7),lower limb edema(1/7).Associated systemic diseases: hypertension(2/7),diabetes(1/7),hypothyroidism(1/7),leukopenia(1/7),postoperative adrenal tumor(1/7),chronic urticaria(1/7),fatty liver(2/7). Laboratory findings: ESR was elevated in 4 cases(4/5),WBC count was decreased in 1 case(1/7),RBC count and hemoglobin were decreased in 2 cases(2/7),and CRP was elevated in 3 cases(3/7).Hypothyroidism and ANA spectrum was abnormality in 1 cases(1/2).Histopathology: All the 7 patients presented with septal panniculitis.Fat septal thickening,fibrosis,granuloma formation,capillary hyperplasia and fat lobule involvement were observed in all cases,but lack of vasculitis or vascular occlusion.Among them,neutrophilic microabscesses was seen in 1 case. Lipomembranous fat necrosis was seen in 2 cases.Miescher granuloma was seen in1 case.And erythrocyte exocytosis was seen in 5 cases.Treatment: Except for 1 patient who recovered without treatment,the others were treated with glucocorticoid systematically.5 cases were effective,but 1 case relapsed in the course of dosage reduction.(2)Literature review: Exclude the literatures with atypical clinical manifestations and incomplete clinical data.There are 15 literatures about CEN published at home and abroad from January 1995 to December 2020.Conclusion: 1.CEN is seen predominantly in middle-aged women.It typically affect the lower leg,but the arm and trunk are occasionally involved.The clinical manifestations of CEN are varied,usually manifested as erythematous to brownish nodules and plaques,but may also have a wandering tendency.The lesions are solitary or less numerous,the pain is mild,the course of disease is longer,and there is usually no systemic symptoms.2.The vast majority of patients with CEN are idiopathic,and some are associated with streptococcal infections,thyroid disease,pregnancy,and oral contraceptives.3.Histologically,CEN presents as septal panniculitis,similar to the late stage of EN,but the septal thickening,fibrosis,and granulomatous formation are more pronounced,fat lobules are commonly involved,and lipomembranous fat necrosis can be seen.Capillary hyperplasia is also more obvious,usually without vasculitis,thrombosis.Miescher granuloma was seen in some patients.4.The treatment of glucocorticoid has a good effect,but some patients may relapse in the course of dosage reduction. |
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