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Erythema Elevatum Diutinum
Author's Accepted Manuscript
Erythema Elevatum Diutinum Raghav Bansal MBBS, Joshua Aron MD, Ishita Rajnish MBBS
www.amjmedsci.com
PII: DOI: Reference:
S0002-9629(16)30275-0 http://dx.doi.org/10.1016/j.amjms.2016.05.005 AMJMS186
To appear in:
Am J Med Sci
Cite this article as: Raghav Bansal MBBS, Joshua Aron MD, Ishita Rajnish MBBS, Erythema Elevatum Diutinum, Am J Med Sci, http://dx.doi.org/10.1016/j. amjms.2016.05.005 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Erythema Elevatum Diutinum Raghav Bansal MBBS 1, Joshua Aron MD1, Ishita Rajnish MBBS2 1. Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York. 2. Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York. The corresponding author for the manuscript is Raghav Bansal Room D3 -22F 79-01 Broadway, Elmhurst Hospital Center Elmhurst, NY 11373 Phone: 7182005306 Fax: 7183341738 Email: [email protected] No external funding source utilized None of the authors have conflict of interest regarding this manuscript
A 50-year-old man presented with painful nodular lesions of the hand and elbow (Figure A). Laboratory findings revealed high serum IgA level of 2290mg/dl and positive hepatitis C antibody with high viral load. Biopsy revealed lamellar fibrosis, preponderance of neutrophils with leukocytoclasts and histiocytes (Figure B) and was diagnosed with Erythema Elevatum Diutinum (EED).
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EED is a rare and distinctive form of chronic cutaneous leukocytoclastic vasculitis belonging to the group of the neutrophilic dermatoses (1). The lesions manifests as symmetrical, firm, yellow or pinkish to red, purple or brown papules, plaques or nodules on the backs of the hands, feet and extensor surfaces of the extremities overlying joints. EED can occur in any age, but most common in 3rd to 6th decade. Extracutaneous symptoms may include arthralgia, constitutional symptoms and occular abnormalities. The exact pathogenesis of EED is not yet defined but it may occur in isolation or in the context of an inflammatory or systemic disease, paraproteinemia (especially monoclonal IgA gammopathy), infectious (including HIV and Hepatitis) or autoimmune disease. Diagnosis is made based on the clinical and histopathological findings of skin biopsy. The patient was started on dapsone with good response (2). Work up and treatment of an associated underlying cause (if present) is also recommended. Our patient is currently being evaluated for starting Hepatitis C therapy.
1) Prat L, Bouaziz JD, Wallach D et al Neutrophilic dermatoses as systemic diseases. Clin Dermatol. 2014 May-Jun;32(3):376-388. 2) Momen SE, Jorizzo J, Al-Niaimi F Erythema elevatum diutinum: a review of presentation and treatment. J Eur Acad Dermatol Venereol. 2014 Dec;28(12):15941602.
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Erythema Elevatum Diutinum Raghav Bansal MBBS, Joshua Aron MD, Ishita Rajnish MBBS
www.amjmedsci.com
PII: DOI: Reference:
S0002-9629(16)30275-0 http://dx.doi.org/10.1016/j.amjms.2016.05.005 AMJMS186
To appear in:
Am J Med Sci
Cite this article as: Raghav Bansal MBBS, Joshua Aron MD, Ishita Rajnish MBBS, Erythema Elevatum Diutinum, Am J Med Sci, http://dx.doi.org/10.1016/j. amjms.2016.05.005 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Erythema Elevatum Diutinum Raghav Bansal MBBS 1, Joshua Aron MD1, Ishita Rajnish MBBS2 1. Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York. 2. Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York. The corresponding author for the manuscript is Raghav Bansal Room D3 -22F 79-01 Broadway, Elmhurst Hospital Center Elmhurst, NY 11373 Phone: 7182005306 Fax: 7183341738 Email: [email protected] No external funding source utilized None of the authors have conflict of interest regarding this manuscript
A 50-year-old man presented with painful nodular lesions of the hand and elbow (Figure A). Laboratory findings revealed high serum IgA level of 2290mg/dl and positive hepatitis C antibody with high viral load. Biopsy revealed lamellar fibrosis, preponderance of neutrophils with leukocytoclasts and histiocytes (Figure B) and was diagnosed with Erythema Elevatum Diutinum (EED).
1
EED is a rare and distinctive form of chronic cutaneous leukocytoclastic vasculitis belonging to the group of the neutrophilic dermatoses (1). The lesions manifests as symmetrical, firm, yellow or pinkish to red, purple or brown papules, plaques or nodules on the backs of the hands, feet and extensor surfaces of the extremities overlying joints. EED can occur in any age, but most common in 3rd to 6th decade. Extracutaneous symptoms may include arthralgia, constitutional symptoms and occular abnormalities. The exact pathogenesis of EED is not yet defined but it may occur in isolation or in the context of an inflammatory or systemic disease, paraproteinemia (especially monoclonal IgA gammopathy), infectious (including HIV and Hepatitis) or autoimmune disease. Diagnosis is made based on the clinical and histopathological findings of skin biopsy. The patient was started on dapsone with good response (2). Work up and treatment of an associated underlying cause (if present) is also recommended. Our patient is currently being evaluated for starting Hepatitis C therapy.
1) Prat L, Bouaziz JD, Wallach D et al Neutrophilic dermatoses as systemic diseases. Clin Dermatol. 2014 May-Jun;32(3):376-388. 2) Momen SE, Jorizzo J, Al-Niaimi F Erythema elevatum diutinum: a review of presentation and treatment. J Eur Acad Dermatol Venereol. 2014 Dec;28(12):15941602.
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