A 59-year-old woman has had recurrent painful nodules on both legs for more than three years. Results of previous punch biopsy were nonspecific, although there is a possibility of erythema nodosum (EN). A trial of steroids produced no significant change. In addition, the patient has stage I breast cancer and has had an MI. What could be causing her recurrent nodules?
—Sanober H. Mumtaz, MD, Tyler, Tex.
First, I think you need to take another biopsy. Since EN is a panniculitis, you need to get a good sample of the fat. This can most easily be obtained with a 6-mm punch biopsy. If the diagnosis is made, a workup to elucidate any possible underlying disorder would be warranted. Infectious etiologies and sarcoidosis would probably be the most common associations. Many cases, however, are idiopathic.
—Jeffrey M. Weinberg, MD (111-9)