![]() It is a clinical diagnosis with a good history and physical exam, which often reveals the history of painful bumps with varying degrees of erythema that usually goes through some color changes, similar to a bruise within a couple of weeks.Ī biopsy revealing inflammation about the subcutaneous fat without vasculitis would help confirm the diagnosis, but is usually not necessary if the clinical course is typical and no menacing underlying disease is suspected. It is most commonly associated with group A streptococcal infections, but can be triggered by a wide variety of infectious and noninfectious causes. It usually occurs on the anterior aspects of the lower legs (shins), but can occur anywhere. The lesion on her chin turned out to be cutaneous herpes simplex infection, an uncommon trigger for erythema nodosum (B), which is thought to be a delayed hypersensitivity reaction resulting in a panniculitis with a surrounding inflammatory reaction. Otherwise, her skin is clear, with no petechiae, other areas of bruising or other lesions seen, and the rest of her exam is normal. The patient also has an impetiginous lesion near her chin ( Figure 5), which further history revealed that she has had a sore in that location before, but cannot remember when. ![]() On examination, her vital signs are normal, and her skin exam reveals the apparent bruising described above ( Figures 1-4), with some underlying swelling. The bruises seem to be appearing almost exclusively on the extensor surfaces of her arms, but she also complains of some pain on her lateral, lower left leg, but no skin changes were noticed, and she has had no fever recently or any other systemic symptoms. The problem began as erythematous bumps that were somewhat painful and appeared to be progressive with more areas of spontaneous, firm swelling over the first week, followed by bruising. She denied any injury or recent illness, and she was taking no medications. ![]() If you continue to have this issue please contact to HealioĪ 13-year-old previously healthy female is seen by her primary for evaluation of some unexplained painful bruising of her upper extremities that began about 2 weeks earlier.
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