Article

Relationship of erythema nodosum to other manifestations of Crohn's disease

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Abstract

Erythema nodosum has been considered part of the clinical spectrum of inflammatory bowel disease (IBD) since Bargen1 reviewed 693 cases of ulcerative colitis in 1929. He, as well as Kelley and Logan,2 Samitz and Greenberg,3 Jacobs,4 and Brown et al5 noted that the skin lesions corresponded to intestinal and extra-intestinal manifestations of active ulcerative colitis. The same relationship for Crohn's disease and erythema nodosum can be inferred from their data. Many of these early reports included patients with segmental colitis or right-sided colon disease or both. Investigators who have specifically examined the relationship of active Crohn's disease and erythema nodosum have agreed that there is a positive correlation. Jacobs4 reported four cases and Sams and Winkelmann6 reported three cases of erythema nodosum and active Crohn's disease. Van Patter et al7 and Greenstein et al8 have reviewed various clinical manifestations of Crohn's disease and found that the typical patient had a parallel course of bowel disease and erythema nodosum.

The current thinking is that a positive correlation exists between other manifestations of Crohn's disease activity and the appearance of erythema nodosum. However, as reported here, the relationship between erythema nodosum and the activity of the bowel disease is more variable than previous reports indicate.

Methods and definitions

Records of patients with Crohn's disease and erythema nodosum at the Cleveland Clinic in the period 1961 to 1976 were reviewed. In all patients, Crohn's disease was documented by accepted roentgenographic and pathologic criteria.7,9 Of the 12 patients who met the criteria for inclusion . .


 

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