2010, vol. 16, br. 3-4, str. 147-151
|
|
Nodozni eritem u ambulanti primarne zdravstvene zaštite
Erythema nodosum at primary health care dispensary
Sažetak
Uvod. Nodozni eritem (Erythema nodosum - EN je inflamatorna nodularna reakcija struktura potkožnog tkiva (paniculitis) na razne agense. Istovremeno se javljaju tople, bolne, eritematozne promene po koži iznad nodusa, najčešće prednjih površina potkolenica, skočnih, kolenih i ručnih zglobova. Okidajući faktor (Trigger fastor) je u više od polovine obolelih slučajeva nepoznat (odrasli). Nodozni eritem se javlja izolovano ili u sklopu brojnih hroničnih inflamatornih i autoimunih oboljenja, infekcija gastrointestinalnog trakta, streptokoknih infekcija grla, graviditeta, sarkoidoze, kao rekcija na lekove i druga stanja. Prikaz slučaja. Prikazan je slučaj petogodišnje devojčice sa eritematoznim promenama po koži i bolnim nodularnim promenama u potkožnom tkivu prednjih strana potkolenica i kolena. Majka navodi da je 2-3 dana ranije bila subfebrilna, malaksala, imala je gušobolju i bolove u zglobovima. Iz lične anamneze: devojčica je rođena sa manjom porođajnom težinom, bolovala je od infekcija grla, uha i mokraćnih puteva. Roditelji negiraju hronična oboljenja u porodici, malignitet, tuberkulozu (TBC), hereditarna i autoimuna oboljenja. Rezultati kliničkog ispitivanja su pokazali: krvna slika (KS): (Le 15,9; Gr 71,2%), SE 60 mm/h, S-reaktivni protein (CRP) 36 mg/l, u sedimentu urina 75 Le, malo bakterija, Le-esteraza++, bris grla negativan, urinokultura negativna. Na osnovu anamneze, kliničke slike i laboratorijskih analiza dete je otpušteno kući sa Dg: Erythema nodosum i savetom: mirovanje, antibiotika 10 - 14 dana, analgo-antipiretika i kontrola. U toku tri nedelje dolazi do poboljšanja i sanacije promena bez ulceracija i ožiljaka. Zaključak. Na osnovu anamneze, kliničke slike, KS, SE, CRP i dobro reagovanje na antibiotike, prikazani slučaj EN je najverovatnije reakcija na infektivni agens.
Abstract
Introduction. Erythema nodosum (EN) is inflammatory nodular reaction of subcutaneous tissue (panniculitis) to various agents. It is accompanied by simultaneous appearance of painful, warm, reddish efflorescences on the skin, usually on the anterior side of shins, knees or ankles. In more than a half of the cases trigger factor cannot be determined. EN appears either as isolated condition or as symptom in numerous chronic inflammatory and autoimmune diseases, bowel infections, streptococcal pharyngitis, pregnancy, sarcoidosis, as reaction to medicaments and in other conditions. Case report. A 5 - year old girl presents with erythematous skin efflorescences and painful subcutaneous lumps on the anterior surfaces of the shins, knees and ankles. Her mother reported that girl had low-grade fever, weakness, sore throat and arthralgia 2 or 3 days earlier. In personal history girl was under-weight in birth, and since birth, she suffered from throat infections, otitis media, and urinary tract infections. Her parents deny the existence of chronic diseases, malignancy, TBC, hereditary and autoimmune diseases in the family. Abnormal laboratory findings were: WBC-15.9, (Gr-71.2 %), sedimentation rate-60 mm/h, CRP 36 mg/l., In urine: leucocytes 75, Le-esterase ++, small number of bacteria. Throat swab and urinoculture were negative. Based on anamnesis, clinical picture, and lab results, the child was checked out of hospital with diagnosis Erythema Nodosum. Advice was antibiotics 10 - 14 days, bed rest, analgesics and checkup. In three weeks, the patient was better and skin changes vanished completely without ulcerations and scars. Conclusion. According to anamnesis, clinical manifestations, BC, CRP, Sedimentation rate, good reaction to antibiotics, EN in this case seems to be a reaction to infective agent.
|