Sarcoidosis

■ Inflammatory bowel disease

■ Behcet disease

■ Malignancies, esp. hematological

■ Idiopathic

History: Lesions may be associated with fever, malaise, leg edema, and arthralgia. Recurrence not uncommon. Resolution after 2-6 wk.

Physical: Painful, dull, erythematous nodules 1 cm — 5 cm in diameter, located on anterior lower legs of young women. No ulceration, discharge or scarring.

Investigations: Thorough review of systems; CBC, urinalysis, chest X-ray, ASOT titer and throat swab (w/ streptococcal pharyngitis).

DDx: Insect bite reaction, erysipelas, erythema induratum, urticaria.

Management

Investigate for and treat underlying cause. Most patients benefit from bed rest, gentle support hose, applying ice or cool compresses, elevating legs, & NSAIDs. Less common Tx choices: Potassium iodide 300 mg—900 mg/d x 2—4 wk, oral prednisone, colchicine, dapsone.

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