Erythema nodosum migrans successfully treated with indomethacin: A rare entity


1 Department of Dermatology, Skin Disease and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student Research Committee (SRC), Semnan University of Medical Sciences, Semnan, Iran


Erythema nodosum migrans (subacute nodular migratory panniculitis) is a panniculitis characterized by migrating subcutaneous nodules or plaque on the lower extremity. We describe a 75-year-old woman with idiopathic erythema nodosum migrans which was manifest centrifugally spreading, slightly morpheaform erythematous plaque on the lower left leg successfully treated with indomethacin. She was initially diagnosed and treated as a case with cellulitis and with poor clinical response. A biopsy specimen from this lesion showed that the septal was thickening; fibrous tissue was also seen with lymphohistiocytic infiltrate and occasional multinucleated giant cells with some inflammatory cells infiltrated into the periphery of the fat lobules. Erythema nodosum migrans should be kept in mind in the differential diagnosis of any morpheaform centrifugally expended plaque, especially in the lower extremities in cases of unknown etiology.


Papagrigoraki A, Gisondi P, Rosina P, Cannone M, Girolomoni G. Erythema nodosum: Etiological factors and relapses in a retrospective cohort study. Eur J Dermatol 2010;20:773-7.  Back to cited text no. 1
Requena L, Requena C. Erythema nodosum. Dermatol Online J 2002;8:4.  Back to cited text no. 2
Bafverstedt B. Erythema nodosum migrans. Acta Derm Venereol 1968;48:381-4.  Back to cited text no. 3
Vilanova X, Pinol Aguade J. Subacute nodular migratory panniculitis. Br J Dermatol 1959;71:45-50.  Back to cited text no. 4
Ross M, White GM, Barr RJ. Erythematous plaque on the leg. Vilanova's disease (subacute nodular migratory panniculitis). Arch Dermatol 1992;128:1644-5, 7.  Back to cited text no. 5
de Almeida Prestes C, Winkelmann RK, Su WP. Septal granulomatous panniculitis: Comparison of the pathology of erythema nodosum migrans (migratory panniculitis) and chronic erythema nodosum. J Am Acad Dermatol 1990;22:477-83.  Back to cited text no. 6
Perry HO, Winkelmann RK. Subacute Nodular Migratory Panniculitis. Arch Dermatol 1964;89:170-9.  Back to cited text no. 7
White WL, Hitchcock MG. Diagnosis: Erythema nodosum or not? Semin Cutan Med Surg 1999;18:47-55.  Back to cited text no. 8
Chen Y-CLJ-S, Chiu HC. Erythema Nodosum Migrans Mimicking Cellulitis: Report a case. Dermatol Sinica 2009;19:63-7.  Back to cited text no. 9
Hannuksela M. Erythema nodosum migrans. Acta Derm Venereol 1973;53:313-7.  Back to cited text no. 10
Lazaridou E, Apalla Z, Patsatsi A, Trigoni A, Ioannides D. Erythema nodosum migrans in a male patient with hepatitis B infection. Clin Exp Dermatol 2009;34:497-9.  Back to cited text no. 11
Lehman CW. Control of chronic erythema nodosum with naproxen. Cutis 1980;26:66-7.  Back to cited text no. 12
Barr WG, Robinson JA. Chronic erythema nodosum treated with indomethacin. Ann Intern Med 1981;95:659.  Back to cited text no. 13