A 17-year-old boy with Crohn's disease with colonic involvement of 2 years of evolution, in maintenance treatment with azathioprine, consults for the appearance for 5 days of subcutaneous red purplish, hot, painful, bilateral, pretibial localization nodules, associated with an increase in the number of stools and abdominal pain. The most appropriate approach in this case is:
The patient's presenting picture is presumably erythema nodosum. About 10% of cases of erythema nodosum are associated with inflammatory bowel disease, both ulcerative colitis and Crohn's disease. As mentioned, in most cases, erythema nodosum has a self-limited course. When associated with inflammatory bowel disease, erythema nodosum usually resolves with treatment of the intestinal flare, and recurs with disease recurrences. Local measures include elevation of the legs and bed rest. In particularly severe cases, oral administration of potassium iodide has been shown to be helpful. Although the use of aspirin and other NSAIDs is effective for erythema nodosum, their use in patients with inflammatory bowel disease should be limited, as they may worsen the intestinal picture, the usefulness of antidepressants in this picture has not been described, so answer nº1 would not be correct.
Recommend relative rest and warm cloths on both legs and add antidepressant treatment.
Biopsy areas of skin away from the injured areas and prescribe opioid analgesics for entry.
Suspect the existence of a malignant intestinal tumor lesion as a trigger of the cutaneous process.
Suspect bilateral lower extremity ischemia of drug-induced origin.
Adjustment of bowel disease treatment.
Although the use of aspirin and other NSAIDs is effective for erythema nodosum, their use in patients with inflammatory bowel disease should be limited, as they may worsen the intestinal picture, the usefulness of antidepressants in this picture has not been described, so answer nº1 would not be correct.
When associated with inflammatory bowel disease, erythema nodosum usually resolves with treatment of the intestinal flare, and recurs with disease recurrences.