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Erythema Nodosum — SCE Dermatology MCQ

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HardConnective Tissue & VasculitisErythema NodosumSCE Dermatology

A woman with ulcerative colitis develops bilateral tender pretibial nodules after starting a new medicine. Biopsy is being considered because lesions persist. Which histological pattern would support erythema nodosum?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Predominantly septal panniculitis with Miescher granulomas and no primary vasculitis

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · A = shown as D · B = shown as E

A is correct. Erythema nodosum is the prototypic septal panniculitis without primary vasculitis; Miescher radial granulomas may be present. Bilateral tender shin nodules fit, and inflammatory bowel disease, infection and medicines are recognised triggers. Pancreatic panniculitis is lobular with enzymatic fat necrosis, subcutaneous panniculitis-like T-cell lymphoma shows atypical lymphocytes rimming adipocytes, erythema induratum is a lobular or mixed panniculitis with vasculitis, and subcutaneous granuloma annulare or rheumatoid nodules have palisading granulomas rather than classic EN. The trigger still requires review rather than assuming either colitis activity or the medicine is solely responsible.

Reference: DermNet erythema nodosum: https://dermnetnz.org/topics/erythema-nodosum