Brief communications
719
Erythema nodosum from Yersinia enterocolitica N.E.BALDOCK AND M.D.CATTERALL Departments of Medicine and Dermatology, Royal Naval Hospital, Haslar, Gosport, Hants. Accepted for publication 29 May 1975
There have been a number of reports from Scandinavia and France incriminating Yersinia enterocolitica (YE) as a cause of erythema nodosum (EN) (Mollaret & Destombes, 1964; Mygind & Thulin, 1970; Hannuksela, 1971; Leino & Kallionaki, 1974). Hannuksela reported that one in ten cases of EN in Finland was caused by YE. We are unaware of any such cases having been reported from the U.K., although there have been reports of EN due to Yersinia pseudotuberculosis (Turner & Wilkinson, 1969; Wilkinson, Turner & Mair, 1969). CASE REPORT
Whilst on holiday in Ibiza, a 24-year-old female developed diarrhoea, associated with colicky abdominal pain. This acute illness settled on her return to England 2 days later. After a further 16 days, she developed red, painful nodules on both shins and presented at the Casualty Department 3 days after their onset. On examination, she had classical EN affecting the anterior aspects of both lower legs. There was no associated pyrexia and clinical examination revealed no other abnormal findings. The following investigations were normal or negative: Haemoglobin; A.S.O. titre; urine culture; throat swab; stool microscopy; chest X-ray and E.C.G. E.S.R. was 60 mm in ist h (Westergren); white cell count 10,600 per mm-*, with 81% polymorphs; Tubercuhn test weakly positive; culture of faeces revealed a mixed growth of normal flora only. YE type 3 antibodies were detected in the serum, to a titre of i : 640. Ten days later, the titre had fallen to 1:160, these results being consistent with active infection. On receipt ofthe initial serology, she was given a io-day course of tetracycline; the EN cleared rapidly. With many people now spending brief periods abroad, we feel that YE infection should be considered routinely as a cause of both EN and 'traveller's diarrhoea' in the U.K. ACKNOWLEDGMENT
We would like to thank Dr N.S. Mair for performing the serology REFERENCES HANNUKSELA, M . (1971) Erythema nodosum, with special reference to sarcoidosis. Annals of Clinical Research, 3, Suppl. 7. LEINO, R. & KALLIONAKI, J.L. (1974) Yersiniosis as an internal disease. Annals of Internal Medicine, 81,458. MOLLARET, H . H . & DHSTOMBES, P. (1964) Les germes 'X' en Pathologie humaine. Presse Medicate, 72,2913.
720
Brief communications
MYGINDJ N . & THULIN, H . (1970) Yersinia enterocolitica—a new cause of erythema nodosum. British Journal of Dermatology, 82, 351. TURNER, T . W . & WILKINSON, D.S. (1969) Pasteurella pseudotuberculosis as a cause of erythema nodosum. British Journal of Dermatology, 81, 823. WILKINSON, D.S., TURNER, T.W. & MAIR, N.S. (1969) Erythema nodosum due to Pasteurella pseudotuberculosis. British Medical Journal, ii, 226.
719
Erythema nodosum from Yersinia enterocolitica N.E.BALDOCK AND M.D.CATTERALL Departments of Medicine and Dermatology, Royal Naval Hospital, Haslar, Gosport, Hants. Accepted for publication 29 May 1975
There have been a number of reports from Scandinavia and France incriminating Yersinia enterocolitica (YE) as a cause of erythema nodosum (EN) (Mollaret & Destombes, 1964; Mygind & Thulin, 1970; Hannuksela, 1971; Leino & Kallionaki, 1974). Hannuksela reported that one in ten cases of EN in Finland was caused by YE. We are unaware of any such cases having been reported from the U.K., although there have been reports of EN due to Yersinia pseudotuberculosis (Turner & Wilkinson, 1969; Wilkinson, Turner & Mair, 1969). CASE REPORT
Whilst on holiday in Ibiza, a 24-year-old female developed diarrhoea, associated with colicky abdominal pain. This acute illness settled on her return to England 2 days later. After a further 16 days, she developed red, painful nodules on both shins and presented at the Casualty Department 3 days after their onset. On examination, she had classical EN affecting the anterior aspects of both lower legs. There was no associated pyrexia and clinical examination revealed no other abnormal findings. The following investigations were normal or negative: Haemoglobin; A.S.O. titre; urine culture; throat swab; stool microscopy; chest X-ray and E.C.G. E.S.R. was 60 mm in ist h (Westergren); white cell count 10,600 per mm-*, with 81% polymorphs; Tubercuhn test weakly positive; culture of faeces revealed a mixed growth of normal flora only. YE type 3 antibodies were detected in the serum, to a titre of i : 640. Ten days later, the titre had fallen to 1:160, these results being consistent with active infection. On receipt ofthe initial serology, she was given a io-day course of tetracycline; the EN cleared rapidly. With many people now spending brief periods abroad, we feel that YE infection should be considered routinely as a cause of both EN and 'traveller's diarrhoea' in the U.K. ACKNOWLEDGMENT
We would like to thank Dr N.S. Mair for performing the serology REFERENCES HANNUKSELA, M . (1971) Erythema nodosum, with special reference to sarcoidosis. Annals of Clinical Research, 3, Suppl. 7. LEINO, R. & KALLIONAKI, J.L. (1974) Yersiniosis as an internal disease. Annals of Internal Medicine, 81,458. MOLLARET, H . H . & DHSTOMBES, P. (1964) Les germes 'X' en Pathologie humaine. Presse Medicate, 72,2913.
720
Brief communications
MYGINDJ N . & THULIN, H . (1970) Yersinia enterocolitica—a new cause of erythema nodosum. British Journal of Dermatology, 82, 351. TURNER, T . W . & WILKINSON, D.S. (1969) Pasteurella pseudotuberculosis as a cause of erythema nodosum. British Journal of Dermatology, 81, 823. WILKINSON, D.S., TURNER, T.W. & MAIR, N.S. (1969) Erythema nodosum due to Pasteurella pseudotuberculosis. British Medical Journal, ii, 226.
