Inflammatory bowel disease with erythema nodosum as the initial manifestation - two clinical cases

AIMS: To describe two cases of inflammatory bowel disease whose diagnosis was preceded by the appearance of erythema nodosum and to alert to this extra-intestinal manifestation as the initial presentation of the disease. CASES DESCRIPTION: Two adolescents of 12 and 15 years of age were referred to the pediatrics emergency department because of erythema nodosum accompanied by anorexia and weight loss. The available diagnostic tests were suggestive of chronic inflammatory disease and the abdominal ultrasound was suggestive of inflammatory bowel disease. The diagnosis of Crohn's disease was confirmed after completion of upper digestive endoscopy and total colonoscopy with biopsies. CONCLUSIONS: Erythema nodosum may be the form of presentation of potentially serious diseases with well established therapies and prognostic implications. In children or adolescents with erythema nodosum, the index of suspicion of inflammatory bowel disease should be high, although other differential diagnoses should be considered. The importance of early diagnosis of inflammatory bowel disease in pediatric age refers to the therapeutic opportunity and specific complications in this age group, as growth disturbance, which occurs more frequently in Crohn's disease.