Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • nodules on shins
  • uveitis, red eyes, retinal nodules, or candle-wax drippings
  • anesthetic patches
  • nodules on other skin areas

Other diagnostic factors

  • joint pains
  • fever
  • diarrhea, constipation, abdominal pain, hematochezia
  • enlarged spleen
  • miliary nodules on the retina

Risk factors

  • streptococcal infection
  • sarcoidosis
  • tuberculosis
  • coccidioidomycosis
  • histoplasmosis
  • blastomycosis
  • brucellosis
  • Behcet disease
  • oral contraceptives
  • sulfonamides
  • iodides and antiepileptic drugs
  • psittacosis
  • leprosy
  • inflammatory bowel disease

Diagnostic investigations

1st investigations to order

  • CBC
  • antistreptolysin-O (ASO) titer
  • ESR
  • CXR
  • PPD skin testing
Full details

Investigations to consider

  • serum ACE level
  • granuloma lesion biopsy
  • coccidioidin skin test
  • histoplasmin skin test
  • lepromin skin test
  • blastomycosis serology
  • brucellosis serology
  • psittacosis serology
  • x-ray symptomatic joints
  • rheumatoid factor testing
  • Yersinia agglutination titer
  • Yersinia stool cultures
  • colonoscopy
  • serum IgD
  • deep punch biopsies including subcutaneous fat, or incisional biopsies
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Daniela Kroshinsky

Director of Pediatric Dermatology

Department of Dermatology

Massachusetts General Hospital

Boston

MA

Disclosures

DK declares that she has no competing interests.

Dr Daniela Kroshinsky would like to gratefully acknowledge Dr Om P. Sharma, a previous contributor to this monograph. Dr Kroshinsky would also like to thank Priyanka Vedak for her contribution to this monograph. OPS declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Internal Medicine

Clinical Professor of Dermatopathology

Northeastern Ohio Universities College of Medicine

Warren

Associate Clinical Professor of Dermatology

Case Western Reserve University School of Medicine

Cleveland

OH

Disclosures

RTB declares that he has no competing interests.

Consultant Dermatologist

King's College Hospital

London

UK

Disclosures

EH declares that she has no competing interests.

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