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Summary
A healthy patient presented with painful skin lesions on the anterior surface of her legs. Erythema nodosum was diagnosed but all the usual causes were ruled out. The finding of bilateral enlarged axillary lymph nodes with necrosis and granulomas led to the diagnosis of Bartonella infection, an unusual cause of erythema nodosum. Imaging also revealed splenomegaly and small para-aortic lymph nodes. Up to one quarter of the patients with cat-scratch disease present atypically, a considerably higher prevalence than previously reported. A comprehensive review of the literature (PubMed, since inception, all languages) revealed a remarkable array of unusual presentations which are summarised and briefly discussed.
- dermatology
- general practice / family medicine
- infectious diseases
- malignant and benign haematology
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Footnotes
Contributors All authors treated the patient and participated in preparing the manuscript, primarily written by AS. AS and ID planned the study and reported the patient. AS conducted the review of the literature and is responsible for box. LU undertook the analysis of the imaging studies and performed the biopsy.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.