Caso para diagnóstico

Abstract

O eritema elevatum diutinum é vasculite cutânea rara. Caracteriza-se por pápulas e nódulos eritêmato-acastanhados, que podem coalescer formando placas. A região extensora dos membros é a mais acometida, e lesões antigas apresentam aspecto xantomatoso. O exame histopatológico apresenta infiltrado neutrofílico perivascular com depósito dérmico de fibrina, edema endotelial e leucocitoclasia. Apresenta-se um caso de eritema elevatum diutinum sem doença secundária associada.

Erythema elevatum diutinum

“…Erythema elevatum diutinum (EED) is a rare chronic cutaneous vasculitis that affects adults between 30 and 60 years of age, with no race or gender predilection. It was initially described by Hutchinson in 1878, however, the name EED was only coined in 1894 by Radcliffe-Crocker et al 1 …”

“…In cases resistant to this drug, colchicine, systemic, intralesional, and high potency topical corticosteroids, sulfapyridine, and niacinamide combined to tetracycline can be tried. 1 , 5 Residual hyperpigmentation with occasional atrophy is common after regression of the lesions. 3 …”

“…We highlight that EED is a rare chronic disease, that is manifested by symmetrical erythematous violaceous papules and nodules on the extensor surfaces of the hands, feet, and knees, besides buttocks and lower limbs. 1 It can also appear in atypical areas such as trunk, postauricular or palmoplantar regions. 4 The lesions have an initial soft consistency, that becomes hardened during their course due to fibrosis.…”

Erythema elevatum diutinum and hypothyroidism: coincidence or causal relationship?

“…1 - 4 It is presumed that the pathogenesis is related to deposition of immune complexes on vessel walls, activation of the complement cascade, neutrophil chemotaxis, excessive premature expression of proinflammatory cytokines, releasing lysozymes, collagenase, myeloperoxidase and hydrolases that induce deposition of fibrin inside and around the vessels. 3 , 5 , 6 , 7 It is clinically manifested by erythematous violaceous papules and nodules, isolated or confluent in plaques, of hardened consistency; at first they are soft, gradually becoming hardened and symmetrical, predominantly on the extensor surface of the extremities, mainly over the joints of hands, elbows, knees and ankles. Lesions have already been described on the trunk and retroauricular region.…”

“… 8 High potency and intralesional topical corticoids may be very effective to reduce lesion size and are the treatment of choice for localized cases. 5 In positive HIV patients, the association with the antiretroviral therapy seems to be effective. 2 , 9 A typical case is reported, from the anatomo-clinical point of view, of EED associated with hypothyroidism, corroborating a report in the literature of Hashimoto thyroiditis as a possible autoimmune disease related to EED.…”