title: Erythema nodosum in kidney transplant recipient: a rare complication of pneumonia treatment.
abstract: Erythema nodosum (EN) is a cutaneous inflammatory reaction, usually reported in young women, but it is rarely observed among transplant patients. Localization in the lower extremities is typical, mostly involving the anterior surfaces of the legs. Several viral, bacterial, mycotic, and non-infectious etiologies, such as autommune disorders, drugs, inflammatory bowel diseases, sarcoidosis, pregnancy, and malignancies, have been found. We describe the case of a young woman kidney transplant recipient developing bilateral, erythematous, warm nodules localized on the anterior surface of her legs after antibiotic treatment for pneumonia with levofloxacin. Her immunosuppression was sirolimus and mycophenolate mofetil. EN was diagnosed by skin biopsy; microscopic examination showed septal panniculitis with granulomas. As a complete remission of the lesions was obtained in our patient after interruption of levofloxacin therapy, we suspect that levofloxacin was involved in the pathogenesis of EN. In fact, the management of EN is based on the treatment of underlying or associated conditions.
authors.affiliation: Department of Nephrology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy. m.gregorini@smatteo.pv.it
authors.forename: M
authors.initials: M
authors.lastname: Gregorini
authors.forename: M
authors.initials: M
authors.lastname: Castello
authors.forename: T
authors.initials: T
authors.lastname: Rampino
authors.forename: P
authors.initials: P
authors.lastname: Esposito
authors.forename: R
authors.initials: R
authors.lastname: Rosso
authors.forename: G
authors.initials: G
authors.lastname: Borroni
authors.forename: A
authors.initials: A
authors.lastname: Dal Canton
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004893:Erythema Nodosum / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D007866:Leg / Q000473:pathology; D064704:Levofloxacin; D015242:Ofloxacin / Q000009:adverse effects* / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D012867:Skin / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin