title: Erythema nodosum as a result of estrogen patch therapy for prostate cancer: a case report.
abstract: BACKGROUND
  Erythema nodosum is often associated with a distressing symptomatology, including painful subcutaneous nodules, polyarthropathy, and significant fatigue. Whilst it is a well-documented side-effect of estrogen therapy in females, we describe what we believe to be the first report in the literature of erythema nodosum as a result of estrogen therapy in a male.
  
  
  METHODS
  A 64-year-old Afro-Caribbean man with locally advanced carcinoma of the prostate agreed to participate in a randomized controlled trial comparing estrogen patches with luteinizing hormone-releasing hormone analogs to achieve androgen deprivation, and was allocated to the group receiving estrogen patches. One month later he presented with tender lesions on his shins and painful swelling of his ankles, wrists, and left shoulder. This was followed by progressive severe fatigue that required hospital admission, where he was diagnosed with erythema nodosum by a rheumatologist. Two months after discontinuing the estrogen patches the erythema nodosum, and associated symptoms, had fully resolved, and to date he remains well with no further recurrence.
  
  
  CONCLUSIONS
  Trial results may establish transdermal estrogen as an alternative to luteinizing hormone-releasing hormone analogs in the management of prostate cancer, and has already been established as a therapy for male to female transsexuals. It is essential to record the toxicity profile of transdermal estrogen in men to ensure accurate safety information. This case report highlights a previously undocumented toxicity of estrogen therapy in men, of which oncologists, urologists, and endocrinologists need to be aware. Rheumatologists and dermatologists should add estrogen therapy to their differential diagnosis of men presenting with erythema nodosum.
authors.affiliation: MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK. c.coyle@ucl.ac.uk.
authors.forename: Christopher
authors.initials: C
authors.lastname: Coyle
authors.affiliation: Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK. s.mangar@imperial.ac.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mangar
authors.affiliation: Department of Surgery, 'B' Block Hammersmith Campus, Imperial College Faculty of Medicine, DuCane Road, London, W12 0NN, UK. p.abel@imperial.ac.uk.|Department of Urology (3N), Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK. p.abel@imperial.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Abel
authors.affiliation: MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK. ruth.langley@ucl.ac.uk.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Langley
mesh_terms: D000279:Administration, Cutaneous; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects*; D004893:Erythema Nodosum / Q000139:chemically induced* / Q000473:pathology; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects; D004967:Estrogens / Q000008:administration & dosage* / Q000009:adverse effects*; D005221:Fatigue / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure
chemical_list: D018931:Antineoplastic Agents, Hormonal; D004967:Estrogens; D004958:Estradiol