Recurrent erythema nodosum and pulmonary sarcoidosis.

Case report In March 1959, a 36-year-old woman was referred with a 2-month history of EN and a chest X-ray showing bilateral hilar lymphadenopathy (BHL), enlarged paratracheal lymph nodes and extensive bilateral nodular pulmonary infiltration. The Heaf test was weakly positive (grade I). A diagnosis of sarcoidosis was made. The EN resolved quickly and chest X-rays showed progressive regression without treatment. By August 1960 the chest X-ray was normal and remained so until she was discharged from follow-up in 1962. In March 1976, she had a recurrence of severe EN. She also developed shortness of breath. A chest X-ray showed BHL and extensive bilateral nodular infiltration. The ESR was 58 mm/hr and a Heaf test was negative. Biopsy of the EN showed dermal and intradermal granulomas consistent with florid sarcoidosis. Lung function tests showed restrictive changes with lung volumes and transfer factor about 70% of predicted. The EN resolved and the chest X-rays gradually cleared without treatment. By April 1978 the chest X-ray was normal. In October 1979, aged 56, she developed extensive EN again. She also had a dry cough and the chest X-ray again showed large BHL, enlarged paratracheal nodes and bilateral nodular pulmonary infiltration. Her ESR was 47 mm/hr and her lung volumes had deteriorated. Prednisolone 15 mg daily was started. The EN disappeared over several weeks and her chest X-ray and dynamic lung volumes progressively improved as the corticosteroids were reduced slowly. Since July 1980, she has been off corticosteroids and her chest X-ray has remained normal.