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A biopsy of one of several red, tender, subcutaneous nodules from the anterior lower legs of a 27-year-old man is obtained by a dermatologist. On histopathology, she sees a panniculitis (inflammation of subcutaneous fat) with widen- ing of tissue septa from edema, increased neutrophils, and fibrin exudation. Which of the following diseases is often present in someone with these nodules?

(A) Acne vulgaris
(B) Crohn’s disease
(C) Eczema
(D) Pancreatitis
(E) Psoriasis 


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(B) Crohn’s disease
The correct answer is B. This patient has erythema nodosum, an inflammation of subcutaneous fat that is often accompanied by fever and malaise that is described clinically and pathologically in the question stem. The exact mechanism is unknown, but it often occurs together with inflammatory bowel disease (Crohn’s disease or ulcerative colitis), sarcoidosis, certain drugs (such as oral contraceptives and sulfonamides), certain malignant neoplasms, and certain infections (such as tuberculosis, β-hemolytic streptococci, coccidioidomycosis, histoplasmosis, and leprosy).

Answer A is incorrect. Acne vulgaris is a disorder of the epidermis that has both inflammatory and noninflammatory variants. It is associ- ated with the bacterium Propionibacterium acnes.

Answer C is incorrect. Eczema is an inflammatory skin disorder that is associated with contact allergies, asthma, ultraviolet light exposure, repeated physical skin rubbing, and certain drugs. It is not associated with erythema nodosum.

Answer D is incorrect. Pancreatitis, which is associated with many cases of biliary tract dis- ease and alcoholism, is not associated with erythema nodosum.

Answer E is incorrect. Psoriasis is a nonpruritic inflammatory skin disorder associated with arthritis, enteropathy, spondylitic disease, and certain HLA types, including HLA-B27, HLA- 13, and HLA-17.