Considerable attention has been directed in recent years to the etiology of erythema nodosum. Various explanations for this cutaneous eruption have been given and include the following: (1) It is a manifestation of tuberculosis; (2) it occurs as part of the symptom complex of rheumatic fever; (3) it has its origin in streptococcic infection; (4) it is a specific infectious disease the etiology of which is not known, and (5) it may occur during the course of various infections, and any one of a number of toxic and bacterial agents may be the cause, including the tubercle bacillus and the hemolytic streptococcus.
While most writers appear to accept the tuberculous concept of erythema nodosum, my colleagues and I have been impressed by the close association which the appearance of this eruption has with streptococcic infections. Because of the apparent confusion in the literature and our own previous observations, the following
SPINK WW. PATHOGENESIS OF ERYTHEMA NODOSUM: WITH SPECIAL REFERENCE TO TUBERCULOSIS, STREPTOCOCCIC INFECTION AND RHEUMATIC FEVER. Arch Intern Med (Chic). 1937;59(1):65–81. doi:10.1001/archinte.1937.00170170071005
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