Clinical exam is characteristic of a panniculitis. Individual lesions may be mistaken for bacterial cellulitis; however, the nodular component supports the diagnosis of erythema nodosum. If a presumed bacterial cellulitis has no obvious portal of bacterial entry, erythema nodosum should be considered in the differential diagnosis. If the diagnosis is unclear, a deep punch biopsy or an incisional biopsy including subcutaneous fat is indicated. After the diagnosis of erythema nodosum is established, one must search for possible etiologies. Work-up includes a thorough history and physical examination. Further evaluation, as directed by history and physical findings, may include a throat culture, a stool culture, a complete blood count, a chest radiograph to rule out sarcoidosis, and placement of a PPD.
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