Iqbal Akhtar Khan.
Erythema Nodosum associated with Giardiasis: Predilection for young females.
J Pak Assoc Derma Jan ;9(4):39-43.

Erythema nodosum (EN) is usually a disturbing, occasionally a distressing and rarely a frustrating clinical condition. It is an immunological reaction triggered by a variety of inciting factors. Its association with Giardia Lamblia infection is a rarity.

CASE REPORT: A 22 years old unmarried female presented one evening to the consultancy of the author. She complained of malaise, mild abdominal discomfort and anorexia for three days; and four episodes of loose and watery motions since that morning. She was afebrile, moderately dehydrated but exhausted, nauseating and reluctant to accept anything by mouth. The abdominal examination was unremarkable except mild tenderness in the epigastrium. Injection Metoclopramide 10 mg was given intramuscularly and intravenous line was maintained with Ringer Lactate Infusion. The detailed history revealed that she, a resident of Karachi, was on a 16 days trip to rural area to participate in a family function. On the second day of her return (five days prior to presentation) she developed painful nodules on both shins; which she attributed to insect bites and used some soothing cream. Having got no relief she went to a general practitioner who advised her anti-allergic tablets and corticosteroid skin ointment. This prescription did not alleviate her cutaneous problem but she was continuing it. She came to the author for her gastrointestinal problem. To find out any correlation between both complaints a thorough examination was planned. Symmetrical tender red nodules about 3-5 cm size appearing in crops were found on both shins. She denied having such lesions on other parts of the body. There was no involvement of knees and ankles. Unfortunately, due to cultural restraint, it was not possible to photograph the lesions. Having made the spot diagnosis of EN, a search was made for the possible aetiology. The ear, nose, throat and chest were OK. There was no lymphadenopathy. There was no history of use of any medication in the past two months. There was nothing suggestive of any chronic intestinal disease (Continued...).

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com