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Year : 1990  |  Volume : 56  |  Issue : 1  |  Page : 50-51

Erythema nodosum in psittacosis

Correspondence Address:
S Tharakaram

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A 23-year-old woman developed erythema nodosum on her lower legs, two weeks after a respiratory infection manifesting with generalised bodyache, rhinorrhoea, sore throat, cough and sputum. Her pet budgerigar had been unwell two weeks previously. CFT for psittacosis showed a high titre. Oral tetracycline 4 gm a day for 3 weeks was effective.

Keywords: Erythema nodosuum, Psittacosis

How to cite this article:
Tharakaram S, Chapman R S. Erythema nodosum in psittacosis. Indian J Dermatol Venereol Leprol 1990;56:50-1

How to cite this URL:
Tharakaram S, Chapman R S. Erythema nodosum in psittacosis. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 May 30];56:50-1. Available from: http://www.ijdvl.com/text.asp?1990/56/1/50/3482

Psittacosis, caused by Chlamydia psittaci, is primarily an infectious disease of birds. Man usually acquires the infection from birds by inhaling their infected excreta. Among the many presenting features of human psittacosis, erythema nodosum is a rare one. Early recogni­tion and prompt treatment are essential to reduce the morbidity associated with psittacosis.

  Case Report Top

A 23-year-old woman was admitted with a one week history of joint pains and painful dusky-red skin lesions affecting both lower legs. Two weeks earlier, she had suffered a respiratory infection with generalised aches, rhinorrhoea, sore throat and productive cough with purulent sputum. Oral penicillin for five days afforded only some relief. She worked as a butcher's assistant but never handled live poultry. There was no previous history of tuberculosis, rheuma­tic fever, skin rash or joint disease. A point of special interest obtained retrospectively was, that approximately two weeks before she deve­loped the chest infection, her pet budgerigar had been unwell with loss of condition.

The lesions were symmetrical, tender, dusky­red, raised nodules and plaques on the front and sides of both lower legs. In addition, there was an asymmetrical arthritis affecting the right elbow and ankle and both knees. Other systems were normal.

Her ESR was 90 mm. Complement fixation test for psittacosis showed a high titre of I : 1024. Throat swabs, urine culture, ASO titre. Mantoux test and chest X-ray were normal.

The patient was treated with oral tetracycline I gm four times a day for three weeks, along with topical 10% ichthammol in glycerine and oral analgesics. The erythema nodosum resolved through a phase of skin staining to normal skin. She was welt and asymptomatic when seen seven weeks after her admission. Permission to kill the budgerigar for veterinary examination was witheld; hence it was treated with medicated seed for one month.

  Comments Top

Tuberculosis, streptococcal infection and sarcoidosis are the most frequent causes of erythema nodosum. Ulcerative colitis, drugs, internal malignancy and mycosis fungoides are the less common causes as is psittacosis.[1] Psittacosis[2] is a chlamydial infection usually affecting birds; a subgroup B can primarily affect cattle. Affected birds may have ruffled feathers, conjunctivitis, gastro-intestinal and respiratory manifestations, though carriers of the condition may not show overt disease. In birds, the diagnosis of psittacosis is usually achieved by sacrificing the bird and examining its feathers and nasal secretions for Cl-psittaci.

In man, psittacosis as a cause of erythema nodosum should be considered if the patient has a recent pneumonic infection and a history of contact with aviaries or pet birds. Some patients may not have such a contact history at all; in such cases the cause may be human psittacosis. This agent, TWAR-Chlamydia[3] is believed to be more virulent and possibly more common than suspected. In man, the diagnosis can be considered established if either a rising titre of anti-chlamydial antibodies or a four-fold rise in antibodies is found.

Psittacosis is relatively uncommon although the Communicable Diseases Unit, Scotland reports a mean of 73 cases a year in a population of 5 million.[4] In a minor epidemic of psittacosis in East Anglia (England) in 1964, six cases of erythema nodosum were recorded.[5] Our patient showed similar features to previous cases that have been reported, though she did not have pneumonia at admission possibly because of the penicillin given by her general practitioner, which was also useful in one of the cases from East Anglia.[5] Tetracycline is the drug of choice but erythromycin is an effective alternative.

Control of the disease in birds is important. Affected birds should either be sacrificed or quarantined and treated with medicated seed for one month. Unaffected birds in the aviary are also treated with medicated seed for 30 days. Improved general hygiene and clean cages are valuable preventive measures.

  References Top

1.Rook A., Wilkinson DS, Ebling FJG et al Textbook of Dermatology, Vol 2, Fourth ed, Blackwell Scientific Publications, Oxford, 1986; p 1156-1159.  Back to cited text no. 1    
2.Cruickshank R, Duguid JP, Marmion BP et al Medical Microbiology, Vol 1, Twelveth ed, Churchill Livingstone, London, 1973; p 518-522.  Back to cited text no. 2    
3.Leading Article : TWAR-Chlamydia in a new guise, Lancet, 1988; i : 974-975.  Back to cited text no. 3    
4.Personal communication Communicable Diseases Unit, Scotland, 1988.  Back to cited text no. 4    
5.Sarner M and Wilson RJ : Ervthema nodosum and psittacosis, Report of five cases, Brit Med J, 1965; ii : 1469-1470.  Back to cited text no. 5    


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