Herpes Zóster (Culebrilla)

Descripción General

Definición

El herpes zóster (también conocido como culebrilla) es una infección viral de reactivación causada por el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la varicela-zóster que se manifiesta como una erupción vesicular en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un dermatoma, unilateral y dolorosa.

Epidemiología

• Incidencia anual en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos: 1,2 millones de personas
• Aproximadamente el 30% de la población experimentará herpes zóster a lo largo de su vida.
• Más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Edad avanzada
  • Inmunodeprimidos
  • Sexo femenino
• Solo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos previamente afectados por la varicela

Etiología

Organismo causante: virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la varicela-zóster

• También conocido como herpesvirus humano tipo 3
• Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de ADN de doble cadena con envoltura
• Pertenece a la familia de los LOS Neisseria Herpesviridae Herpesviridae A family of enveloped, linear, double-stranded DNA viruses infecting a wide variety of animals. Subfamilies, based on biological characteristics, include: alphaherpesvirinae; betaherpesvirinae; and gammaherpesvirinae. Herpes Simplex Virus 1 and 2

Transmisión:

• Contacto directo con las ampollas
• Gotitas respiratorias (de individuos con enfermedad diseminada)
• Causa la varicela en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos expuestos sin inmunidad

Factores de riesgo

• Paciente inmunodeprimido:
  • Trasplante
  • Terapia inmunosupresora
  • Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la inmunodeficiencia humana (VIH)
  • Trastorno autoinmune
• Enfermedad activa o crónica
• Traumatismo físico
• Antecedentes familiares
• Edad
• Estrés

Fisiopatología

El virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la varicela-zóster causa 2 síndromes distintos:

Infección primaria (varicela):

• Se transmite a través del aerosol → se dirige a las células mucoepiteliales.
• Viremia Viremia The presence of viruses in the blood. Erythema Infectiosum → contagiosa, se produce una enfermedad febril.
• Tras la resolución, las partículas virales permanecen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria ganglios de la raiz dorsal o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum otros ganglios sensoriales.
• El sistema inmunitario del huésped suprime la replicación del virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology → permanece latente durante años o décadas (periodo de latencia).

Infección secundaria (herpes zóster):

• El sistema inmunitario del huésped no logra contener el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology → el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la varicela-zóster se reactiva.
• Se extiende por el nervio sensorial → piel → erupción.
• Respuesta inflamatoria en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria ganglios sensoriales:
  • Implica a las células plasmáticas y a los LOS Neisseria linfocitos T.
  • Puede provocar daños neuronales → dolor Dolor Inflammation neuropático.

Presentación Clínica y Complicaciones

Presentación más frecuente

Neuritis aguda:

• Síntoma más común (a menudo precede a la erupción)
• Dolor Dolor Inflammation neuropático:
  • Ardientes
  • Apuñalamiento
  • Palpitante
  • Constante o intermitente
• Hipersensibilidad
• Alodinia

Erupción:

• Unilateral
• Distribución en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum dermatoma
• Inicialmente aparece como pápulas eritematosas
• Progresa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum bullas o grupos de vesículas
• Se vuelve pustulosa o hemorrágica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 3–4 días
• Las lesiones comienzan a formar costras en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 7–10 días (ya no son infecciosas).
• Pueden aparecer cicatrices e hipo o hiperpigmentación.

Síntomas sistémicos (< 20% de los LOS Neisseria casos):

• Fiebre
• Cefalea
• Malestar
• Fatiga

Herpes zóster diseminado

Las siguientes son presentaciones graves, que pueden ocurrir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunodeprimidos:

Diseminación cutánea:

• Las lesiones vesiculares tienen una distribución generalizada.
• Puede acompañarse de afectación visceral.
• Asociada con ↑ riesgo de transmisión

Afectación de órganos viscerales:

• Neumonía
• Hepatitis
• Encefalitis
• Puede ocurrir con o sin erupción.

Otras presentaciones

Herpes zóster oftálmico:

• Afecta a la rama oftálmica del 5to nervio craneal
• Síntomas:
  • Dolor Dolor Inflammation unilateral
  • Hipoestesia
  • Cefalea
  • Malestar
  • Fiebre
• Progresa a:
  • Conjuntivitis
  • Uveítis
  • Episcleritis
  • Queratitis
  • Pérdida de visión

Síndrome de Ramsay Hunt (herpes zóster ótico):

• Afecta al AL Amyloidosis ganglio geniculado y al AL Amyloidosis 8vo nervio craneal.
• Tríada de síntomas:
  • Parálisis facial ipsilateral
  • Dolor Dolor Inflammation de oído
  • Vesículas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el canal auditivo o pabellón auricular
• Características adicionales:
  • Disgeusia
  • Anomalías auditivas
  • Lagrimeo

Complicaciones

Neuralgia postherpética:

• Complicación más común
• Persistencia significativa del dolor Dolor Inflammation durante 90 días después del desarrollo de la erupción
• Otros síntomas:
  • Adormecimiento
  • Disestesias
  • Prurito
  • Alodinia

Necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage retiniana aguda:

• Características:
  • Iridociclitis aguda
  • Vitritis
  • Retinitis necrotizante
  • Vasculitis Vasculitis Inflammation of any one of the blood vessels, including the arteries; veins; and rest of the vasculature system in the body. Systemic Lupus Erythematosus retiniana oclusiva
• Complicaciones:
  • Pérdida rápida de la visión
  • Desprendimiento de retina Retina The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outermost layer is pigmented, whereas the inner nine layers are transparent. Eye: Anatomy

Otras complicaciones:

• Infecciones bacterianas secundarias de la piel
• Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis aséptica
• Neuropatía motora periférica
• Síndrome de Guillain-Barré
• Síndromes de accidente cerebrovascular

Diagnóstico

El diagnóstico del herpes zóster se basa principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la presentación clínica. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con presentaciones atípicas, se puede utilizar lo siguiente:

• PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR):
  • Utiliza una muestra de lesiones vesiculares para detectar el ADN del virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la varicela-zóster.
  • Método de prueba preferido por su alta sensibilidad
  • Más rápida que otros métodos de diagnóstico
  • Puede utilizarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todas las etapas de la enfermedad.
• Anticuerpo fluorescente directo (ADF):
  • Analiza el raspado de lesiones.
  • Sensibilidad limitada
  • No se puede realizar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lesiones con costra.
• El frotis de Tzanck:
  • Sensibilidad y especificidad más bajas
  • Confirma una lesión herpética, pero no diferencia de los LOS Neisseria distintos virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology del herpes.
  • Muestra células gigantes multinucleadas.

Tratamiento y Prevención

Terapia antiviral Antiviral Antivirals for Hepatitis B

• La terapia antiviral Antiviral Antivirals for Hepatitis B tiene como objetivo:
  • ↓ Gravedad y duración del dolor Dolor Inflammation
  • Ayudar a la rápida curación de las lesiones
  • Prevenir la formación de nuevas lesiones
  • ↓ Desenvolvimiento de virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology
  • Prevenir las complicaciones
• Opciones:
  • Aciclovir
  • Valaciclovir
  • Famciclovir Famciclovir An aminopurine derivative and prodrug of penciclovir which is a competitive inhibitor of herpes simplex 2 DNA polymerase. It is used to treat herpes simplex virus infection. Antivirals for Herpes Virus
• El tratamiento debe ser administrado:
  • ≤ 72 horas después del inicio de los LOS Neisseria síntomas
  • Durante la erupción de nuevas lesiones
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todos los LOS Neisseria pacientes inmunodeprimidos

Medidas de soporte

• Analgésicos:
  • Acetaminofén
  • AINE
  • Antidepresivos tricíclicos
  • Gabapentinoides:
    • Gabapentina
    • Pregabalina
• Corticosteroides (por ejemplo, prednisona) para el dolor Dolor Inflammation intenso o las complicaciones neurológicas
• Antibióticos:
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de sospecha de infección bacteriana secundaria
  • Proporcionan cobertura estafilocócica y estreptocócica.

Tratamiento de enfermedades complicadas

• Neuralgia postherpética:
  • Los LOS Neisseria antidepresivos tricíclicos y los LOS Neisseria gabapentinoides son la terapia de primera línea
  • Medicamentos tópicos (capsaicina) para controlar el dolor Dolor Inflammation leve o moderado
  • Opioides o glucocorticoides intratecales solo si fallan otras medidas
• Herpes zóster oftálmico:
  • Pacientes inmunocompetentes: antivirales orales
  • Pacientes inmunodeprimidos: aciclovir IV
  • Considerar fuertemente la derivación a oftalmología temprana
• Necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage retiniana aguda:
  • Inicial: aciclovir IV
  • Seguido de: valaciclovir oral
  • ↓ Agudeza visual: glucocorticoides
• El síndrome de Ramsay Hunt:
  • Valaciclovir oral y prednisona
  • Síntomas severos: terapia antiviral Antiviral Antivirals for Hepatitis B intravenosa

Prevención

Medidas para prevenir la transmisión:

• Cubrir la erupción
• Evitar el contacto con:
  • Mujeres embarazadas no inmunes
  • Bebés prematuros
  • Pacientes inmunodeprimidos

Vacunas:

• Indicadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos ≥ 50 años de edad
• Tipos de vacunas:
  • Vacuna viva contra el zóster (vacuna viva atenuada):
    • Ya no está disponible en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos, pero se utiliza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum otros países.
    • Contraindicada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunodeprimidos
  • Vacuna recombinante contra el zóster (vacuna recombinante con glucoproteína E, p. ej., Shingrix)

Diagnóstico Diferencial

• Herpes simple: Causado por el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology del herpes simple y que se propaga por contacto directo con lesiones herpéticas o contacto con mucosas. La infección primaria suele presentarse con síntomas prodrómicos sistémicos seguidos de disuria, linfadenopatía dolorosa y grupos de vesículas dolorosas llenas de líquido sobre una base eritematosa. El diagnóstico se confirma con pruebas de laboratorio, como la PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR) y la AFD. El tratamiento incluye una terapia antiviral Antiviral Antivirals for Hepatitis B.
• Celulitis: Infección bacteriana común de la piel que afecta a las capas más profundas de la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions y el tejido subcutáneo. La causa más común de esta enfermedad es el Staphylococcus aureus Staphylococcus aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Brain Abscess y el Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus pyogenes. La celulitis se presenta como una zona eritematosa y edematosa, caliente y sensible al AL Amyloidosis tacto. El diagnóstico es clínico y el tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la administración de antibióticos y adaptarlos al AL Amyloidosis agente etiológico sospechoso.
• Foliculitis: Inflamación de los LOS Neisseria folículos pilosos causada por una infección bacteriana o fúngica. Los LOS Neisseria pacientes pueden presentar pápulas/pústulas eritematosas con prurito y dolor Dolor Inflammation alrededor de los LOS Neisseria folículos pilosos. El diagnóstico es clínico. El tratamiento suele ser de apoyo, pero en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria casos graves puede ser necesario un tratamiento antibiótico tópico u oral.
• Dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) alérgica de contacto: Inflamación de la piel debida al AL Amyloidosis contacto con un alérgeno. Los LOS Neisseria pacientes suelen presentar una erupción local, roja, pruriginosa y pueden aparecer ampollas. El diagnóstico se realiza a través de los LOS Neisseria antecedentes clínicos y la exploración, pero puede utilizarse la prueba del parche cutáneo para determinar un factor desencadenante. El tratamiento incluye corticosteroides tópicos y evitar los LOS Neisseria alérgenos.
• Molusco contagioso: Es una infección viral de la piel causada por un poxvirus que suele aparecer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños de < 5 años de edad. Las lesiones son pápulas agrupadas, de color carne, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de cúpula, con umbilicación central. La enfermedad es leve en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunocompetentes y se resuelve por sí sola en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum meses. Un paciente inmunodeprimido puede presentar lesiones extensas y enfermedad sistémica que requiere tratamiento. El diagnóstico es clínico. La crioterapia con nitrógeno líquido es la primera línea en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria pacientes que requieren terapia.