Introduction:

Erythema nodosum is a rare disease whose pathophysiology is based on a type 4 delayed hypersensitivity response and its most common form of presentation is in the form of bilateral and symmetrical nodules and cutaneous plaques, predominantly affecting the pre-tibial region. Although the idiopathic etiology is still quite frequent, close to half of the cases are of secondary etiology, with oral contraceptives being amongst the most associated drugs with this entity, and this causal relationship being described for a greater number of estroprogestative associations. A rare case of erythema nodosum secondary to the association of ethinyl estradiol 0.03 mg + levonorgestrel 0.15 mg is described.

Case description:

We report a case of a 20-year-old woman who developed painful unilateral nodules in the pre-tibial region, related to the initiation of the combination of ethinyl estradiol 0.03 mg, and levonorgestrel 0.15 mg. The user describes the injuries as being longstanding, although she has never sought medical care in the past. After further investigation of the clinical history and suspicion of the causal relationship between the combined oral contraceptive and the appearance of lesions compatible with erythema nodosum, it was decided to suspend the same and start prednisolone 20 mg/day, with the user having a very favorable evolution. After discussing the existing therapeutic options, the user chose to switch to Implanon®.

Conclusion:

The literature is increasingly reporting the causal relationship between oral contraceptives, not only the combined type but also the isolated type, and the appearance of erythema nodosum. This is a rare and complex relationship. When a patient starts with painful nodules, a case of erythema nodosum must be considered, being aware of potential triggers - as combined oral contraceptives. In these cases, options must be explained to the user; therapeutic suspension is not the only way.

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