Celiac Disease Presenting With Erythema Nodosum in a Child: Case Report and Review of the Literature.

Celiac disease (CD) is a chronic autoimmune enteropathy with a wide spectrum of gastrointestinal and extraintestinal manifestations. Erythema nodosum (EN), the most common form of panniculitis in children, has only rarely been reported in association with CD, and the nature of this relationship remains unclear. We describe the case of a 2.5-year-old girl who presented with erythematous nodules on the lower extremities, which had been present for 3 weeks. Clinical evaluation confirmed the diagnosis of EN. Common infectious, inflammatory, and drug-related causes were excluded. Due to a history of long-standing constipation, serological testing for CD was performed, revealing markedly elevated antitissue transglutaminase IgA antibodies and positive antiendomysial IgA antibodies. CD was diagnosed according to ESPGHAN criteria, and a gluten-free diet (GFD) was initiated. The EN lesions resolved within 3 weeks, which is compatible with the known self-limiting course of the condition. We also reviewed previously published pediatric cases describing the co-occurrence of EN and CD. Most reported patients exhibited additional clinical features suggestive of CD, including gastrointestinal symptoms, growth impairment, anemia, arthralgia, asthenia, or a previously diagnosed CD with recent dietary nonadherence. Although a temporal association between initiation of a GFD and resolution of EN has been described, a causal relationship cannot be established based on the available evidence.