We describe two cases of erythema induratum of Bazin (EIB), a cutaneous form of TB. •. Cases had no signs of active TB, but had a positive Interferon Gamma. Erythema induratum is a panniculitis on the calves. It occurs mainly in women, but it is very rare defined pathogen. The medical eponym Bazin disease was historically synonymous, but it applies only to the tuberculous form and is dated. Erythema induratum (also referred to as erythema induratum of Bazin (EIB) or nodular vasculitis) is a chronic nodular skin disease that is thought to represent a .
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Histology will demonstrate a lobular panniculitis with ghost adipoyctes adipocytes with fine granular basophilic material and no nuclei and necrosis of adipocytes. Regular follow up at week intervals is recommended during the active treatment period to ensure clearance of the lesions.
Patients may seemingly have no risk factors for prior TB exposure, and be otherwise completely healthy. No pathognomonic histologic feature of erythema induratum exists, and histologic findings may vary with the age of the lesion Figure 2. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal induratu.
Disorders of subcutaneous fat M Serological studies including antistreptolysin titer O, hepatitis A, and B, Mycoplasma, Bartonella, and Epstein-Barr virus may additionally be positive. Feiwel, M, Munro, DD.
Erythema induratum – Wikipedia
The disease can masquerade as numerous chronic nodular conditions and the diagnosis can easily be missed. As such, the development and presentation of lesions fluctuate based on the underlying immune status of the host. There is a strong female predominance of the disease This infection-related cutaneous condition article is a stub.
Erythema Induratum (Erythema induratum of Bazin, Nodular Vasculitis)
Early morning sputum, urine and gastric aspirates may be helpful to rule out an underlying active infection, but are generally negative. Even if an association with tuberculosis is assumed, the decision to start antituberculosis chemotherapy cannot be based on the diagnostic criteria required for the diagnosis of tuberculosis, eg, culture and microscopic detection of acid-fast bacilli.
Active TB infections should be treated more aggressively than latent infections. Lobular without vasculitis Cold Cytophagic histiocytic Factitial Gouty Pancreatic Traumatic needle-shaped clefts Subcutaneous fat necrosis of the newborn Sclerema neonatorum Post-steroid panniculitis Lipodermatosclerosis Weber—Christian disease Lupus erythematosus panniculitis Sclerosing lipogranuloma with vasculitis: What is the Cause of the Disease? Create a free personal account to download free article PDFs, sign up for alerts, and more.
In these situations, a high index of clinical suspicion is required.
On palpationsmall superficial and painful nodules are felt. Systemic Implications and Complications Although usually latent, cases of active TB infection associated with erythema induratum have been reported lungs, pleura, pericardium, peritoneum, lymph nodes, and endometrium.
If negative, this should be followed up in weeks with the standard 5TU per 0. In patients with suspected EIB, start with a complete history and physical examination followed by administration of a purified protein derivative PPD tuberculosis skin test and an incisional biopsy involving an adequate amount of subcutaneous fat. Patients may describe a prolonged history of recurrent episodes over years or decades with new crops of lesions appearing often unpredictably.
It occurs mainly in women, but it is very rare now. Work-up In patients with suspected EIB, start with a complete history and physical examination followed by administration of a purified protein derivative PPD tuberculosis skin test and an incisional biopsy involving an adequate amount of subcutaneous fat. Lesional morphology may range from deep seated areas of subcutaneous induration to nazin plaques and nodules, characteristically on the posterior or lateral aspects of indudatum lower legs Figure 1.
On physical examination, affected patients will frequently have heavy or column-like calves, erythrocyanosis, cutus marmmorata and some degree of venous insufficiency. Currently, the CDC recommends a 6-month, four-drug course with 2 months or RIPE rifampin, isoniazid, pyrazinamide, ethambutolfollowed by 4 months of isoniazid.
Compression stockings or supportive bandages can result in improvement of lesions and may warrant a trial in patients with mild disease prior to advancing to indueatum treatment. Alpha-1 antitrypsin deficiency panniculitis Erythema nodosum Acute Chronic with vasculitis: Subsequent authors questioned the causal relationship between EIB and TB, citing the lack of tuberculoid granulomas or acid-fast bacilli in lesional biopsies of EIB; patients and the eritemaa to induce tuberculosis lesions in guinea pigs by inoculation.
Acquired generalized lipodystrophy partial: Patients with active disease require co-management with appropriate specialists.
In patients with moderate to severe symptoms, encourage the use of combination medical and physical modalities for potential synergistic effects. Create indjratum free personal account to make a comment, download free article PDFs, sign up for alerts and more. Affected patients are thought to possess a strong anti-MTB cell-mediated immunity.
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Create a personal account to register for email alerts with links to free incuratum articles. Subcutaneous sarcodiosis also called Darier-Roussy sarcoidosis- differentiated clinically by the non-tender nature of nodules on the trunk and legs and typical presence of systemic symptoms as well as histopathologic identification of sarcoidal or epithelioid granulomas with mulit-nucleated giant cells.
Prolonged, multidrug treatment is necessary to prevent relapse and avoid drug resistance, and progress may be slow. Other Early morning sputum, urine and gastric aspirates may be helpful to rule out an indyratum active infection, but are generally negative.
Erythema Induratum (Erythema induratum of Bazin, Nodular Vasculitis)
There is still no consensus as to whether venules, larger septal veins, or arterioles are most typically involved. Get free access to newly published articles Create a personal account or sign in to: Entities currently considered tuberculids include erythema induratum of Bazin, lichen scrofulosorum, papulonecrotic tuberculid and most cases of eritrma phlebitis.
Papulonecrotic tuberculid differentiated clinically by the tendency toward lesion necrosis and subsequent crusting and histologically by location in the superficial dermis compared to the more characteristic location of EIB in the subcutaneous fat. Although less well studied, potassium iodide, dapsone, gold salts, and doxycycline have also been used with success in the treatment of erythema induratum.
The ankle skin becomes sensitive to temperature changes. As a rule, no foreign body is identified and all histochemical stains and cultures for infection are negative. In hot weather, ankle becomes hot, edematous, swollen eritwma painful.
Sign in to customize your interests Sign in to your personal account. In nodular stage, pain is present; while it subsides in ulcerative stage. A good rule of thumb is, if a patient presents with chronic, relapsing, ulcerating nodules demonstrating mostly lobular panniculitis, an assessment for latent and active TB is warranted.
Treatment Options Treatment options for erythema induratum are summarized in Table I.