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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Patients may seemingly have no risk factors for prior TB exposure, and be otherwise completely healthy. Ulcerated nodules exhibit overlying crust with a rolled erythematous, blue-tinged border.
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.
Prolonged, multidrug treatment is necessary to prevent relapse and avoid drug resistance, and progress may be slow. In nodular stage, pain is present; while it subsides in ulcerative stage. Create a free personal account to download free article PDFs, sign up for alerts, customize your interests, and more. Lesional morphology may range from deep seated areas of subcutaneous induration to well-defined plaques and nodules, characteristically on the posterior or lateral aspects of the lower legs Figure 1.
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 inability to induce tuberculosis lesions in guinea pigs by inoculation. Nonsteroidal antiinflammatory agents NSAIDS may alleviate discomfort associated with nodular or ulcerated lesions and should also be considered.
Regular follow up at week intervals is recommended during the active treatment period to ensure clearance of the lesions. While relatively rare, atypical presentations of EIB may occur.
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Historical context Until recently, clinicians long debated the pathogenesis of EIB and the aforementioned association with Mycobacterium tuberculosis. 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: As a rule, no foreign body is identified and all histochemical stains and cultures for infection are negative.
Diagnosis confirmation Clinically, EIB can mimic a number of conditions presenting as lower extremity nodules, including: Currently, the CDC recommends a 6-month, four-drug course with 2 months or RIPE rifampin, isoniazid, pyrazinamide, ethambutolfollowed by 4 months of isoniazid.
Predisposing factors include abnormal amount of subcutaneous fat, thick ankles and abnormally poor arterial supply. Patients with cutaneous polyarteritis nodosa may additionally present with generalized symptoms including fever, malaise, joint and muscle aches as well as neurological symptoms including numbness, tingling, sensory disturbances, weakness, and areflexia, whereas patients with EIB are classically asymptomatic.
Erythema induratum is classified as a tuberculid or a chronic nodular skin eruption that represents a cutaneous hypersensitivity reaction to disseminated M tuberculosis MTB or its antigens. Actinomycetaceae Actinomyces israelii Actinomycosis Cutaneous actinomycosis Tropheryma whipplei Whipple’s disease Arcanobacterium haemolyticum Arcanobacterium haemolyticum infection Actinomyces gerencseriae.
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The clinical response to anti-tuberculosis therapy can also be used as an indicator to discern the two entities. Get free access to newly published articles Create a personal account or sign in to: Powered By Decision Support in Medicine. Sign in to make a comment Sign in to your personal account. J Am Acad Dermatol. Fresh crops of nodules appear in periphery of ulcer and ultimately break down. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account.
You can help Wikipedia by expanding it. They eriema down to form small and multiple ulcers.
Mycobacterium-related cutaneous conditions Infection-related cutaneous condition stubs. Create a free personal account to download free article PDFs, sign up for alerts, and more. On palpationsmall superficial and painful nodules are felt.
Erythema induratum – Wikipedia
In these situations, a high index of clinical suspicion is required. Early lesions are generally confined to the subcutaneous fat lobular inflammation and display a predominantly lymphocytic infiltrate, whereas later lesions may extend into the deep dermis and display noncaseating granulomas typical of TB infection.
Sign in to customize your interests Sign in to your personal account. Other Early morning sputum, urine and gastric aspirates may be helpful to rule out an underlying active infection, but are generally negative.
Patients with active disease require co-management with appropriate specialists. In hot weather, ankle becomes hot, edematous, swollen and painful.