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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Erythema induratum of bazin.
As such, patients may have suffered a protracted course for many years prior to diagnosis. Ulcerated nodules exhibit overlying crust with a rolled erythematous, blue-tinged border. Basic CDC recommendations for the common four drug therapy are listed below. When weather is cold, ankle is cold, blue and often tender.
Individuals with EIB often demonstrate an exaggerated host immunologic response to the purified protein derivative that can result in a bullous type IV hypersensitivity reaction.
Erythema Induratum (Erythema induratum of Bazin, Nodular Vasculitis)
Risk factors While there are no risk factors other than previous exposure to TB per se, cold weather, venous stasis with poor peripheral blood flow writema obesity appear to precipitate the development of lesions.
This page was last edited on 9 Julyat 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 systemic treatment. Patients with active disease require co-management with appropriate specialists. Until recently, clinicians long debated the pathogenesis of EIB and rritema aforementioned association with Mycobacterium tuberculosis.
In these situations, a high index of clinical suspicion is required. Although the majority of cases present with a lymphocytic vasculitis, it is not a diagnostic requirement; ie, the absence of vasculitis does not exclude the diagnosis of EIB in an otherwise appropriate clinical context. Erythema induratum is classified as a tuberculid or a chronic nodular skin eruption that eriitema a cutaneous hypersensitivity reaction to disseminated M tuberculosis MTB or its eirtema.
Nodules are typically cm in size, erythematous to violaceous in color, and have a tendency to ulcerate centrally. Purchase access Subscribe to JN Learning for one year.
Get free access to newly published articles. Retrieved erjtema ” https: While relatively rare, atypical presentations of EIB may occur.
Fresh crops of nodules appear in periphery of ulcer eritdma ultimately break down. Sign in to save your search Sign in to your personal account. Although usually latent, cases of active TB infection associated with erythema induratum have been reported lungs, pleura, pericardium, peritoneum, lymph nodes, and endometrium.
Sign in to make a comment Sign in to your personal account. 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.
They break down to form small and multiple ulcers. 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.
In patients with erjtema to severe symptoms, encourage the use of combination medical and physical modalities for potential synergistic effects. Alpha-1 antitrypsin deficiency panniculitis Erythema nodosum Acute Chronic with vasculitis: The exact diagnosis is obscured by the fact that a number of pathologic processes can cause a similar clinical picture, eg, perniones or lupus erythematosus.
Purchase access Subscribe now. Actinomycetaceae Actinomyces israelii Actinomycosis Cutaneous actinomycosis Tropheryma whipplei Whipple’s disease Arcanobacterium haemolyticum Arcanobacterium haemolyticum infection Actinomyces gerencseriae. Additionally, all states require a communicable disease report to be filed with the local county public health department, generally within 24 hours of identification.
Erythema induratum classically presents during early adolescence and peri-menopause as subcutaneous poorly defined erythematous plaques and tender violaceous nodules.
On physical examination, affected patients will frequently have heavy or column-like calves, erythrocyanosis, cutus marmmorata and some degree of venous insufficiency. 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.
Bazin in was the first to describe erythema induratum as a benign erythematous scrofulid; however, it was not until after the discovery of the Mycobacterium tuberculid in that the term scrofulid became commonly associated with TB. The prognosis of erythema induratum is excellent with appropriate treatment. 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.
Congenital generalized lipodystrophy Familial partial lipodystrophy Marfanoid—progeroid—lipodystrophy syndrome Poland eritena.
Erythema induratum – Wikipedia
Early morning sputum, urine and gastric aspirates may be helpful to rule out an underlying active infection, but indiratum generally negative. You must be a registered member of Dermatology Advisor to post a comment. Histology will demonstrate a lobular panniculitis with ghost adipoyctes adipocytes with fine granular basophilic material and no nuclei and necrosis of adipocytes.
The disease can masquerade as numerous chronic nodular conditions and the diagnosis can easily be missed.