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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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. Diagnosis confirmation Clinically, EIB can mimic a number of conditions presenting as lower extremity nodules, including: The prognosis of erythema induratum is excellent with appropriate treatment.
For patients with latent disease and multiple co-morbidities, the risks of systemic antituberculosis therapy should be carefully weighed against the benefits. Men and even young children may present with the disease, and lesions may appear in unusual locations including the feet, buttocks, thighs, arms and rarely the face and ears.
Work-up In patients with suspected EIB, start with a eritsma 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.
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J Am Acad Dermatol.
Sign in to customize your interests Sign in to your personal account. Although the majority of cases present with indhratum lymphocytic vasculitis, it is not a diagnostic requirement; ie, the absence of vasculitis does not exclude indkratum diagnosis of EIB in an otherwise appropriate clinical context. Patients are otherwise healthy without systemic symptoms and often present with a rash as the only symptom of their disease. The clinical response to anti-tuberculosis therapy can also be used as an indicator to discern the two entities.
If an active focus of TB bazn uncovered, appropriate imaging studies should be performed at regular intervals to monitor regression of disease.
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 and obesity appear to precipitate the development of lesions.
Patients with active disease require co-management with appropriate specialists. Early morning sputum, urine and gastric aspirates may be helpful to rule out an underlying active infection, but are generally negative.
Erythema induratum is a panniculitis on the indurqtum. Other Early morning sputum, urine and inxuratum aspirates may be helpful to rule out an underlying active infection, but are generally negative. As such, the development and presentation of lesions fluctuate based on the underlying immune status of the host. Patients may seemingly have no risk factors for prior TB exposure, and be otherwise completely healthy.
Clinically, EIB can mimic a number of conditions presenting as lower extremity nodules, including:. Sign in to save your search Sign in to your personal account. On physical examination, affected patients will frequently have heavy or column-like calves, erythrocyanosis, cutus marmmorata and some degree of venous insufficiency. As a rule, no foreign body is identified and all histochemical stains and cultures for infection are negative.
Individual lesions typically heal slowly over the course of several months, but may persist for years without appropriate treatment. Alpha-1 antitrypsin deficiency panniculitis Erythema nodosum Acute Chronic with vasculitis: 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.
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. Corynebacterium diphtheriae Diphtheria Corynebacterium minutissimum Erythrasma Corynebacterium jeikeium Group JK corynebacterium sepsis.
Erythema nodusum differentiated eritemma by the location on the anterior lower extremities, compared to the more characteristic posterior-lateral aspects of the legs of EIB and tendency towards spontaneous healing without ulceration or scarring.
Fresh crops of nodules appear in periphery of ulcer and ultimately break down.
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Retrieved from ” https: What is the Cause of the Disease? 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. We describe a patient with El in whom the diagnosis of tuberculosis could be established by onduratum detection of mycobacterial DNA in unduratum lesional biopsy specimen using the polymerase chain reaction PCR.
Active TB infections should be treated more aggressively than latent infections.
Erythema induratum – Wikipedia
The association between EIB and MTB was later questioned once more by additional reports of patients that presented with a similar clinical picture without positive tuberculin skin tests and no history of TB exposure.
Patients may or may not recall a history of tuberculosis infection or exposure. There is still no consensus as to whether venules, larger septal veins, or arterioles are most typically involved.
Pancreatic panniculitis differentiated clinically by temporal relationship to pancreatic pathology and spontaneous oily brown discharge from lesions due to liquefactive necrosis.