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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It occurs mainly in women, but it is very rare now. Characteristic findings on physical examination On physical examination, affected patients will frequently have heavy or column-like calves, erythrocyanosis, cutus marmmorata and some degree of venous insufficiency.
Nodules are typically cm in size, erythematous to violaceous in color, and have a tendency to ulcerate centrally. Treatment options for erythema induratum Medical Treatment Surgical Procedures Physical Modalities Anti-tuberculosis treatment rifampin, isoniazid, and pyrazinamide Baazin indicated Rest Non-steroidal anti-inflammatory agents Compression stockings Potassium iodide Supportive bandages Dapsone Oral gold salts Doxycycline.
The disease can masquerade as numerous chronic nodular conditions and the diagnosis can easily be missed. Historically, when it has occurred, it has often been concomitant with cutaneous tuberculosisand it was formerly thought to be always a reaction to the tuberculum bacillus.
Erythema Induratum (Erythema induratum of Bazin, Nodular Vasculitis)
The tuberculous origin of erythema induratum Ela chronic nodular eruption of the lower legs, has long remained circumstantial, since Mycobacteria cannot be cultured from lesional specimens. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account.
Laboratory tests Additional laboratory tests indurxtum a complete blood count with differential, chemistry panel, erythrocyte sedimentation rate, and liver function tests are typically normal in erythema induratum. Get free access to newly published articles.
As hazin rule, no foreign body bazn identified and all histochemical stains and cultures for infection are negative. When weather is cold, ankle is cold, blue and often tender. Currently, the CDC recommends a 6-month, four-drug course with 2 months or RIPE rifampin, isoniazid, pyrazinamide, ethambutolfollowed by 4 months of isoniazid.
Erythema induratum of bazin.
Page and No pathognomonic histologic feature of erythema induratum exists, and histologic findings may vary with the age of the lesion Figure 2. EIB exhibits a predominantly lobular or septolobular pattern of panniculitis indistinguishable from the non-M tuberculosis MTB associated cases classified as nodular indratum.
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.
On physical examination, affected patients will frequently have heavy or column-like calves, erythrocyanosis, cutus marmmorata and some degree of venous insufficiency. Actinomyces israelii Actinomycosis Cutaneous actinomycosis Tropheryma whipplei Whipple’s disease Arcanobacterium haemolyticum Arcanobacterium haemolyticum infection Actinomyces gerencseriae.
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Patients may describe a prolonged history of recurrent episodes over years or decades with new crops of lesions appearing often unpredictably. 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.
Encourage patients to persist with treatment.
The prognosis of erythema induratum is excellent with appropriate treatment. Regular follow up at week intervals is recommended during the active treatment period to ensure clearance of the lesions. While eriteja rare, atypical presentations of EIB may occur. Additional laboratory tests including a complete blood count with differential, chemistry panel, erythrocyte sedimentation rate, and liver function tests are induraum normal in erythema induratum.
Views Read Edit View history. Feiwel, M, Munro, DD. Congenital generalized lipodystrophy Familial partial lipodystrophy Marfanoid—progeroid—lipodystrophy syndrome Poland syndrome. 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.
Prolonged, multidrug treatment is necessary to prevent relapse and avoid drug resistance, and progress may be slow. Induatum ankle skin becomes sensitive to temperature changes. Pancreatic panniculitis differentiated clinically by temporal relationship to pancreatic pathology and spontaneous oily brown discharge from lesions due to liquefactive necrosis.
Caseation necrosis is a late finding evident in approximately erirema half of cases. 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.