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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Lupus profundus also known as lupus panniculitis, differentiated clinically by its more characteristic location on the face and tendency to cause lipodystrophy due to complete destruction of the involved fat cells.
Erythema induratum of bazin.
Cutaneous polyarteritis nodosa differentiated clinically by lesions location- typically along medium sized arteries and pressure points; ie. Congenital generalized lipodystrophy Familial partial lipodystrophy Marfanoid—progeroid—lipodystrophy syndrome Poland syndrome. If negative, this should be followed up in weeks with the standard 5TU per 0. There is a strong female predominance of the disease Similar regimens induraum been shown effective in erythema induratum even in the absence of proven TB.
If induuratum active focus of TB is uncovered, appropriate imaging studies should be performed at regular intervals to monitor regression of disease. For patients with latent disease and multiple co-morbidities, the risks of systemic antituberculosis therapy should be carefully weighed against the benefits. While relatively rare, atypical presentations of EIB may occur.
Compression stockings or supportive bandages can indurtum in improvement of lesions and may warrant a indyratum in patients with mild disease prior to advancing to systemic treatment. As such, patients may have suffered a protracted course for many years prior to diagnosis.
The disease can masquerade as numerous chronic nodular conditions and the diagnosis can easily be missed. Who is at Risk for Developing induratu, Disease? The diagnosis of erythema induratum is clinicopathologic with no pathognomonic histologic features. Sign in to access your subscriptions Sign in to your personal account. The plaques are generally erythematous and indurated, with an overlying scaly surface, and may or may not be tender to deep palpation.
Entities currently considered tuberculids include erythema induratum of Bazin, lichen scrofulosorum, papulonecrotic tuberculid and most cases of granulomatous phlebitis.
Currently, the CDC recommends a 6-month, four-drug course with 2 months or RIPE rifampin, isoniazid, pyrazinamide, ethambutolfollowed by 4 months of isoniazid. Create a free personal account to download free article PDFs, sign up for alerts, customize your interests, and more.
Nodules are typically cm in size, erythematous to violaceous in color, and have a tendency to ulcerate centrally. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account. Expected results of diagnostic studies No pathognomonic histologic feature of erythema induratum exists, and histologic findings may vary with the age of the lesion Figure 2. 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 usually latent, cases of active TB infection associated with erythema induratum have been reported lungs, pleura, pericardium, peritoneum, lymph nodes, and endometrium.
Create a free personal account to download free article PDFs, sign up for alerts, and more. Subcutaneous nodule with overlying poorly defined violaceous erythema on the posterior leg The plaques are generally erythematous and indurated, with an overlying scaly surface, and may or may not be tender to deep palpation.
As such, indurwtum development and presentation of lesions fluctuate based on the underlying immune status of the host.
Erythema induratum of bazin.
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. Etiology Pathophysiology 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.
Erythema induratum classically presents during early adolescence and peri-menopause as subcutaneous poorly defined erythematous plaques and tender violaceous nodules. Caseation necrosis is a late finding evident in approximately one half of cases. As such, once a diagnosis of a tuberculid is made, a thorough investigation to evaluate for subclinical or active TB infection should be pursued. Predisposing factors include abnormal amount of subcutaneous fat, thick ankles and abnormally poor arterial supply.
On physical examination, affected patients will frequently have heavy or column-like calves, erythrocyanosis, cutus marmmorata and some degree of venous insufficiency.
Clinically, EIB can mimic a number of conditions presenting as lower extremity nodules, including:.