Abstract
Background Mycobacterium tuberculosis (MTB) infection has been suggested to contribute to the pathogenesis of erythema nodosum (EN) and nodular vasculitis (NV), the classic forms of panniculitis. However, there is little evidence to demonstrate the presence of MTB in the skin lesions. This study is aimed at evaluating the association between MTB infection and the development of EN and NV in a Chinese population.MethodsA total of 107 patients (36 EN, 27 NV, and 44 others) with vasculitis and 40 control cases with other skin diseases were recruited and their skin lesion samples were subjected to real time polymerase chain reaction (PCR) analysis of the IS6110 and mpt64 gene fragments of MTB. Their blood mononuclear cells were tested for MTB antigen-specific IFN-γ responses by QuantiFERON®-TB Gold In-Tube (IT) assays.ResultsPCR analysis revealed that 7/23 (30.4%) and 7/18 (38.9%) of the EN and NV samples were positive for the IS6110 DNA, respectively, which were significantly higher than 3/34 (8.8%) of other vasculitis (OV) and 3/40 (7.5%) of the control samples (p<0.05). The nested Real-Time PCR assay indicated that 6/7 (86%) of the IS6110-positive EN samples, all of the IS6110-positive NV and control samples, but only 1/3 of the IS6110-positive OV samples, were positive for the mpt64 gene. Similarly, 19/32 (59.4%) of the EN patients, 20/26 (76.9%) of the NV patients, and 17/36 (47.2%) of the OV patients were positive for MTB antigen-specific IFN-γ responses, which were significantly higher than 6/40 (15%) of the controls (p<0.05).ConclusionOur data strongly suggest that MTB infection and active TB are associated with the development of NV and EN in Chinese.
Highlights
Erythema nodosum (EN) is a frequent pathologic variant of panniculitis in the clinic
The tuberculin used in the TST test contains a crude mixture of more than 200 Mycobacterium tuberculosis (MTB) antigens, which are widely shared with M. bovis BCG and other environmental mycobacteria
We investigated the presence of MTB infection in the skin lesions of 107 patients with suspicious panniculitis and vasculitis by real-time polymerase chain reaction (PCR) of the IS6110 and mpt64 gene fragments that are conservative in mycobacterium [9,25], and we examined MTB-specific INF-c responses in those patients to explore the importance of MTB infection in the development of erythema nodosum (EN) and nodular vasculitis (NV) in Chinese patients
Summary
Erythema nodosum (EN) is a frequent pathologic variant of panniculitis in the clinic. There are many etiologic factors that may contribute to the development of EN, and they include infection with streptococcus or Mycobacterium tuberculosis (MTB), Mycobacterium leprae [3,4,5], severe inflammation, drug-related hyperreactivity, estrogen and malignant diseases [6,7]. Streptococcal infection is the most common etiological factor for the development of EN, especially in children. Drug-related hyperreactivity, hormonal reactions, inflammatory bowel disease, and sarcoidosis are common causative factors of EN in adults. Mycobacterium tuberculosis (MTB) infection has been suggested to contribute to the pathogenesis of erythema nodosum (EN) and nodular vasculitis (NV), the classic forms of panniculitis. This study is aimed at evaluating the association between MTB infection and the development of EN and NV in a Chinese population
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