Nodular vasculitis or erythema induratum without cutaneous tuberculosis: An unusual presentation in an uncommon site

Ramin Mofarrah,Ramina Mofarrah,Nafiseh Jallab,Kousar Jahani Amiri,Naghmeh Jallab

doi:10.7241/ourd.20212.8

Abstract

Erythema induratum (EI) is a rare chronic disease, which occurs with cutaneous tuberculosis (TB). Nodular vasculitis, much rarer than erythema induratum, describes the same condition but without cutaneous TB, with lesions usually in the lower legs and rarely on the breasts. We report the case of a 46-year-old female with a history of crusted skin and necrotic lesions two years before, which, once self-limited, multiplied one month before and transferred to uncommon sites of the body, such as the breast. There was no evidence of other clinical presentations, and a chest X-ray gave no pathological findings. A biopsy was taken from the lesions, and the patient was diagnosed with erythema induratum without cutaneous tuberculosis, that is, nodular vasculitis. After treatment with calcineurin-inhibiting tacrolimus ointment, topical corticosteroids, and immunosuppressive oral azathioprine, the lesions improved.

Highlights

Nodular vasculitis (NV) is an uncommon, mostly lobar form of panniculitis [1], manifesting itself as erythematous nodules or plaques located preferentially on the calves, which may ulcerate and drain
The term nodular vasculitis was coined by Montgomery to refer to cases of lesions similar to erythema induratum unassociated with tuberculosis [4]
Oral immunosuppression with azathioprine was started due to the lack of effectiveness of the previous treatment. This resulted in improvement of the lesions with no recurrence. We report this case both because erythema induratum without TB is rare and because the breast is an uncommon site for this disease

Summary

INTRODUCTION

Nodular vasculitis (NV) is an uncommon, mostly lobar form of panniculitis [1], manifesting itself as erythematous nodules or plaques located preferentially on the calves, which may ulcerate and drain. The term nodular vasculitis was coined by Montgomery to refer to cases of lesions similar to erythema induratum unassociated with tuberculosis [4]. These lesions are located on the anterior and/or posterior legs, including the calves, thighs, upper limbs, and trunk [5]. © Our Dermatol Online 2.2021 www.odermatol.com once self-limited, multiplied one month before and transferred with uncertain etiology These firm, brownish-red to red lesions were located on the right breast and the posterior side of the left calf A granulomatous lesion with several multinucleated giant cells was present in the deep dermis (Fig. 2) Based on these findings, a diagnosis of nodular vasculitis was reached. This resulted in improvement of the lesions with no recurrence

Findings

DISCUSSION

CONCLUSION