Abstract
BackgroundErythema induratum of Bazin (EIB) – nodular vasculitis associated with Mycobacterium tuberculosis (TB) – and Tuberculosis-Associated Ocular Inflammation (TB-AOI) represent uncommon manifestations of TB. There is limited data and a lack of diagnostic and treatment standards for these conditions.MethodsEleven-year retrospective review of EIB and TB-AOI cases managed in a provincial TB program with prospective phone-based follow-up of anti-tubercular therapy (ATT) recipients. Presumptive TB-AOI and EIB diagnoses were determined by ophthalmologist or dermatologist assessments correlated with positive tuberculin skin test and/or QuantiFERON-TB Gold, along with pathologic criteria in EIB cases.ResultsOf 21 EIB and 20 TB-AOI cases that received ATT, 13 and 11, respectively, were reached for follow-up. The majority of EIB and TB-AOI cases were female and immigrated from TB high-burden countries. Median durations of pre-diagnosis symptoms were 2 and 0.8 years (IQR 2.5 & 1.1) for EIB and TB-AOI cases, respectively. Overall, 14 different ATT regimens were used for a median duration of 6 months (range 5–9). ATT related adverse events resulting in treatment discontinuation occurred in 14% of EIB and 10% of TB-AOI cases. On last follow-up, 76% of EIB and 42% of TB-AOI had improvement or resolution of disease.ConclusionEIB and TB-AOI were uncommon presentations receiving variable therapy. While treatment response was modest for EIB cases, TB-AOI cases had sub-optimal treatment outcomes. The unique diagnostic and management challenges presented by these conditions in TB low-incidence settings highlight a need for improved treatment candidate selection, therapy standardization, and cross-specialty medical collaboration.
Highlights
Erythema induratum of Bazin (EIB) – nodular vasculitis associated with Mycobacterium tuberculosis (TB) – and Tuberculosis-Associated Ocular Inflammation (TB-AOI) represent uncommon manifestations of TB
The fourth most populous province in Canada, has an above national average TB case incidence rate of 5.1 [18]. In this setting our study aimed to evaluate referral trends, clinical management patterns and long-term outcomes for EIB and TB-AOI cases managed in a provincial TB program
Demographics and case characteristics A total of 22 EIB and 20 TB-AOI cases were identified over the 11-year study period
Summary
Erythema induratum of Bazin (EIB) – nodular vasculitis associated with Mycobacterium tuberculosis (TB) – and Tuberculosis-Associated Ocular Inflammation (TB-AOI) represent uncommon manifestations of TB. When believed to be related to a hypersensitivity reaction to TB antigens such conditions have been referred to as tuberculids, and more recently tuberculosis-associated ocular inflammation (TB-AOI) when involving the eye [4, 6, 7]. Erythema induratum of Bazin (EIB) is a tuberculid form of lobular panniculitis often occurring on the arms or legs with a clinical appearance similar to erythema nodosum but distinguished by characteristic nodular vasculitis on pathology [8, 9]. While EIB and TB-AOI represent distinct clinical entities, they pose similar diagnostic and treatment challenges to a TB program, often resulting in empiric treatment of presumed cases, and for this reason were combined in our study
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