Tuberculosis-Associated Erythema Nodosum

Jennifer Laborada,Philip R Cohen

doi:10.7759/cureus.20184

Abstract

Erythema nodosum is panniculitis that is frequently observed in women aged 18 to 34 years. It usually occurs as an idiopathic condition; however, it may be associated with drugs, infections, malignancy, pregnancy, and systemic illnesses. Erythema nodosum presents with the sudden onset of tender, warm, erythematous nodules typically on the ankles, knees, and shins. Although the pathogenesis has not been fully elucidated, evidence supports a delayed type IV hypersensitivity reaction. It is often a clinical diagnosis that does not require a biopsy; appropriate work-up and careful medication history are crucial to identifying an underlying etiology if present. This report describes a woman from Vietnam, a tuberculosis endemic country, who presented with erythema nodosum that was determined to be a sequela of latent tuberculosis. Several studies have demonstrated an association between erythema nodosum and tuberculosis, especially in endemic regions. Summarized data reveals the incidence of tuberculosis-associated erythema nodosum to be six percent; however, when individuals with either secondary erythema nodosum or infection-associated erythema nodosum are evaluated, the incidence of tuberculosis-associated erythema nodosum is 11% or 21%, respectively. Evaluation of erythema nodosum should include a tuberculin or QuantiFERON test, chest roentgenogram, and/or an acid-fast bacilli sputum culture if the diagnosis of tuberculosis is being considered.

Highlights

This report describes a woman from Vietnam, a tuberculosis endemic country, who presented with erythema nodosum that was determined to be a sequela of latent tuberculosis
Erythema nodosum is septal panniculitis characterized by erythematous nodules on the lower extremities
We describe a woman who presented with erythema nodosum

Summary

Introduction

Erythema nodosum is septal panniculitis characterized by erythematous nodules on the lower extremities. A 59-year-old Vietnamese woman presented with a six-week history of red and painful swollen nodules on the distal legs; she denied other symptoms of cough, dysuria, fatigue, fever, malaise, sore throat, and weight loss. Her primary care physician suspected cellulitis and prescribed a 10-day course of doxycycline 100 mg twice per day. Correlation of the clinical presentation with laboratory studies suggested a diagnosis of tuberculosisassociated erythema nodosum She was evaluated by an infectious disease specialist who confirmed the diagnosis of latent tuberculosis; her abnormal chest roentgenogram was not considered to be related to tuberculosis. All of her lesions had flattened with residual post-inflammatory hyperpigmentation

Discussion

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Disclosures