Erythema Induratum Research Articles

Disseminated Erythema Induratum of Bazin in an Indian Female

Disseminated Erythema Induratum of Bazin in an Indian Female

Clinico-Laboratory Profile of Tuberculides: An Experience at a Tertiary Care Centre from Chandigarh, India.

Tuberculides are characterised by delayed-type of immunologic reactions to Mycobacterium tuberculosis or its products in immuno-competent individuals. We herein describe clinico-epidemiological features and response to treatment in patients with tuberculides from a tertiary care centre from North India. This was a retrospective analysis of the clinical records of all the cutaneous tuberculosis (TB) patients (year 2000-2019) enrolled in the TB clinic. The patient records fulfilling the diagnostic criteria of tuberculides were considered for analysis. A total of 225 patients attended the tuberculosis clinic; out of this, 34 were diagnosed as tuberculides. Out of these 34 cases, 21 were identified as LS, 2 erythema induratum of Bazin, 1 papulonecrotic tuberculide, and 10 erythema nodosum. History of contact to open cases of TB was present in 15/34 (44.1%) patients. History of BCG vaccination was found in 15/34 (44.1%) patients. The focus of underlying TB could be identified in 20/34 (58.8%) patients. Skin biopsy was performed in all patients. In all patients, the diagnosis was confirmed by clinico-pathological correlation, positive TST, and the underlying focus of TB. All patients received 6 months regimen of anti-tubercular therapy with first-line drugs. In this study, we demonstrated various forms of tuberculides; lichen scrofulosorum was the most common form. We also included erythema nodosum cases also, which responded well to ATT. Observation from our study showed that tuberculides are important cutaneous markers for underlying tuberculosis infection, which helps in early detection of occult tuberculosis and timely management.

Should antituberculosis treatment be prescribed in erythema induratum? A case-control and incidence correlation study in Taiwan, 2001-2020.

Erythema induratum (EI) is a tuberculid associated with Mycobacterium tuberculosis infection. Using polymerase chain reaction (PCR), M. tuberculosis has been identified in Taiwan with a high percentage of EI. However, this pathogen is now rarely detected in Taiwan. To explore the association between EI, the annual incidence of tuberculosis (TB) in Taiwan and treatment outcomes over the last two decades. Patients diagnosed with EI between 2001 and 2020 were enrolled based on histopathology, tissue culture and positive M. tuberculosis PCR tests. Other cases of panniculitis with positive M. tuberculosis PCR results were used as controls. The clinical information of participants was obtained. The results were correlated with the annual incidence of TB and compared between groups. Fifty-five biopsy specimens from patients with EI met the inclusion criteria; three (5%) had positive M. tuberculosis PCR results. One patient diagnosed with erythema nodosum in the control group had a positive M. tuberculosis PCR (n = 1/27; 4%). There was no significant relationship between M. tuberculosis and EI (odds ratio 1.5, 95% confidence interval -0.964 to 3.964). The correlation between the incidence of M. tuberculosis and the number of EI cases was not statistically significant (r = -0.185, P = 0.45). Only four patients received anti-TB treatment; they all showed clinical improvement without recurrence. One patient with M. tuberculosis PCR-positive EI was not treated with anti-TB therapy; however, the skin lesion improved after 3 months. No other patients in the EI group were diagnosed with M. tuberculosis infection over a follow-up period of 508 person-years. Most cases of EI in Taiwan are nodular vasculitis and not tuberculid, owing to well-controlled TB. This condition can be alleviated without anti-TB treatment.

A cross sectional descriptive study of dermoscopic features of clinical variants of cutaneous tuberculosis

Tuberculosis continues to be a major public health concern worldwide with almost 20–40% of the world's population being affected yearly. Cutaneous Tuberculosis (TB) is a rare and underdiagnosed entity that manifests in about 1–1.5% of extrapulmonary tuberculosis cases worldwide. Dermoscopy is a non-invasive tool which will be a useful aid to histopathology in the confirmation of the diagnosis alongside culture, and molecular techniques. This is a cross-sectional descriptive study that was conducted at a tertiary care center in Mumbai, India. A total of 31 patients were enrolled in this study; 14 males and 17 females. The mean duration of disease was 4.3 months and the average age was 31 years. There were 10 cases of lupus vulgaris, 7 scrofuloderma, 5 papulonecrotic tuberculid (PNT), 3 tuberculosis verrucosa cutis (TBVC), and 2 cases each of erythema induratum of Bazin, lichen scrofulosorum and resolved lupus vulgaris. All the lesions demonstrated orange yellow background suggestive of dermal granuloma. Other key dermoscopic features noted include yellowish-white scales, patulous follicles, white structureless areas, milia-like cysts, white streaks, pigment globules, hairpin and linear vessels. Newer findings such as the crown of vessels and perifollicular pallor in lichen scrofulosorum, and radiating white streaks in PNT were also noted. Dermoscopy of infective granulomas such as cutaneous tuberculosis is a less explored field of dermatology. Newer dermoscopic features of each clinical variant of cutaneous TB have been described.

A Case of C-ANCA Associated Vasculitis Presenting With Localised Skin Thickening

ANCA vasculitis, caused by antibodies named ANCA (anti-neutrophilic cytoplasmic autoantibodies), is an autoimmune disorder affecting small blood vessels of the body. Among p-ANCA and c- ANCA, c-ANCA (cytoplasmic ANCA) usually targets proteinase three inside neutrophils, causing inflammation of blood vessels. Herein, we report a case of a 56-year-old female patient with c- ANCA-associated vasculitis. The patient presented with a localized skin thickening on the medial aspect of the left thigh and an oral ulcer. Skin biopsy shows erythema induratum (nodular vasculitis). After several investigations, we found c-ANCA positive and concluded the diagnosis as c-ANCA-associated vasculitis. We treat the patient with injectable methylprednisolone, injectable cyclophosphamide, and Mesna. Then we gave oral mycophenolate mofetil and prednisolone. J Dhaka Med Coll. 2022; 31(1) : 158-162

Erythema Induratum of Bazin: A Rare Finding in an Old Woman with Subcutaneous Nodules in the Lower Limbs

Erythema induratum of Bazin (EIB) is a chronic nodular eruption that frequently occurs on lower legs of young or middle-aged women. The clinical manifestations of EIB revealed various dermatological disorders that can be easily leads to misdiagnosis. We report a case of a 50-year-old woman who initially presented with EIB. The histopathological specimen was collected from her medial aspect of let leg. The epidermis is unremarkable. The dermis shows fibro fatty tissue, skin adnexae and foci of granuloma with Langhans type of giant cells and some lymphocytic infiltration in the deep dermis which was suggestive of erythema induratum. Her lesions responded to antitubercular therapy (ATT). This case study may help extend the therapeutic regimens for cutaneous tuberculosis.
 CBMJ 2023 January: Vol. 12 No. 01 P: 121-123

Tuberculids: A Narrative Review.

Tuberculids are a group of dermatoses with tuberculoid histology and the absence of tubercle bacilli. They are considered to be hypersensitivity reactions to circulating Mycobacterium tuberculosis (M. tb) or its antigens in individuals with good immunity. The objective of the review is to provide a detailed literature review of all available articles on tuberculids in the past 10 years and provide an update on epidemiology, etiopathogenetic mechanisms, clinical manifestations, and treatment. A search was performed on PubMed using the keywords lichen scrofulosorum, papulonecrotic tuberculid, erythema induratum, and erythema nodosum tuberculosis for all articles, with no restrictions on age, gender, or nationalities. An update on tuberculids, including some new concepts in pathogenesis, atypical presentations, new investigative modalities, and treatments are reviewed.

Ulcerated, tender nodules of the lower extremities

Ulcerated, tender nodules of the lower extremities

Erythema Induratum of Bazin, a Rare Manifestation of Cutaneous Tuberculosis: A Case Report

Background: Erythema induratum of Bazin is a rare manifestation of cutaneous tuberculosis. It may mimic some systemic disorders like sarcoidosis, poly arteritis nodosa, lymphoproliferative disorder, Histoplasmosis, and lupus profundus. Case Presentation: A 38-year young female, diabetic, and hypertensive presented with multiple painful skin lesion over anterior part of her leg for 3 months. These skin lesion used to appear as painful erythematous nodules of variable size and shape over the anterior and lateral aspects of both legs that became ulcerate, healed with hyperpigmentation. On examinations, all of her systemic examinations revealed unremarkable except skin lesion. Punch biopsy from skin lesion revealed lobular panniculitis with granuloma suggestive of erythema induratum and MTB gene Xpert from skin lesion found positive. Thereafter, she was put on anti TB therapy six-month regimens according to the national TB guideline, Bangladesh. After 2 and half months of treatment, her skin lesion disappeared. Conclusion: In a TB prevalent country, erythema induratum should be kept in differential diagnosis along with others. As it is usually underdiagnosed or misdiagnosed because of the absence of typical clinical features of TB, therefore comprehensive investigations like skin biopsy with histopathology, detecting DNA of Mycobacterium tuberculosis by PCR, positive Mantoux test are the cornerstone for confirmatory diagnosis. J MEDICINE 2022; 23: 165-168

Colchicine in Managing Skin Conditions: A Systematic Review

(1) Background: Colchicine is a natural alkaloid with anti-inflammatory properties used to treat various disorders, including some skin diseases. This paper aims to incorporate all the available studies proposing colchicine as a treatment alternative in the management of cutaneous conditions. (2) Methods: In this systematic review, the available articles present in various databases (PubMed, Scopus-Embase, and Web of Science), proposing colchicine as a treatment for cutaneous pathological conditions, have been selected. Exclusion criteria included a non-English language and non-human studies. (3) Results: Ninety-six studies were included. Most of them were case reports and case series studies describing colchicine as single therapy, or in combination with other drugs. Hidradenitis suppurativa, pyoderma gangrenosum, erythema nodosum, erythema induratum, storage diseases, perforating dermatosis, bullous diseases, psoriasis, vasculitis, acne, urticaria, stomatitis, actinic keratosis, and pustular dermatosis were the main diseases discussed in literature. Although the therapeutic outcomes were variable, most of the studies reported, on average, good clinical results (4) Conclusions: Colchicine could be, as a single therapy or in combination with other drugs, a possible treatment to manage several skin diseases.

A Case of Erythema Induratum of Bazin with Migratory Erythema at Unilateral Lower Limb

A Case of Erythema Induratum of Bazin with Migratory Erythema at Unilateral Lower Limb

Non-ulcerative Variant of Erythema Induratum of Bazin in an Indian Female.

Non-ulcerative Variant of Erythema Induratum of Bazin in an Indian Female.

Dermatologic Manifestations of Systemic Diseases in Childhood

Dermatologic Manifestations of Systemic Diseases in Childhood

Erythema induratum of Bazin as an indicative manifestation of cavitary tuberculosis in an adolescent: a case report

BackgroundErythema induratum of Bazin (EIB) is a rare cutaneous manifestation of tuberculosis (TB) that frequently occurs in middle-aged women. The clinical manifestations of EIB can mimic various skin diseases, easily leading to misdiagnosis or underdiagnosis. We report a case of a 16-year-old Chinese girl who initially presented with EIB and was subsequently diagnosed with cavitary TB.Case presentationThe patient is a 16-year-old Chinese girl who presented with clusters of erythematous subcutaneous nodules on the posterior part of her right lower leg matching the clinical manifestations of EIB but was otherwise asymptomatic. The patient was subsequently diagnosed with cavitary TB on the basis of a positive result from a T-SPOT.TB test and the observation of cavitary lung lesions in chest computed tomography scanning. A good clinical response was observed in the patient after the initial phase of a standard 6-month antibiotic regimen.ConclusionsAdolescents infected with Mycobacterium tuberculosis frequently present atypical symptoms. Cutaneous manifestations of tuberculosis in adolescents can be considered good clinical indicators to predict the underlying disease. Strong clinical suspicion is required for a prompt diagnosis in adolescents with EIB.

The master of masquerade: A case series of unusual presentations of cutaneous tuberculosis in the immunocompromised host

Cutaneous tuberculosis is known for its varied presentations, especially in the setting of immunosuppression. Clinical manifestations can be modified by the site of involvement as well as the type of cutaneous tuberculosis in a particular patient. Although cutaneous tuberculosis only accounts for a small percentage (1–2%) of extrapulmonary cases, it is encountered fairly frequently in dermatology practice in an endemic country like India. These cases are being presented to highlight unusual presentations of well-known forms of cutaneous TB (TB gumma and erythema induratum of Bazin) and rare morphologies (panniculitis) in immunosuppressed individuals, thereby emphasizing the need for the dermatologist in a TB-endemic country to be constantly vigilant.

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

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.

Erythema induratum of Bazin—A subcutaneous granulomatous vasculitis that caused difficulty in walking

Erythema induratum of Bazin—A subcutaneous granulomatous vasculitis that caused difficulty in walking

Association between erythema nodosum/ erythema induratum of Bazin and Mycobacterium tuberculosis infection in Koreans.

Erythema nodosum and erythema induratum of Bazin are similar inflammatory diseases of the lower extremities. These are clinically distinguishable entities, though overlap can occur. Both diseases are reported to be related to Mycobacterium tuberculosis infection, but it is very difficult to identify Mycobacterium tuberculosis in skin lesions. This study aimed to develop a new nested polymerase chain reaction targeting the IS6110 insertion sequence of M. tuberculosis to improve the M. tuberculosis detection rate in skin lesions of erythema nodosum or erythema induratum of Bazin. From May 2016 to Jan 2018, 14 patients with clinically suspicious erythema nodosum or erythema induratum were enrolled in the study. Two cases were classified as erythema nodosum and 12 as erythema induratum. Individual patients were subjected to a 4-mm punch biopsy, and their venous whole blood was sampled immediately after diagnosis. Eight patients were tested for M. tuberculosis using QuantiFERON, of which seven (87.5%) were positive. IS6110-nested polymerase chain reaction on all 14 patients identified 11 (78.6%) positive cases. Four of the eight (50%) individuals tested with QuantiFERON were also positive in the IS6110 nested polymerase chain reaction. The difference between the outcomes of the QuantiFERON and the IS6110-nested polymerase chain reaction tests was not statistically significant. There was also no significant agreement between the results of both assays. Sequencing the IS6110-nested polymerase chain reaction products showed a 97%-100% nucleotide sequence identity with the H37Rv genome. It is important to test for tuberculosis in patients with multiple tender subcutaneous nodules on their lower extremities in high-burden tuberculosis countries like Korea. We need to register more suspicious patients to verify the association between erythema nodosum/erythema induratum of Bazin and M. tuberculosis. Furthermore, it is necessary to improve the more sensitive polymerase chain reaction technique to identify M. tuberculosis directly in cutaneous lesions.

Erythema induratum of Bazin: A study of 34 cases in an endemic country

Erythema induratum of Bazin: A study of 34 cases in an endemic country

Panniculitis at the Site of Injection: Infection or Foreign Body Reaction?

Abstract Introduction/Objective A 63 year old diabetic female presented to the dermatology clinic with painful abdominal nodules. The nodules seemed to wax and wane every 1–2 weeks and appeared in different locations on the abdomen. The lesions were subcutaneous, tender, firm, and mobile with no discoloration. The patient had diabetes treated with injectable exenatide but no other significant medical or travel history. Methods The differential diagnoses included mycobacterial infection, mechanical insult from injectable diabetes medication, erythema nodosum, erythema induratum, and lupus panniculitis. Ultrasound was indicative of panniculitis. A biopsy of the active lesion was performed. Results The biopsy showed septal and lobular panniculitis with mixed inflammation and multinucleated giant cells. Small, circular, non-polarizable pink amphorous material was associated with the infiltrate. The amphorous material was strongly acid fast. The patient had a negative quantiferon-TB test. Scanning electron microscopy with energy dispersive x-ray analysis showed that the material contained more oxygen and less carbon than surrounding tissue, but no abnormal elements were identified. Infrared spectroscopy of the foreign material most closely matched poly(L- lactide-co-glycolide). Conclusion The diagnosis of exenatide induced granulomatous panniculitis was made. The patient had recently started using this injectable glucagon-like peptide-1 receptor agonist, which has been associated with panniculitis. The injectable formulation is loaded onto microspheres composed of poly (DL-lactic-co-glycolic acid), which is closely related to poly(L-lactide-co-glycolide). This material has been shown to stain strongly acid fast. This case of granulomatous panniculitis due to injectable diabetic medication highlights an important potential pitfall that pathologists should be aware of, especially in cases where mycobacterial infection is in the differential.