We describe two cases of erythema induratum of Bazin (EIB), a cutaneous form of TB. •. Cases had no signs of active TB, but had a positive Interferon Gamma. Erythema induratum is a panniculitis on the calves. It occurs mainly in women, but it is very rare defined pathogen. The medical eponym Bazin disease was historically synonymous, but it applies only to the tuberculous form and is dated. Erythema induratum (also referred to as erythema induratum of Bazin (EIB) or nodular vasculitis) is a chronic nodular skin disease that is thought to represent a .
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Additionally, all states require a communicable disease report to be filed with the local county public health department, generally within 24 hours of identification. Alpha-1 antitrypsin deficiency panniculitis Erythema nodosum Acute Chronic with vasculitis: You can help Wikipedia by expanding it.
Systemic Implications and Complications Although usually latent, cases of active TB infection associated with erythema induratum have been reported lungs, pleura, pericardium, peritoneum, lymph nodes, and endometrium. The diagnosis of erythema induratum is clinicopathologic with no pathognomonic histologic features.
Patients may describe a prolonged history of eritrma episodes over years or decades with new crops of lesions appearing often unpredictably. On physical examination, affected patients will frequently have heavy or column-like calves, erythrocyanosis, cutus marmmorata and some degree of venous insufficiency. Less commonly, lesions may appear on the thighs, buttocks, arms and rarely the face and ears.
The clinical response to anti-tuberculosis therapy can also be used as an indicator to discern the two entities.
Treatment Options Treatment options for erythema induratum are summarized in Table I. If an active focus of TB is uncovered, appropriate imaging studies should be performed at regular intervals to monitor regression of disease. If negative, this should be followed up in weeks with the standard 5TU per 0.
What is the Cause of the Disease? There is a strong female predominance of the disease While there are no risk factors other than previous exposure to TB per se, cold weather, venous stasis with poor peripheral blood flow and obesity appear to precipitate the development of lesions.
Etiology Pathophysiology Erythema induratum is classified as a tuberculid or a chronic nodular skin eruption that represents a cutaneous hypersensitivity reaction to disseminated M tuberculosis MTB or its antigens.
Patients are otherwise healthy without systemic symptoms and often present with a rash as the only symptom of their disease. Sign eritem to download free article PDFs Sign in to access your subscriptions Sign in to your personal account.
Erythema induratum is a panniculitis on the calves. Diagnosis confirmation Clinically, EIB can mimic a number of conditions presenting as lower extremity nodules, including: Actinobacteria primarily A00—A79—, — Regular follow up at week intervals is recommended during the active treatment period to ensure clearance of the lesions. Create a personal account to register for email bazi with links to free full-text articles.
Cutaneous polyarteritis nodosa differentiated clinically by lesions location- typically along medium sized arteries and pressure points; ie.
Erythema induratum is characterized by painful, knduratum, sometimes ulcerating nodules on the lower legs that, histopathologically, show a lobular panniculitis. The association between EIB and MTB was later questioned once more by additional reports of patients that presented with a similar clinical picture without positive tuberculin skin tests and no history of TB exposure.
Pancreatic panniculitis differentiated clinically by temporal relationship to pancreatic pathology and spontaneous oily brown discharge from lesions due to liquefactive necrosis. This page was last edited on 9 Julyat Erythema induratum is classified as a tuberculid or a chronic nodular skin eruption that represents a cutaneous hypersensitivity reaction to disseminated M tuberculosis MTB or its antigens.
In patients with suspected EIB, start with a complete history and physical examination followed by administration of a purified protein derivative PPD tuberculosis skin test and an incisional biopsy involving an adequate amount of subcutaneous fat. The exact diagnosis is obscured by the fact that a number of pathologic processes can cause a similar clinical picture, eg, perniones or lupus erythematosus.
Although less well studied, potassium iodide, dapsone, gold salts, and doxycycline have also been used with success in the treatment of erythema induratum.
Erythema induratum – Wikipedia
Patients with cutaneous polyarteritis nodosa may additionally present with generalized symptoms including fever, malaise, joint and muscle aches as well as neurological symptoms including numbness, tingling, sensory disturbances, weakness, and areflexia, whereas patients with EIB are classically asymptomatic. This infection-related cutaneous condition article is a stub. As such, once a diagnosis of a tuberculid is made, a thorough investigation to evaluate for subclinical or active TB infection should be pursued.
Prolonged, multidrug treatment is necessary to prevent relapse and avoid drug resistance, and progress may be slow.
Erythema Induratum (Erythema induratum of Bazin, Nodular Vasculitis)
The disease preferentially affects the posterior and anterolateral aspects of the lower legs of women; however it can occur in other locations as well as in men and children.
Hong Kong Med J. Erythema nodusum differentiated clinically by onduratum location on the anterior lower extremities, compared to the more characteristic posterior-lateral aspects of the legs of EIB and tendency towards spontaneous healing without ulceration or scarring. Lupus profundus also known as lupus panniculitis, differentiated clinically by its more characteristic location on the face and tendency to cause lipodystrophy due to complete destruction of the involved fat cells.
Erythema induratum of bazin.
No pathognomonic histologic feature of erythema induratum exists, and histologic findings may vary with the age of the lesion Figure 2. Historical context Until recently, clinicians long debated the pathogenesis of EIB and the aforementioned association with Mycobacterium tuberculosis.
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