We report the case of a woman with eib who developed addisons disease during treatment with antituberculosis drugs. In 1945, montgomery et al, while fully acknowledging the existence of tuberculosisassociated erythema induratum, coined the term nodular vasculitis to describe chronic inflammatory nodules of the legs that s. 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. Erythema induratum represents a chronic skin disease most often caused by mycobacterium tuberculosis, consisting of chronic inflammatory nodules commonly located on the lower limbs of the patient. C montreal, quebec, canada erythema induratum of bazin is a rare entity, the cause and treatment of which are topics of continuing controversy. 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. It occurs with any skin injury, infection, or inflammation. Pdf erythema induratum of bazin and renal tuberculosis. Peripheral neuropathy may manifest as a result of hypersensitivity reaction to tuberculousis antigens causing tissue and nerve damage in patients with erythema induratum of bazin eib. It occurs mainly in women, but it is very rare now. Erythema induratum of bazin 5minute clinical consult. What you should be alert for in the history 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 hypersensitivity response to mycobacterium tuberculosis or its antigens. Clinically it has common features with diseases like nodular vasculitis, perniosis, polyarteritis nodosa and erythema nodosum.
Poncets disease is a reactive arthritis that may accompany tuberculosis. Historically, when it has occurred, it has often been concomitant with cutaneous tuberculosis, and it was formerly thought to be always a reaction to the tuberculum bacillus. When weather is cold, ankle is cold, blue and often tender. Beyond treating underlying triggers, therapeutic options consist mainly of nonsteroidal anti. Erythema induratum of bazin eib is considered a tuberculide reaction and consists of recurrent painful nodules predominantly on the calves. The diagnosis can be difficult because tubercle bacilli are usually not found in smears or cultures of lesions. Erythema induratum of bazin is a mostly lobular panniculitis. Erythema induratum was first identified in 1861, by bazin, as a nodular eruption that occurred on the lower legs posterior face of young women with tuberculosis. Erythema induratum and nodular vasculitis had been seen as the same disease for many years but nodular vasculitis is now considered to be a multifactorial syndrome of lobular panniculitis in which tuberculosis may or may not be one of the various aetiologies. A histopathologic study of 101 biopsy specimens from 86 patients sonia segura, md,a ramo. Erythema induratum nodular vasculitis is a related but distinctly different clinicopathologic reaction pattern of the subcutaneous fat. It is characterized by recurrent nodular and ulcerative lesions.
Erythema induratum of bazin is a disease that usually affects women, in whom erythematous subcutaneous nodules and plaques appear on the posterior part of the lower extremities, some of which ulcerate. Tabular summary of treatment details, clinical outcome, and. Treatment of eib and other cases of nodular vasculitis should be directed at the underlying cause of the immune response. Similarities exist between this condition and nodular vasculitis, but at this time the two are considered separate entities. In patients suspected to have en but with necrotizing vasculitis, the possibility of cutaneous polyarteritis nodosa must be considered. Erythema induratum is a panniculitis on the calves. In hot weather, ankle becomes hot, edematous, swollen and painful. Biopsy sample was obtained and pathology showed septal and lobular hypodermitis with compromise of adipose lobules and lymphohistiocytic infiltrate that suggested the formation of granuloma, which was considered bazin s indurated erythema. When erythema induratum is present in cutaneous tuberculosis, it is known as erythema induratum of bazin eib however, erythema induratum may be of the nontuberculosis type too. In many countries, tuberculosis is still the main etiologic factor. Please confirm that you would like to log out of medscape.
The differential diagnosis includes diseases like nodular vasculitis, perniosis, polyarteritis nodosa and erythema nodosum. Erythema induratum of bazin should be considered as a separate entity of nodular vasculitis caused by latent foci of tuberculous infection. Erythema induratum bazin nach lungentuberkulose memmel. We studied 101 skin biopsy specimens from 86 patients with clinicopathologic diagnosis of erythema induratum of bazin. A biopsy revealed changes consistent with nodular vasculitis. The term nodular vasculitis was thus proposed to differentiate the lesions of erythema induratum of nontuberculosis origin from those of tuberculosis origin known today as erythema induratum of bazin. Erythema induratum of bazin presenting as peripheral. After appropriate antimicrobial treatment in tuberculous cases. This website is intended for mature audiences only, it contains pictures that some viewers may find disturbing. This study reports on a case of eib in a yearold female, who presented multiple tender nodules on her lower extremities.
Erythema induratum of bazin type associated with tb. It is classically caused by an antigenic stimulus from mycobacterium tuberculosis but may be associated with several other underlying disorders. Erythema induratum of bazin eib nodular vasculitis associated with. A purified protein derivative and quantiferon test were positive, favoring the diagnosis of erythema induratum of bazin. Erythema induratum of bazin associated with addisons disease. Lesions are usually localized to the lower legs especially calf area, but can affect. Get a printable copy pdf file of the complete article 183k, or click on a page image below to browse page by page. Erythema induratum of bazin eib is a hypersensitivity reaction to mycobacterium tuberculosis infection. The term erythema induratum ei was coined by bazin in 1855, who described deep violaceous nodules on the posterior lower legs of young women. Erythema induratum erythema induratum of bazin, nodular. Full text full text is available as a scanned copy of the original print version. Erythema induratum of bazin eib is considered to be a tuberculid reaction and consists of recurrent painful nodules.
Changes in cortisol metabolism following rifampicin therapy. Erythema induratum, also known as nodular vasculitis or bazin disease, is categorized as a tuberculid skin eruption, which is a group of skin conditions associated with an underlying or silent. Erythema induratum definition of erythema induratum by. Erythema induratum ei was first described by bazin in 1861, who attributed the condition to tuberculosis tb. Erythema induratum project gutenberg selfpublishing. There is considerable controversy in the literature about whether or not vasculitis is a histopathologic requirement to establish the diagnosis of erythema induratum of bazin. Currently, erythema induratum and nodular vasculitis are thought to result from a common inflammatory pathway, that is, a. The medical eponym bazin disease was historically synonymous, but it applies only to the tuberculous form and is dated. Erythema induratum of bazin is a disease that usually affects women, in whom erythematous subcutaneous nodules and plaques appear on the. It has been regarded as a manifestation of tuberculin hypersensitivity, a type of.
It occurs mainly in women, but it is very rare defined pathogen. Ei presents clinically as recurrent crops of tender, violaceous nodules and plaques on the posterior lower legs. Atypisches erythema induratum bazin bei tuberkuloser. If you log out, you will be required to enter your username and password the next time you visit. Erythema induratum bazin eliph dermatopathologieatlas. It is traditionally considered to be the tuberculous counterpart of nodular vasculitis, but is now known to occur without tuberculous precedent. Erythema induratum of bazin is a chronic, nodular eruption that usually occurs on the lower legs of young women. Primary inoculation tuberculosis of the skin is the cutaneous analogue of the pulmonary ghon focus primary cutaneous tuberculosis may be associated with tattooing, ritual circumcision, nose piercing, inoculation of homeopathic solutions or injury by contaminated objects to laboratory workers, surgeons or prosectors. We report a case of a 40yearold woman who presented a course of protracted and recurrent episodes over five years of. In patients suspected to have en but with necrotizing vasculitis, the possibility of cutaneous polyarteritis nodosa must be. Successful treatment of erythema induratum of bazin.
Erythema induratum of bazin has distinct clinical, histopathologic, and immunohistochemical features. Lesions have also been reported on the feet, thighs, buttocks, and forearms. Erythema induratum of bazin associated with addisons. In such cases, it is known as erythema induratum, whitfield type.
Vasculitis and zones of fat necrosis are absent in en and frequent in erythema induratum. Erythema induratum of bazin eib is a tuberculid, a condition occurring on the legs of female and in young and plump well nourished women. Pujol,md,a felicidade trindade, md,b and luis requena, mdb barcelona and madrid, spain background. This report documents the cases of two patients with ulcerating leg nodules. Erythema induratum an overview sciencedirect topics. In 1861, bazin gave the name erythema induratum to a nodular eruption that occurred on the lower legs of young women with tuberculosis. Erythema nodosum must be distinguished from erythema induratum and nodular vasculitis. It is seen most commonly in adolescent and menopausal women, is initiated or exacerbated by cold weather, and typically presents as one or.
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