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. Currently, erythema induratum and nodular vasculitis are thought to result from a common inflammatory pathway, that is, a. Erythema induratum of bazin eib nodular vasculitis associated with. 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. 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 of bazin eib is considered a tuberculide reaction and consists of recurrent painful nodules predominantly on the calves. Erythema induratum of bazin is a chronic, nodular eruption that usually occurs on the lower legs of young women. Erythema induratum definition of erythema induratum by. Erythema induratum of bazin 5minute clinical consult. Erythema induratum of bazin is a disease that usually affects women, in whom erythematous subcutaneous nodules and plaques appear on the. Erythema induratum of bazin eib is a hypersensitivity reaction to mycobacterium tuberculosis infection. It has been regarded as a manifestation of tuberculin hypersensitivity, a type of. The medical eponym bazin disease was historically synonymous, but it applies only to the tuberculous form and is dated. This report documents the cases of two patients with ulcerating leg nodules. Vasculitis and zones of fat necrosis are absent in en and frequent in erythema induratum. Erythema induratum of bazin and renal tuberculosis.
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 is characterized by painful, erythematous, sometimes ulcerating nodules on the lower legs that, histopathologically, show a lobular panniculitis. Erythema induratum bazin nach lungentuberkulose memmel. Erythema induratum nodular vasculitis is a related but distinctly different clinicopathologic reaction pattern of the subcutaneous fat. This website is intended for mature audiences only, it contains pictures that some viewers may find disturbing. Please confirm that you would like to log out of medscape.
It is characterized by recurrent nodular and ulcerative lesions. Erythema induratum an overview sciencedirect topics. Treatment of eib and other cases of nodular vasculitis should be directed at the underlying cause of the immune response. It is seen most commonly in adolescent and menopausal women, is initiated or exacerbated by cold weather, and typically presents as one or. 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. Full text full text is available as a scanned copy of the original print version. 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 and active renal tuberculosis. If you log out, you will be required to enter your username and password the next time you visit. It occurs mainly in women, but it is very rare defined pathogen.
Atypisches erythema induratum bazin bei tuberkuloser. 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. 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 studied 101 skin biopsy specimens from 86 patients with clinicopathologic diagnosis of erythema induratum of bazin. Erythema induratum of bazin type associated with tb. In patients suspected to have en but with necrotizing vasculitis, the possibility of cutaneous polyarteritis nodosa must be. 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. Ei presents clinically as recurrent crops of tender, violaceous nodules and plaques on the posterior lower legs. 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 ei was first described by bazin in 1861, who attributed the condition to tuberculosis tb. A purified protein derivative and quantiferon test were positive, favoring the diagnosis of erythema induratum of bazin. Erythema induratum is a panniculitis on the calves. Erythema induratum of bazin is a rare entity, the cause and treatment of which are topics of continuing controversy.
When weather is cold, ankle is cold, blue and often tender. 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. Treatment with a standard fourdrug antituberculous regimen resulted in radiographic and clinical improvement. In many countries, tuberculosis is still the main etiologic factor. We report the case of a woman with eib who developed addisons disease during treatment with antituberculosis drugs. In such cases, it is known as erythema induratum, whitfield type. 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. 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 of bazin associated with addisons. It occurs mainly in women, but it is very rare now. Pdf erythema induratum of bazin and renal tuberculosis. It is traditionally considered to be the tuberculous counterpart of nodular vasculitis, but is now known to occur without tuberculous precedent. Poncets disease is a reactive arthritis that may accompany tuberculosis. In 1861, bazin gave the name erythema induratum to a nodular eruption that occurred on the lower legs of young women with tuberculosis. In hot weather, ankle becomes hot, edematous, swollen and painful. It is classically caused by an antigenic stimulus from mycobacterium tuberculosis but may be associated with several other underlying disorders. Erythema induratum bazin eliph dermatopathologieatlas. Pujol,md,a felicidade trindade, md,b and luis requena, mdb barcelona and madrid, spain background. Erythema induratum erythema induratum of bazin, nodular. The diagnosis can be difficult because tubercle bacilli are usually not found in smears or cultures of lesions. Erythema nodosum must be distinguished from erythema induratum and nodular vasculitis.
Tabular summary of treatment details, clinical outcome, and. Lesions are usually localized to the lower legs especially calf area, but can affect. Erythema induratum of bazin presenting as peripheral. Similarities exist between this condition and nodular vasculitis, but at this time the two are considered separate entities. 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.
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. Beyond treating underlying triggers, therapeutic options consist mainly of nonsteroidal anti. Erythema induratum project gutenberg selfpublishing. Erythema induratum of bazin eib is a tuberculid, a condition occurring on the legs of female and in young and plump well nourished women. Erythema induratum of bazin has distinct clinical, histopathologic, and immunohistochemical features. We report a case of a 40yearold woman who presented a course of protracted and recurrent episodes over five years of. Erythema induratum of bazin associated with addisons disease. A type of panniculitis characterized histologically by the presence of granulomas, vasculitis, and necrosis. Erythema induratum of bazin eib is considered to be a tuberculid reaction and consists of recurrent painful nodules.
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. Lesions have also been reported on the feet, thighs, buttocks, and forearms. Erythema induratum of bazin is a mostly lobular panniculitis. Successful treatment of erythema induratum of bazin.
Erythema induratum of bazin should be considered as a separate entity of nodular vasculitis caused by latent foci of tuberculous infection. A histopathologic study of 101 biopsy specimens from 86 patients sonia segura, md,a ramo. Clinically it has common features with diseases like nodular vasculitis, perniosis, polyarteritis nodosa and erythema nodosum. After appropriate antimicrobial treatment in tuberculous cases. Changes in cortisol metabolism following rifampicin therapy. Get a printable copy pdf file of the complete article 183k, or click on a page image below to browse page by page. A biopsy revealed changes consistent with nodular vasculitis. 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. In patients suspected to have en but with necrotizing vasculitis, the possibility of cutaneous polyarteritis nodosa must be considered. 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. It occurs with any skin injury, infection, or inflammation. 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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