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. Similarities exist between this condition and nodular vasculitis, but at this time the two are considered separate entities.
Erythema Induratum (EI) more often affects middle-aged women , but men and children can also acquire this illness.
An EI case usually suffers from pulmonary tuberculosis, but other sites of infection, like cervical lymphadenitis , renal parenchyma , epididymo-orchitis  or aortic valvular lesions of the same etiology  are possible. One study  even describes EI after Bacillus Calmette–Guérin (BCG) vaccine administration. In addition, it is important to evaluate the existence of human immunodeficiency virus (HIV) concomitant infection clinical traits .
The patients show erythematous or violaceous nodules, 1 - 4 cm in size, or plaques with a scaly surface located on the lower limbs, that may be tender and have a recurrent character, reappearing once every 3 or 4 months. Nodules sometimes cause shallow ulcers that heal, leaving scars and hyper pigmented areas. The affected regions, like calves, ankles, thighs, buttocks, but also trunk and arms are edematous. Disseminated forms have been described . Pruritus is absent. The disease may worsen with cold weather. The clinical picture may be completed by the presence of distal painful peripheral neuropathy , cutis marmorata or erythrocyanosis. Systemic complaints are usually absent, but other dermal manifestations of tuberculosis, such as papulonecrotic tuberculids may coexist.
Liver, Gall & Pancreas
Workup should include a complete cell blood count with differential, inflammatory markers (such as the erythrocyte sedimentation rate) and liver function tests. M. tuberculosis infection can be diagnosed in may ways: interferon-gamma release assays  such as QuantiFERON--tuberculosis (TB) Gold In-Tube test and the T-SPOT-TB test . The manifestation of pathognomonic lesions and a positive QuantiFERON exam establish the diagnosis, even if acid-fast bacilli are not detected or the thoracic radiography is normal . The purified protein derivative tuberculosis skin test is positive in these patients and an exaggerated host immunologic response and hypersensitivity reaction are to be expected after administration. In case an underlying active disease is suspected, the physician should order urine, early morning sputum, and gastric aspirates microbiological examination.
Imaging modalities include thoracic radiographs (posteroanterior and lateral) that may show aspects of active or inactive tuberculosis. If the diagnosis cannot be established otherwise, an excisional biopsy should be done. The tissue will then be analyzed using hematoxylin-eosin, specific stains for acid-fast bacilli, but also for bacteria and fungi. In cases with negative tuberculosis findings, hepatitis C and HIV infection should be searched for. Furthermore, a histological analysis will depict a granulomatous panniculitis with possible inflammatory vasculitis , noncaseating granulomas and caseation-like necrosis. Other cell types, like giant, epithelioid cells or histiocytes are also encountered in late stages, while fresh lesions mainly contain lymphocytes. The presence of M. tuberculosis deoxyribonucleic acid in the excised tissue can be proven using polymerase chain reaction . However, its absence does not confirm the non-existence of the ailment.
- Multiple Ulcerations
They break down to form small and multiple ulcers. Fresh crops of nodules appear in periphery of ulcer and ultimately break down. In nodular stage, pain is present; while it subsides in ulcerative stage. [en.wikipedia.org]
They break down to form small and multiple ulcers. Fresh crops of nodules appear in periphery of ulcer and ultimately break down. [ipfs.io]
One patient had concurrent active pulmonary tuberculosis, and the other had a history of previous treatment for pulmonary tuberculosis. The treatment regimen for these patients is outlined. [ncbi.nlm.nih.gov]
Treatment Options Treatment options for erythema induratum are summarized in Table I. Table I. [dermatologyadvisor.com]
Prognosis The prognosis is good if treated properly. To date, no fatal cases of erythema induratum have been reported. However, the chronic, recurrent, painful nodules and resultant scarring can be a source of significant morbidity. [emedicine.com]
Prognosis If TB is the cause, the lesions will disappear with appropriate TB treatment. Spontaneous resolution of lesions is common within a few months, leaving areas of postinflammatory hyperpigmentation and atrophic scarring. [patient.co.uk]
Fastest Basicmedical Insight Engine Key Facts Terminology Granulomatous lobular panniculitis with vasculitis Etiology/Pathogenesis Mycobacterium species, Brucella species, hepatitis C Clinical Issues Usually multiple painful nodules on calves or shins [basicmedicalkey.com]
The etiology of erythema induratum, a rare disease of the skin in the United States but occasionally seen in natives of Asian countries, remains a source of debate. [ncbi.nlm.nih.gov]
Some investigators, however, prefer to retain the name erythema induratum of Bazin for those cases in which an etiologic relationship with tuberculosis is demonstrated and refer to the remainder of cases as nodular vasculitis. [dermaamin.com]
[…] vessels TERMINOLOGY Synonyms Erythema induratum of Bazin, nodular vasculitis Definitions Granulomatous lobular panniculitis with vasculitis ETIOLOGY/PATHOGENESIS Infectious Agents Mycobacterium species, Brucella species, hepatitis C CLINICAL ISSUES Epidemiology [basicmedicalkey.com]
[…] induratum with a negative tuberculin test, the cause is often unknown but there have been case reports of an association of erythema induratum with infectious disorders caused by nocardia, Pseudomonas spp., Fusarium spp., hepatitis C, and hepatitis B. [ 1 ] Epidemiology [patient.co.uk]
Epidemiologically, erythema induratum is an extremely rare diagnosis. The disease has a female predominance of up to 90% ( Bolognia, Jorizzo, & Schaffer, 2012 ). There is no racial predilection. [nursingcenter.com]
Epidemiology Incidence Although NV is quite common, erythema induratum is rare other than in India, Hong Kong, and some areas of South Africa. [unboundmedicine.com]
We review the characteristics of EIB and examine how the unique presentation of peripheral neuropathy may relate to the pathophysiology of this disease. [ncbi.nlm.nih.gov]
Pathophysiology Predisposing factors include abnormal amount of subcutaneous fat, thick ankles and abnormally poor arterial supply. Abnormal arterial supply causes low-grade ischemia of ankle region. [ipfs.io]
Pathophysiology The disease or diseases represent an inflammatory reaction. One antigen is Mycobacterium tuberculosis. [patient.co.uk]
Most common (86%) form of cutaneous TB (tuberculid) in Hong Kong found between 1993 and 2002 Predominant age: 13 to 66 years (mean 37 years) Predominant sex: female (80–90%) > male Etiology and Pathophysiology The morphologic, molecular, and clinical [unboundmedicine.com]
Centers for Disease Control and Prevention. [5minuteconsult.com]
Safe sex precautions, including condom use Counsel regarding not sharing needles in order to prevent HIV or hepatitis C transmission. [unboundmedicine.com]
Can Be Treated (Centers for Disease Control and Prevention) Tuberculosis Facts - Testing for TB (Centers for Disease Control and Prevention) Tuberculosis Facts - You Can Prevent TB (Centers for Disease Control and Prevention) Tuberculosis: General Information [icdlist.com]
Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]
If a blood vessel is inflamed, it can narrow or close off, this can limit, or even prevent, blood flow through the vessel and potentially damage organs. The most common type of panniculitis is erythema nodosum, which affects the shins. [knowyourdoctor.com.cy]
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