单侧分布的下肢硬红斑一例

临床资料 患者,男,47岁,农民。主因左下肢结节、溃疡伴疼痛2年,加重1个月,于2011年2月5日就诊。患者2年前无明显诱因左小腿内侧出现数个绿豆大小皮下结节,逐渐增大,结节处皮肤出现红斑、溃疡,伴疼痛,可自行好转;     

Bazin 硬红斑一例

Bazin 硬红斑误诊为丹毒1例周李燕 李超江阴市中医院 无锡 214400 Bazin硬红斑 (erythema induratum)又名硬结性皮肤结核(tuberculosis cutis indurativa),是一种深部血源性皮肤结核。最近我们在临床诊治中有1例被误诊为丹毒的硬红斑患者,现报道如下。患者男,58岁,左下肢肿痛反复发作3月余,2009年5月患者因左下肢肿痛收住外科,予以美洛西林,异帕米星抗感染治疗后肿痛明显消退.8月18日左右,又现左下肢肿痛,局部皮温高,来我科以“丹毒”收住我科,先后予以头孢西丁、阿奇霉素、阿莫西林克拉维酸甲、环丙沙星抗感染2周后,皮疹未见明显好转,疼痛有所加重。体格检查：生命体征正常,内科系统无异常,皮肤科检查：左下肢踝关节内侧一5×10c㎡大小边界不清的暗红色硬化斑,局部皮温偏高,硬斑周围至整个脚背满布褐色色素沉着斑。既往有肺结核史十余年,追问病史,患者至今仍间断服用利福平消炎,未予正规抗痨治疗。07年因摔伤行股骨粗隆间骨折固定术,09年2月行钢板摘除术。实验室检查：血尿常规,肝功生化基本正常,PPD实验阳性,病损皮肤病理示：表皮无异常,真皮内血管及胶原纤维增生,血管汗腺周围嗜酸性粒细胞,淋巴细胞,浆细胞浸润,局部见灶性坏死,周围多核巨细胞及类上皮细胞。经异烟肼、利福平、乙胺丁醇口服半个月,患者局部肿痛明显好转,局部皮温不高,少许压痛,复查肝功能正常,继续服用上述三种抗痨药物,一个月后随访,右下肢红肿大部分消退,患处轻微压痛,局部皮肤较前变软,色素沉着较前变淡,继续上述治疗三个月,病情恢复中。讨论 :硬红斑分为Bazin硬红斑和Whitfield硬红斑。是一种发生于下肢的慢性、复发性、结节性和溃疡性皮肤病,皮损多对称分布,可软化破溃,形成溃疡,愈后留有萎缩性疤痕,色素沉着,自觉疼痛和压痛。患者通常伴有肺结核、淋巴结核或其他远隔部位结核病灶,结核菌素实验阳性〔1〕。病理显示为T细胞介导的超敏反应。Bazin硬红斑是1861年由Bazin首先描述,其和结核的关系一直存在争论,焦点问题在于组织中抗酸染色以及培养中查不到结核菌〔2,3〕。李宝强等在硬红斑皮损中结核杆菌DNA的检测中推测硬红斑不是由完整的结核杆菌在局部沉积或感染所引起,而可能是由其它原因或其它部位的结核杆菌产生的蛋白或碎片作为抗原引起的变态反应所引起〔4〕。大多数学者仍主张首先抗痨治疗,异烟肼治疗至少6-8个月,如果无效可考虑更改治疗方案,临床观察早期并用小剂量泼尼松治疗,皮损消退快且局部组织损伤少。本例患者三联疗法三个月后明显好转。 误诊原因：该患者临床上以疼痛性结节为主要表现,抗炎治疗能缓解,且患者长期间断服用利福平,皮疹缺乏特征性,常与结节性红斑、丹毒、结节性血管炎相混淆, 缺乏对硬红斑的全面认识,忽略了结核方面的检查和组织病理,从而拖延病程。     

硬红斑1例

报道1例硬红斑.余某,男,51岁,右下肢溃疡、疼痛2年多,溃疡愈后留下了凹陷性疤痕,左小腿丘疹、溃疡反复发作2月余.PPD试验呈强阳性,胸片示右肺尖钙化病灶,组织病理见真皮深层及皮下脂肪层见结核样肉芽肿.     

孢子丝菌病误诊为硬红斑1例

临床资料　患者 ,女 ,6 2岁 ,家庭主妇 ,黑龙江人。两年前无明显原因于四肢散在发生小结节 ,多数历经 2～ 3个月后自行消退 ,反复发生。其中右前臂的结节 ,逐渐增大、变红、表面变软 ,偶有脓血流出 ,伴有痛感。使用多种药物 (不详 )无明显效果 ,历经 6个月后破溃处愈后留有萎缩性瘢痕。2个月前四肢小结节再次复发、增多 ,右前臂于原瘢痕附近又出现同样皮损 ,于 1999年 11月 2 9日就诊于某三甲医院 ,ＰＰＤ ,胸片示右上纵隔淋巴结钙化 ,组织病理为肉芽肿性炎症 ,临床诊断为硬红斑。给予利福平 0 .45ｑｄ ,服用 2周。其余雷米封、雷公藤多…     

表现为泛发性环状红斑的梅毒一例

患者,男,57岁.躯干、股部、双手掌见泛发性环状红斑,无脱屑,伴痒痛3个月.实验室检查梅毒非特异性抗体(TRUST)阳性1:128,梅毒特异性抗体(ELISA法)阳性.苄星青霉素240万U分两侧臀部肌注,每周1次,共3次病情好转.     

以红斑水疱为首发临床表现的皮肌炎

报告1例以红斑水疱为首发表现的皮肌炎。患者女,20岁。因面部、躯干及四肢水肿性红斑伴瘙痒20余天,水疱2 d入院。入院后查肌酶及IgE均升高,肌电图提示肌源性损害。右胫前肌肉组织病理检查示部分肌纤维空泡变性。免疫组化示CD68(+)。诊断:皮肌炎。     

以红斑水疱为首发表现的慢性淋巴细胞白血病1例

临床资料患者男,76岁。全身皮肤起红斑、水疱1月余,加重5 d,于2004年9月13日第一次入院。患者1个月前无明显诱因双小腿出现少数丘疹、水疱,伴瘙痒,随后皮损逐渐增多,波及颈部、躯干和上肢。应用抗组胺药物治疗无效。发病前无发热,无服药史,无致敏性物质接触史。既往体健,无家族     

硬红斑的临床及病理研究

我们在既往研究的基础上［１，２］，对２５例硬红斑〔ＥＩ）患者的临床及病理进行了分析，现将结果报告如下。一、临床资料２５例ＥＩ，男４例，女２１例，就诊年龄１８～６０岁，平均４３岁；病期１月至２０年，平均４．５年；发病年龄＜２０岁１例，２０～３０岁８例，３１～４０岁１０例，４１～５０岁４例，５１～６０岁２例。以往有结核病（ＴＢ）史或同时伴有其它部位ＴＢ者１２例，有ＴＢ家族史５例。从事站立性职业者１７例。患者发病前多无明显诱因，３例伴ＴＢ者有低热及全身乏力，其余多无全身症状。冬春季发病者２０例。皮损早…     

Erythema Induratum with Pulmonary Tuberculosis: Report of Three Cases

Three cases of erythema induratum which occurred in the patients with pulmonary tuberculosis are described. The cutaneous lesions were violaceous, indurated nodules on both lower legs above the malleoli. Histologically, tuberculoid granuloma with caseation necrosis was found in one case; necrotizing vasculitis was the prominent finding in other two cases. The erythema induratum promptly responded to antituberculous therapy. We believe that, in light of these cases, the association between erythema induratum and infection with tubercle bacilli should be re-emphasized.     

Erythema induratum of bazin

Erythema induratum of Bazin is a chronic, nodular eruption that usually occurs on the lower legs of young women. It has been regarded as a manifestation of tuberculin hypersensitivity, a type of tuberculid occurring on the legs, whereas nodular vasculitis represents the nontuberculous counterpart. The number of reports of erythema induratum of Bazin is decreasing in most developed countries in accordance with the decreased incidence of tuberculosis. The etiopathogenesis of erythema induratum of Bazin and its relation to tuberculosis are still controversial, because mycobacteria cannot be cultured from the skin lesions. Most authors currently consider erythema induratum of Bazin (nodular vasculitis) a multifactorial disorder with many different causes, tuberculosis being one of them.     

Erythema nodosum and erythema induratum (nodular vasculitis): diagnosis and management

Erythema nodosum is the most common type of panniculitis; it may be due to a variety of underlying infectious or otherwise antigenic stimuli. The pathogenesis remains to be elucidated, but both neutrophilic inflammation and granulomatous inflammation are implicated. Beyond treating underlying triggers, therapeutic options consist mainly of nonsteroidal anti‐inflammatory drugs, symptomatic care, potassium iodide, and colchicine. Erythema induratum (nodular vasculitis) is a related but distinctly different clinicopathologic reaction pattern of the subcutaneous fat. It is classically caused by an antigenic stimulus from Mycobacterium tuberculosis but may be associated with several other underlying disorders. After appropriate antimicrobial treatment in tuberculous cases, therapy for erythema induratum is similar to options for erythema nodosum.     

Erythema induratum Bazin nach Lungentuberkulose

Summary: Mycobacterium tuberculosis can be directly demonstrated in lesions of cutaneous tuberculosis, but mostly could not be demonstrated in Tuberculids. These include erythema induratum of Bazin, papulonecrotic tuberculid as well as lichen scorphulosorum. Tuberculids result from the hematogenous spread of Mycobacteria tuberculosis in a person with a high degree of immunity. We report on a 63‐year‐old woman with erythema induratum of Bazin and pulmonary tuberculosis in medical history, with hightened tuberculin sensitivity and negative bacterial cultures. Polymerase chain reaction (PCR) could not detect Mycobacterium tuberculosis‐specific DNA. After eight weeks only, the patient responded well to a course of antituberculosis therapy (isoniazid, ethambutol, rifampicin and pyracinamide) with marked resolution of the lesions. The tuberculous origin of erythema induratum of Bazin is still controversal, since mycobacteria cannot be cultured from skin lesions. Since the availability of PCR‐diagnostic, in some cases, but not in our patient, PCR was positive für Mycobacterium tuberculosis‐specific DNA. The good response to antituberculosis therapy is a further argument for the association of erythema induratum of Bazin and Mycobacterium tuberculosis     

Erythema induratum of Bazin in a 10‐year‐old boy

Erythema induratum of Bazin (EIB) is a form of tuberculid resulting from hypersensitivity to tuberculosis antigen. EIB occurs most commonly in middle‐aged women and is not typically seen in children. Here, we present a rare case of EIB, presenting as a chronic nodular panniculitis, in a 10‐year‐old Korean boy.     

Erythema induratum of Bazin and Poncet''s disease – successful treatment with antitubercular drugs

Erythema induratum of Bazin (EIB) is considered a tuberculide reaction and consists of recurrent painful nodules predominantly on the calves. Clinically it has common features with diseases like nodular vasculitis, perniosis, polyarteritis nodosa and erythema nodosum. Poncet's disease is a reactive arthritis that may accompany tuberculosis. We report a case of a young woman in which the simultaneous occurrence of erythema induratum of Bazin and Poncet's disease led to a clinical picture very similar to Löfgren's syndrome. The final diagnosis was obtained by polymerase chain reaction detection of mycobacterial DNA in a skin biopsy. A systemic therapy with tuberculostatic drugs led to the disappearance of symptoms. The presented case shows the usefulness of polymerase chain reaction diagnostics in EIB patients without other clinical signs of tuberculosis and a confusing combination of symptoms, and further confirms the presence of mycobacterial DNA in EIB lesions.     

Erythema induratum of Bazin in an infant after Bacille Calmette-Guerin vaccination

We report the first case of erythema induratum of Bazin (EIB) after Bacille Calmette-Guerin (BCG) vaccination in an infant. The patient developed recurrent multiple erythematous and subcutaneous nodules on his legs 2 months after a BCG vaccination. He had no other symptoms or family history of tuberculosis (TB). Histopathological findings revealed a granulomatous lobular panniculitis. EIB often appears as a chronic, nodular eruptions that frequently occur on the lower legs of females with tuberculin hypersensitivity. To date, only a few cases of infants with EIB have been reported. There have been no clinical reports of EIB after BCG vaccination. Our case suggests that Mycobacterium bovis in the BCG vaccination may have caused EIB.     

Mycobacterium tuberculosis found at both skin lesions and Mantoux testing site in a patient with erythema induratum of Bazin

Mycobacterium tuberculosis is very rarely found in erythema induratum of Bazin; recently, we found an unusual case with positive acid‐fast bacilli and polymerase chain reaction for detecting M. tuberculosis in both skin lesions of the extremities and the site of Mantoux test.     

持久性色素异常性红斑一例

患者,男,53岁。颈部、双上肢青灰色斑疹进行性加重5年。系统检查未见明显异常。组织病理示：表皮大致正常,基底层细胞局灶性空泡化,真皮浅层少量炎细胞浸润,可见较多噬黑素细胞。诊断：持久性色素异常性红斑。