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 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.     

与结核相关的脂膜炎研究进展

【摘要】 脂膜炎病因繁多而复杂,感染为重要病因之一,在欧美等结核低发区,以链球菌感染最为常见,但在结核高发地区如我国,结核杆菌感染是脂膜炎的重要因素,以Bazin硬红斑和结节性红斑最为常见。Bazin硬红斑与结核关系最为密切,常表现为下肢屈侧结节、斑块,可出现溃疡,病理表现为小叶性脂膜炎。结节性红斑可作为结核的早期症状出现,可作为结核的预测指标,常表现为双下肢伸侧红斑、结节,极少破溃,间隔性脂膜炎是其病理特征。Bazin硬红斑和结节性红斑的抗结核治疗常可取得理想效果。因此,明确结核分支杆菌与脂膜炎的关系,在脂膜炎的治疗及预后方面,尤其在结核高发地区有着重要意义。     

Erythema induratum in a Kenyan child

A 10-year-old Kenyan girl presented with a 9-month history of a persistent, painful eruption of multiple, tender, non-ulcerated, pigmented nodules involving the calves, shins and soles of the feet. She had recurring fevers particularly at night, lethargy, weight loss and a persistent non-productive cough. The Mantoux test was positive. Chest X-ray revealed mild peribronchial thickening in the hilar region but no evidence of hilar lymphadenopathy, consolidation and/or cavitation suggestive of tuberculosis. Sputum and gastric washings were negative for acid-fast bacilli. Histology on a skin biopsy showed a granulomatous panniculitis with no histological evidence of Mycobacterium tuberculosis , consistent with erythema induratum. In view of her constitutional symptoms, chronic non-productive cough and positive Mantoux test, she was diagnosed with pulmonary tuberculosis despite the non-specific chest X-ray and negative bacteriology. Anti-tuberculous therapy was initiated with pyrazinamide, isoniazid and rifampicin for 2 months followed by dual therapy with isoniazid and rifampicin for a further 4 months. Her constitutional and respiratory symptoms and skin eruption cleared within 6 months with treatment.     

以硬红斑为首发表现的肺结核一例

现将我院诊治的以硬红斑为首发表现的肺结核一例报道如下。患者，女，79岁，双小腿屈侧斑块1个月，无痛痒。皮肤组织病理检查示：皮下脂肪小叶及间隔可见由上皮样细胞、朗汉斯巨细胞、多核巨细胞及淋巴细胞所组成的结核样结节。行支气管镜肺组织活检示：（右肺中叶）大量尘埃颗粒沉着及凝固性坏死，坏死周边见上皮样细胞；支气管灌洗液刷片找到抗酸杆菌。     

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.     

结节性红斑与硬结性红斑皮损原位抗原研究

采用ＰＡＰ法对结节性红斑、慢性游走性结节性红斑、硬红斑及结节性血管炎４种疾病共３５例的原位抗原进行检测。结果在血管的检出例数分别为１１／１２，８／８，８／８，６／７；在胶原纤维表面的检出例数分别为１１／１２，７／８，８／８，６／７；所有病例表皮角朊细胞内均能检出；在血管腔内与血管腔外的红细胞表面的检出例数除慢性游走性结节性红斑为５／８外，其余病种均能检出。提示结节性红斑等４种疾病均为存在免疫复合物     

流式细胞仪检测结节性红斑结节性血管炎患者T细胞亚群

目的　研究结节性红斑、结节性血管炎患者细胞免疫功能。方法　应用流式细胞仪技术 ,通过微量血直接免疫荧光染色法测定患者外周血T细胞亚群。结果　结节性红斑与结节性血管炎患者外周组CD3 + ,CD4+ 较对照组明显下降 (P <0 .0 5 ) ;CD8+ ,CD4+ /CD8+ 比值较对照组有所下降 ,但差异无显著性 (P >0 .0 5 )。结论　结节性红斑、结节性血管炎患者存在细胞免疫功能改变。     

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.     

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.     

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 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: role of polymerase chain reaction in diagnosis

A 55‐year‐old man presented with recurrent multiple ulcerative nodules and plaques of 1‐year duration over the lower extremities. They were recalcitrant to topical (hydrocortisone cream) and systemic (pentoxyfylline, cefotiam) drugs. Skin surface examination of the affected areas showed the skin to be studded with violaceous nodules and/or plaques. A few of these had draining ulcers. The nature of the fluid was serosanguous. The lesions were located on the shins of the legs ( Fig. 1 ). They were bilateral and asymmetrical. In addition, nontender, erythematous nodules of annular configuration were located on the right knee and elbow, and a few toes. The arterial pulsation was within normal limits. Serial hematoxylin‐eosin stained sections prepared from a representative lesion were marked by the presence of palisading granulomatous dermatitis ( Fig. 2 ). A granulomatous folluculitis in the deep dermis and a thrombotic arteriole in the subcutis were also found. Sections counter‐stained for the presence of acid‐fast bacilli were negative. Paraffin‐embedded biopsy specimens were subjected to DNA analysis using the IS6110 gene as a polymerase chain reaction (PCR) primer, and were found to be positive. Serial chest X‐rays taken at an interval of 4 months showed findings indicative of active pulmonary tuberculosis. Anti‐tubercular therapy (ATT) comprising 450 mg of rifampicin, 300 mg of isoniazid, 800 mg of pyrazinamide and 1500 mg of ethambutol was administered for a period of 2 months followed by 450 mg of rifampicin and 300 mg of isoniazid for another 2 months. There was perceptible healing of the lesions, leaving atrophic and hyperpigmented scars.

Figure 1 Open in figure viewer PowerPoint Multiple, violaceous, ulcerated plaques and nodules on the shins of both legs     

Clofazimine-induced enteropathy in treatment-resistant nodular vasculitis

We report a chronic case of nodular vasculitis that responded to oral clofazimine 300 mg daily. The condition had previously responded to moderate dose oral prednisolone, 50 mg daily, but would recur with weaning. Multiple corticosteroid-sparing agents were trialled, however these were either ineffective or poorly tolerated. The introduction of clofazimine enabled prednisolone dose reduction, not achieved with other agents, to 22.5 mg daily, and was associated with complete suppression of disease activity. Unfortunately the patient developed a clofazimine-induced enteropathy and the treatment was ceased after almost 2 years of therapy. Cessation of clofazimine was associated with a flare of the condition. Clofazimine should be considered as a corticosteroid-sparing agent in resistant cases of nodular vasculitis. Clinicians should be aware of clofazimine-induced enteropathy as a potentially serious complication of the therapy.     

结节性红斑及结节性血管炎患者血浆CD62P的表达

目的 探讨结节性红斑及结节性血管炎患者血小板活化功能。方法 应用流式细胞仪技术检测两种血管炎患者血浆CD62P表达。结果 与正常对照组相比,患者组CD62P表达量明显增高(P均<0.01);其中12例患者治疗后血染CD62P表达收治疗前明显下降(P<0.01),但仍高于对照组(P<0.01)。结论 血小板活化在结节性红斑及结节性血管炎的发生、发展中具有重要意义。     

ABC免疫光镜及免疫电镜证实硬红斑皮损炎症区郎格罕细胞

应用Ｌｅｕ６、ＨＬＡ－ＤＲ、Ｓ１００抗体ＡＢＣ免疫光镜及免疫电镜方法对ＥＩ皮损内Ｓ１００蛋白阳性组织细胞性质进行了研究。８例ＥＩ免疫光镜观察显示ＥＩ真皮深部及皮下炎症区Ｓ１００蛋白阳性组织细胞其Ｌｅｕ６及ＨＬＡ－ＤＲ染色亦阳性，且多呈树枝状或椭圆形。３例ＥＩ免疫电镜观察显示Ｌｅｕ６十细胞其细胞核是卷曲的脑回状，胞浆内可见不典型的棒状样的郎格罕颗粒，部分阳性细胞超微结构有受损伤的表现。上述结果表明，ＥＩ皮损内所谓的Ｓ１００蛋白阳性组织细胞为ＬＣ，ＬＣ不仅存在于表皮及真皮，亦存在于皮下组织中，且可能介导了ＥＩ细胞免疫的发生。     

Cutaneous tuberculosis: epidemiologic,etiopathogenic and clinical aspects - Part I

Cutaneous tuberculosis (CTB) is the result of a chronic infection by Mycobacteriumtuberculosis, M. ovis and occasionally by the Calmette-Guerin bacillus. The clinicalmanifestations are variable and depend on the interaction of several factorsincluding the site of infection and the host''s immunity. This article revises thecurrent knowledge about this disease''s physiopathology and immunology as well asdetailing the possible clinical presentations.     

匐行性回状红斑1例

患者男,61岁。躯干、颈部和四肢出现环状红斑,伴脱屑和瘙痒3个月。皮肤组织病理示:真皮浅中层血管周围少许淋巴细胞浸润。肺部CT示:右肺下叶占位性病变。诊断:匐行性回状红斑。