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 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.     

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 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.     

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.     

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 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 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.     

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.     

Inflammatory Nodules of the Lower Legs: A Clinical and Histological Analysis of 134 Cases in Korea

We analysed 134 Korean cases with inflammatory nodules of the lower legs on the basis of clinicopathological findings, responsiveness to various therapeutic agents, and clinical course. There were 53 cases of erythema induratum (EI), 18 of erythema nodosum (EN), 40 of EN-like lesions of Behçet's disease, 15 of other entities, including superficial migratory thrombophlebitis, cutaneous periarteritis nodosa, sarcoidosis, malignant lymphoma, Churg-Strauss syndrome, and parasitosis, and eight unclassified cases. The unclassified group was composed of a spectrum of diseases with clinicopathologic features ranging between those typical of EN and EI. The present study revealed that the profiles of diseases featuring inflammatory nodules of the lower legs in Korea differed from those found in other areas. These geographic and demographic differences should be kept in mind when managing a patient with inflammatory nodules of the lower legs.     

ICAM-1 and LFA-1 Expressions in the Lesional Skin of Annular Erythema Associated with Sjögren Syndrome

ICAM-1 and LFA-1 expression was studied in the lesional skin of ten cases of annular erythema associated with Sjögren syndrome. Most of the infiltrating mononuclear cells around blood vessels expressed LFA-1 in addition to its strong expression on vascular endothelial cells and focal expression on the epidermal basal cell layer in 3 cases. ICAM-1 expression on vascular endothelial cells was similar to LFA-1, although relatively focal and weak expression was observed on mononuclear cells. ICAM-1 expression on keratinocytes was focal and limited to the basal cell layer in annular erythema. These findings suggest that strong expression of ICAM-1 on endothelial cells but not keratinocytes and LFA-1 on mononuclear cells might play some role in the induction of skin lesions in annular erythema associated with Sjögren syndrome.     

Unlocking the mystery of persistent skin ulcers in a young man and successful treatment with a simple regimen

Despite the high prevalence of pulmonary tuberculosis worldwide, extrapulmonary tuberculosis especially cutaneous and osteoarticular tuberculosis occurs rarely, both of which are often difficult to be recognized since their symptoms mimic those of many other cutaneous and osteoarticular diseases. Here, we present a rare case of cutaneous tuberculosis potentially accompanied by osteroarticular tuberculosis in a 36‐year‐old Chinese man who presented with multiple persistent skin ulcers for one year and were nonresponsive to multiple therapeutic approaches. A single anti‐tuberculous regimen with rifampicin resulted in healing of all skin lesions and excellent recovery of the general condition.     

Erythema multiforme,Stevens–Johnson syndrome and toxic epidermal necrolysis: Frozen‐section diagnosis

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) may be fatal. Although classified by body surface area skin detachment, initial stages of both may present with erythema multiforme (EM)‐like lesions. To diagnose and predict disease activity adequately as early as possible for patients revealing EM‐like lesions, we performed frozen‐section diagnosis. Thirty‐five patients clinically diagnosed as EM, SJS or TEN were biopsied to diagnose and predict disease progression within the initial‐visit day. Half of a histological section taken from a lesion was snap‐frozen and immediately cryostat‐sectioned, acetone‐fixed and stained with hematoxylin–eosin. Specimens were examined with light microscopy for presence of epidermal necrosis. A section from unaffected sites was also examined for 11 patients. Specimens were examined with light microscopy for presence of graft‐versus‐host reaction (GVHR)‐like findings: apoptotic keratinocytes and satellite cell necrosis. Epidermal necrosis was seen in nine patients. Initial diagnosis of the nine was one of overlap SJS‐TEN, four of SJS and four of EM, and final diagnosis of those was one of TEN, one of overlap SJS–TEN, four of SJS and three of EM. Dissociation between initial and final diagnosis was seen in three cases. GVHR‐like findings in the epidermis were observed in two patients finally diagnosed as overlap SJS–TEN and TEN. Frozen sections are useful not only to make a diagnosis of erythema multiforme but to assess a potential to exhibit more aggressive clinical behaviors (SJS or TEN).     

33例脂膜炎与结核感染相关性分析

 目的 了解不同类型的脂膜炎患者与结核感染的相关性。方法 纳入2019年1月—2021年12月就诊于常德市第一人民医院33例脂膜炎患者的临床资料,对其临床特征、病理特征、与结核感染的相关性、治疗情况及随访情况进行分析。结果 ①33例脂膜炎患者中,结节性红斑24例,硬红斑9例,男女比例为1 ∶ 4.5,平均年龄46岁,平均病程10个月。②临床发病部位集中在四肢,均伴有疼痛。30例（90.91%)表现为红斑、结节、肿胀,其中1例硬红斑（3.03%）出现溃疡。6例(18.18%)出现发热、咳嗽、盗汗。2例硬红斑患者同时伴有或先后出现丘疹性坏死性结核疹,2例结节性红斑患者伴有全身多关节疼痛。③22例（66.67%,包括9例硬红斑、13例结节性红斑)伴结核分支杆菌潜伏感染（LTBI）。硬红斑患者结核感染阳性率高于结节性红斑患者（P＝0.020）。④皮损组织病理表现为间隔性脂膜炎11例、小叶性脂膜炎3例、混合性脂膜炎19例。与结核感染相关的22例脂膜炎患者病理下多可见上皮细胞肉芽肿、多核巨细胞以及干酪样坏死,其余11例均可见真皮层血管周围及脂肪间隔淋巴细胞浸润,且均未见上皮样肉芽肿及多核巨细胞。33例患者抗酸染色、PAS染色、直接免疫荧光均未见阳性表现。⑤22例与结核感染相关患者中,接受抗结核治疗15例,治愈率为68.18%,拒绝接受抗结核治疗患者7例,治愈率为14.29%。11例结核感染不相关患者采用免疫调节联合治疗,治愈率为100%。所有患者均未出现严重药物不良反应。结论 硬红斑患者的结核感染阳性率比结节性红斑患者高。在结核感染相关的脂膜炎患者中,接受抗结核治疗者治愈率比免疫调节联合治疗者高;对于未发现结核感染证据的结节性红斑,免疫调节治疗可能有效。结节性红斑患者的发病原因可能与结核感染相关。在结核高发地区,结节性红斑患者完善相关筛查极其重要。     

Cutaneous Crohn''s disease mimicking Melkersson–Rosenthal syndrome: treatment with methotrexate

A woman with a 5-year history of unilateral orofacial granulomatosis required repeated evaluations (including sequential colonoscopies) to establish the diagnosis of cutaneous Crohn's disease, a condition that proved responsive to low doses of oral methotrexate administered weekly. To our knowledge this is the first report describing the use of methotrexate for treatment of orofacial granulomatosis caused by underlying Crohn's disease.     

An evaluation of the efficacy of a single‐session 577 nm pro‐yellow laser treatment in patients with postacne erythema and scarring

Erythema and scarring are among the most common complications of severe inflammatory acne. In this study, we aimed to share our experience with pro‐yellow laser and document the efficacy and safety of this treatment in postacne erythema and scarring. The study included 40 patients, 24 (60%) females, and 16 (40%) males with a mean age of 29.5 ± 8.16 (min. 18 years, max. 57 years). The pro‐yellow laser was applied to all patients as a single session with irradiation of 22 J/cm². Improvement in postacne erythema and scars were evaluated after the treatment. The study included 40 patients, 24 patients (60%) were females and 16 patients (40%) were males with the mean age of 29.5 ± 8.16 (ranged between 18 and 57 years old). A total of 21 patients (52.5%) had good improvement (51%‐75% regression), 10 patients (25%) had excellent improvement (76%‐100% regression), and a moderate improvement (26%‐50%) was detected in 9 patients (22.5%). Also, there were mild improvement (1%‐25%) in 20 patients (76.9%) and a moderate improvement (26%‐50%) in 6 patients (23.1%). We found that pro‐yellow laser is highly effective in the treatment of postacne erythema, while its effectiveness was mild to moderate in atrophic acne scars. Also, it has been observed that the pro‐yellow laser system can be used safely immediately after cessation of systemic isotretinoin treatment.