A Case of Erthyema Induratum in a 24-year-old immunocompetent female

Authors: Maria Jenina P. Aguado MD, Marie Claudine Francesca B. Perlas, MD, Luella Joy A. Escueta-Alcos, MD, DPDS, Johannes F. Dayrit, MD, FPDS, Mary Ann P. Aguado, MD, FPDS

Abstract

Introduction: Tuberculosis is major health problem in the Philippines with an incidence of 323 per 100,000. It is caused by Mycobacterium tuberculosis (MTB), which mostly affect the lungs. Cutaneous TB comprises only <2% of TB cases, with high incidence in developing countries. Erythema Induratum of Bazin (EIB) is a tuberculid presenting with inflammatory panniculitis on lower legs.

Case Summary: We present a case of a 24-year-old female with a 10-year history of recurrent tender nodules on both lower extremities. Lesions initially appeared as few erythematous patches evolving into tender nodules with erosions and black crusts. Several consults with a dermatologist and surgeon were done. Patient was given unrecalled topical and oral antibiotics. Wound debridement was also performed with no improvement. Skin biopsy was then performed, which revealed moderately dense granulomatous inflammatory infiltrate consisting of
epitheloid, histiocytes, lymphocytes, and multinucleated giant cells in the dermis, and focal granulomas in the subcutaneous fat, consistent with Erythema Induratum of Bazin. Results of chest X-ray, PPD and serum QTB gold test were negative. However, due to high index of suspicion, anti-tuberculosis therapy was initiated with improvement of lesions.

Conclusion: Patients presenting with intractable skin lesions unresponsive to oral and topical antibiotics should warrant a high index of suspicion for cutaneous TB. Series of examinations should be done to document presence of mycobacteria. Multidrug antituberculosis therapy remains the cornerstone of treatment for erythema induratum.

 

Citation

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Keywords

Erythema Induratum of Bazin, Cutaneous tuberculosis, antituberculosis therapy

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