Erythema induratum in 2 Filipino children: a case report

Authors: Carminda P. Rogacion, MD, Johannes F. Dayrit, MD, FPDS

Abstract

Introduction: Erythema induratum is an inflammatory panniculitis. It commonly presents with ulcerated nodules and deep plaques on the lower legs and is frequently associated with Mycobacterium tuberculosis infection. Usually seen in middle-aged women, recent years demonstrate the increasing incidence of this disease in children. We report two cases of erythema induratum in Filipino children.

Case summary: We encountered two cases of erythema induratum in Filipino children. Both cases were referred by pediatric rheumatologists because of nodules on the legs associated with joint pains and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Case 1 is a 13-year old female who presented with a six-month history of erythematous nodules on both lower extremities. Patient had a previous history of primary complex for which she was previously treated with Anti-Kochs medications. Skin punch biopsy showed lobular panniculis with vasculitis. PPD was positive at 20mm. Case 2 is a 9-year old female with a 3-year history of recurrent erythematous nodules on both lower extremities. Skin punch biopsy showed a lobular granulomatous inflammatory infiltrate in the subcutis consisting of histiocytes, lymphocytes, plasma cells and few multinucleated giant cells, also consistent with a diagnosis of Erythema induratum. PPD was positive at approximately 22mm. Both patients were treated with anti-tuberculous therapy and responded with complete resolution of lesions and joint pains.

Conclusion: Erythema induratum, considered a variant of cutaneous tuberculosis, has been showing increasing incidence in children. More often they are referred by rheumatologists because they present with joint pains and elevated inflammatory markers (ESR and CRP). A thorough history and physical examination provide clues to the diagnosis. Skin punch biopsy, PPD, and Chest X-ray may be requested to further support the diagnosis. Patients demonstrate good prognosis upon treatment with anti-tuberculous therapy.

 

Citation

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Keywords

Erythema induratum, panniculitis, vasculitis, cutaneous tuberculosis

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