Steel magnolias: Erythema induratum in a mother and child

Authors: Brent B. Amurao, Camille Berenguer-Angeles, Cindy Jao-Tan, Lian C. Jamisola

Abstract

Introduction: Erythema induratum of Bazin (EI) is a chronic recurrent panniculitis with vasculitis typically manifesting as erythematous, tender, nodules with occasional ulceration and scarring on the posterior calves as a hypersensitivity reaction to Mycobacterium tuberculosis (MTB). EI represents 35.8% of all cutaneous MTB infections in a recent retrospective study. Familial, non-MTB related cases of EI have been infrequently reported.

Case summary: A 60-year old mother and a 26-year old daughter both developed multiple erythematous well-defined round tender nodules, measuring between 0.5-1.0cm in size, some ulcerated, on the posterolateral and less on the anterior aspects of their bilateral lower extremities; mother had earlier onset and more lesions involving the posterior arms as well. Mother had no prior Bacillus Calmette–Guérin (BCG) vaccination while daughter received immunization. Chest radiography and sputum smear microscopy did not show active tuberculosis infection; however, tuberculin-skin-test was positive (>10mm induration). Wound culture of an ulcerated lesion in the mother showed heavy growth of Pseudomonas stutzerii. Adequate management of EI required antibiotic treatment of the non-MTB infection, a six-month anti-tuberculosis therapy as well as symptom control using non-steroidal anti-inflammatory drugs.

Conclusion and recommendations: EI, though highly correlated with cutaneous tuberculosis, may also be associated with other infectious etiology necessitating antibacterial therapy in conjunction with appropriate anti-tuberculosis regimen. A local registry of cutaneous TB is warranted for effective disease control of an important public health cutaneous condition.

 

Citation

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Keywords

Erythema induratum; cutaneous tuberculosis

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