Nodular vasculitis associated with lung adenocarcinoma

Abstract: Nodular vasculitis is an uncommon type of panniculitis. It was firstly associated to the infection by Mycobacterium tuberculosis and named erythema induratum of Bazin, however nowadays it has been associated with several other underlying disorders and it is better described as nodular vasculitis. Concerning its relationship with malignant conditions, there is only one reported case, in association with metastatic colon adenocarcinoma. We report a case of nodular vasculitis as the first manifestation of lung adenocarcinoma. To the best of our knowledge, this is the first reported association of both diseases.

Nodular vasculitis associated with lung adenocarcinoma.

Nodular vasculitis is an uncommon type of panniculitis. It was firstly associated to the infection by Mycobacterium tuberculosis and named erythema induratum of Bazin, however nowadays it has been associated with several other underlying disorders and it is better described as nodular vasculitis. Concerning its relationship with malignant conditions, there is only one reported case, in association with metastatic colon adenocarcinoma. We report a case of nodular vasculitis as the first manifestation of lung adenocarcinoma. To the best of our knowledge, this is the first reported association of both diseases.

Application of the QuantiFERON®-TB Gold test in erythema induratum.

Erythema induratum (EI) was originally described by Ernest Bazin in 1861 as nodular lesions on the legs in association with tuberculosis (TB). A 33-year-old woman was referred to our hospital with tender ulcerative nodules on her legs. Skin biopsies revealed lobular inflammation of the subcutaneous fat with vasculitis. Although conservative treatment was given, the lesions did not improve. Several months later as the lesions persisted, we suspected a TB infection and additional tests were performed. The chest roentgenogram results were normal. The skin biopsies were negative for acid-fast bacilli (AFB). Mycobacterial cultures of the blood and skin were negative. However, the QuantiFERON®-TB Gold test was positive, which led to a diagnosis of latent TB infection being made. The patient was treated with multidrug antituberculosis therapy, which successfully resolved her skin lesions. Therefore, reported herein is the application of the QuantiFERON®-TB Gold test for the confirmation of latent TB infection in EI patients.

Reiter's syndrome in a patient with polyarthritis and nail involvement.

An 8-year old boy with polyarthritis and nail involvement is presented in this report. Nail involvement in Reiter's syndrome is a rare condition that may include painless erythematous nduration of the base of the nail fold; subungual parakeratotic scaling and thickening opacification, ridging of the nail plate.

Erythema induratum - a hypersensitivity reaction to Mycobacterium tuberculosis.

Erythema induratum (also known as Bazin disease, tuberculosum, tuberculosis cutis indurativa and nodose tuberculid) is a rare condition that produces painful, firm, and sometimes ulcerated nodules on the lower legs. Distinctive and diagnostic histopathology comprises a septolobular panniculitis, necrosis, granulomatous inflammation and vasculitis.

[Indurated erythema as the presenting form of a case of chronic myelomonocytic leukemia]. / Eritema indurado como forma de presentación de un caso de leucemia mielomonocítica crónica.

Chronic myelomonocytic leukemia (CMML) is an oncohematologic disease with a mixed nature, myeloproliferative and myelodysplastic, and presenting features are usually the consequence of peripheral blood cytopenias (anemic syndrome, infections or bleeding). Specific or non-specific cutaneous involvement in patients with myelodysplastic syndromes or chronic leukemias is exceptional, and it takes place often in advanced stages of the disease, as a preample of a transformation from chronic illness to acute leukemia. Recognition and early diagnosis of the skin lesion by cutaneous biopsy, in every patient with myelodysplastic or myeloproliferative disease, have therapeutic and prognostic significance. We describe a patient who presented with a non-especific cutaneous lesion, Bazin's erhythema induratum, as initial manifestation of chronic myelomonocytic leukemia; we also comment diagnostic, therapeutic and clinical evolution aspects.

Erythema induratum in a patient with active tuberculosis of the axillary lymph node: IFN-gamma release of specific T cells.

A 57-year-old woman with tender nodular lesions on her legs, arms, buttocks and face is reported as a case of erythema induratum (EI) with active tuberculosis of axillary lymph nodes. Both skin nodular lesions and lymph nodes responded positively to antituberculous therapy. The patient's peripheral blood mononuclear cells showed a high proliferation and produced interferon-gamma (IFN-gamma) in response to purified protein derivative (PPD). These findings indicate the possibility that PPD-specific T cells, capable of producing IFN-gamma, are likely to be involved in the formation of EI as a type of delayed-type hypersensitivity response to mycobacterial antigens at the site of skin lesions.

Eritema indurado de Bazin. Presentación de 4 casos / Erythema induratum of Bazin. Four cases report

El eritema indurado de Bazin es un cuadro anatomopatológico considerado como una tuberculosis nodular hipodérmica, caracterizada por presentar nódulos rojizos, indurados pequeños, separados por piel sana que ocasiona ligeras molestias y se localizan en la cara posterior de las piernas en mujeres jóvenes y que se presentan principalmente en invierno. Presentamos 4 casos que respondieron bien al tratamiento antifímico que aunado a estudios recientes basados en la amplificación de la reacción en cadena de la polimerasa (PCR) apoyan que el origen de este padecimiento es una reacción inflamatoria inapropiada a la presencia de M. tuberculosis en contra de lo expuesto por Lever, Ebel Hartinger, Schneider y Ondeut, que afirman que el eritema indurado de Bazin es una vasculitis de arterias y venas con necrosis grasa de origen desconocido y por lo tanto su tratamiento debe ser a base de corticoesteroides. El inicio de los 90 marca el surgimiento de la tuberculosis y con ello el advenimiento de nuevos casos de eritema indurado de Bazin, razón por la cual es importante que el médico general esté familiarizado con esta entidad para brindar una atención adecuada a estas pacientes.

Panniculitis: recent developments and observations.

Dermatopathologists rarely greet a biopsy of panniculitis with total confidence that a specific, definitive diagnosis will be rendered. As with many other areas in dermatopathology, our understanding of the pathogenesis of many forms of panniculitis is incomplete. This article examines a subset of panniculitis primarily from a pathogenetic standpoint, with the intention of providing a differential diagnosis for those cases in which ischemic changes are seen in the subcutis. The diverse group of conditions evoked by this approach also shares the distinction of having been the focus of nosologic and causative controversy, both historically and currently. In particular, stasis-associated sclerosing panniculitis, vascular calcification-cutaneous necrosis syndrome (calciphylaxis), oxalosis, and nodular vasculitis-erythema induratum are examined in depth. Erythema nodosum and variants, other granulomatous panniculitides, and panniculitides showing cytophagocytosis are also discussed with current perspectives.

Erythema induratum of Bazin.

BACKGROUND: There has been a long controversy about the tuberculous cause of erythema induratum, a chronic form of nodular vasculitis. METHOD: We investigated clinical, histopathologic, and immunohistochemical features of patients with erythema induratum who showed positive tuberculin hypersensitivity reactions or had associated active tuberculosis. RESULTS: The ages of the 32 patients (M 7: W 25) ranged from 13 to 66 years (mean 36.6 years). All patients displayed recurrent crops of tender, painful, violaceous nodules or plaques. Most lesions presented on the legs, but they also occurred on thighs, feet, buttocks, and forearms. The skin lesions evolved for several weeks and healed with scarring and residual pigmentation. Twenty-two patients were treated with isoniazid alone and the remaining 10 patients received combinations of antituberculous drugs. Relapses were encountered in four patients who received isoniazid alone or stopped the medication against medical advice. In most biopsies, histologic examination revealed lobular or septolobular panniculitis with varying combinations of granulomatous inflammation, primary vasculitis, and necrosis. Immunohistochemical labeling revealed a preponderance of T lymphocytes, monocyte-macrophages, and Langerhans' cells, indicative of a type IV hypersensitivity reaction. CONCLUSION: Erythema induratum of Bazin has distinct clinical, histopathologic, and immunohistochemical features. Erythema induratum of Bazin should be considered as a separate entity of nodular vasculitis caused by latent foci of tuberculous infection.

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.

[Bazin's erythema induratum: obsolete concept and terminology]. / Erythème induré de Bazin: concept et terminologie obsolètes.

In 1855 Ernest Bazin, who had noted hard, deep and violaceous nodules on the legs of young women, created his famous "erythema induratum" classified among the "erythematous benign scrofulides". Some forty years later, identical lesions were observed associated with tuberculosis; Colcott-Fox called them "érythème induré de Bazin", and ever since that time erythema induratum has been presumed to be of tuberculous origin. In 1900, Darier spoke of "tuberculids" for erythema induratum, and Bazin's "scrofulides" were abusively translated as "tuberculids". In the early 20th century many authors described such skin lesions without any evidence of tuberculosis and later on many papers tried to deny this "systematic" association, but the idea that erythema induratum is caused by tuberculosis still lingers on in 1990. There are many arguments against a tuberculous aetiology, but although very few cases in large series are really associated with tuberculosis many patients have been treated with specific antituberculous agents. For numerous authors, erythema induratum in "tuberculous by definition". In 1945 Montgomery et al. created the "nodular vasculitis" concept. The clinical features are very similar to those of erythema induratum but the disease is certainly not of tuberculous origin. This new pathology has been well developed by French and Spanish authors (Bureau, Duperrat, Vilanova). Despite repeated efforts to separate these two "entities" no clinical or histological data are available to distinguish between erythema induratum and nodular vasculitis. The real meaning of "erythema induratum" is far from being clear: in old publications and sometimes in recent textbooks one can find the same name followed by of Bazin, Whitfield or Hutchinson. Some authors call the disease tuberculids, and other believe it is a true cutaneous tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS)

S-100-protein-positive dendritic cells in nodular vasculitis.

We investigated the distribution of S-100-protein-positive dendritic cells in 20 cases of nodular vasculitis (erythema induratum Bazin). The cells were identified by immunohistochemical demonstration in paraffin sections. S-100-protein-positive dendritic cells were present in all cases and comprised up to 11% of the infiltrating cells in lymphohistiocytic areas (mean 3.7%). Because of the dendritic shape and the association with lymphocytes the cells are considered to represent T-zone histiocytes. Our findings suggest a possible role of delayed-type hypersensitivity in nodular vasculitis.