RESUMEN
We describe a case of erythema induratum of Bazin (EIB) that presented recurrently on the extremities during treatment with anti-tuberculosis medications. The anti-tuberculosis medications were effective, so they were continued despite the occurrence of the EIB lesions, and those lesions disappeared 5 months after first appearing. EIB is currently considered a multifactorial disorder with many different causes, with tuberculosis being an example, and it is thought to be a hypersensitive immune response to Mycobacterium tuberculosis. The clinical manifestations may fluctuate depending on the immune response of the host. Our patient was affected with myelodysplastic syndrome, and we believe that this was a major factor that interfered with a normal immune response. This case illustrates the importance of providing intensive anti-tuberculosis treatment from the start, and in cases where EIB co-presents, to continue this treatment until the end, in order to prevent relapse.
Asunto(s)
Antituberculosos , Eritema Indurado , Síndromes Mielodisplásicos , Humanos , Síndromes Mielodisplásicos/complicaciones , Síndromes Mielodisplásicos/tratamiento farmacológico , Eritema Indurado/tratamiento farmacológico , Eritema Indurado/patología , Antituberculosos/uso terapéutico , Recurrencia , Masculino , Anciano , FemeninoRESUMEN
BACKGROUND: Erythema induratum (EI) is a tuberculid associated with Mycobacterium tuberculosis infection. Using polymerase chain reaction (PCR), M. tuberculosis has been identified in Taiwan with a high percentage of EI. However, this pathogen is now rarely detected in Taiwan. OBJECTIVES: To explore the association between EI, the annual incidence of tuberculosis (TB) in Taiwan and treatment outcomes over the last two decades. METHODS: Patients diagnosed with EI between 2001 and 2020 were enrolled based on histopathology, tissue culture and positive M. tuberculosis PCR tests. Other cases of panniculitis with positive M. tuberculosis PCR results were used as controls. The clinical information of participants was obtained. The results were correlated with the annual incidence of TB and compared between groups. RESULTS: Fifty-five biopsy specimens from patients with EI met the inclusion criteria; three (5%) had positive M. tuberculosis PCR results. One patient diagnosed with erythema nodosum in the control group had a positive M. tuberculosis PCR (n = 1/27; 4%). There was no significant relationship between M. tuberculosis and EI (odds ratio 1.5, 95% confidence interval -0.964 to 3.964). The correlation between the incidence of M. tuberculosis and the number of EI cases was not statistically significant (r = -0.185, P = 0.45). Only four patients received anti-TB treatment; they all showed clinical improvement without recurrence. One patient with M. tuberculosis PCR-positive EI was not treated with anti-TB therapy; however, the skin lesion improved after 3â months. No other patients in the EI group were diagnosed with M. tuberculosis infection over a follow-up period of 508 person-years. CONCLUSIONS: Most cases of EI in Taiwan are nodular vasculitis and not tuberculid, owing to well-controlled TB. This condition can be alleviated without anti-TB treatment.
Asunto(s)
Antituberculosos , Eritema Indurado , Mycobacterium tuberculosis , Humanos , Taiwán/epidemiología , Eritema Indurado/tratamiento farmacológico , Eritema Indurado/epidemiología , Antituberculosos/uso terapéutico , Incidencia , Femenino , Masculino , Adulto , Estudios de Casos y Controles , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Anciano , Adulto Joven , Reacción en Cadena de la Polimerasa , Adolescente , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis Cutánea/epidemiología , Tuberculosis Cutánea/diagnósticoRESUMEN
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Asunto(s)
Masculino , Persona de Mediana Edad , Humanos , Escleredema del Adulto/complicaciones , Escleredema del Adulto/diagnóstico , Escleredema del Adulto/terapia , Clobetasol/uso terapéutico , Fotoquimioterapia/métodos , Fotoféresis/métodos , Eritema Indurado/complicaciones , Eritema Indurado/diagnóstico , Faringitis/diagnóstico , Dermis/anatomía & histología , Dermis/citología , Dermis/microbiología , Dermis/patología , Eritema Indurado/tratamiento farmacológico , Eritema Indurado/patología , Eritema Indurado/radioterapiaRESUMEN
El eritema indurado de Bazin (EIB) es una enfermedad nodular crónica que típicamente compromete las piernas de mujeres de mediana edad. La asociación de esta entidad con la tuberculosis ha constituido una controversia desde un principio. Se presenta el caso de una paciente de 66 años de edad, con nódulo-placas en muslo izquierdo y pierna derecha, hiperergia a la tuberculina, paniculitis lobulillar con vasculitis y granulomas tuberculoides en el examen histopatológico. Se asume la asociación con tuberculosis en base a la correlación clínico-patológica compatible con EIB junto a la intradermorreacción de Mantoux hiperérgica y a una respuesta favorable al tratamiento antituberculoso, lo cual confirmó el diagnóstico en forma retrospectiva (AU)
Asunto(s)
Humanos , Femenino , Anciano , Eritema Indurado/diagnóstico , Eritema Indurado/patología , Eritema Indurado/tratamiento farmacológico , Tuberculosis/complicacionesRESUMEN
La tuberculosis nodular profunda o eritema indurado de Bazin es la forma de tubercúlide más común. Se reporta un caso en una mujer de 25 años de edad, por lo poco frecuente que se observan estos casos en la actualidad