Erythema induratum (Bazin Disease): Description, Causes and Risk factors:Also called as Erythema induratum of Bazin.Abbreviation: EIB.ICD-9: 017.1.Alternative Name: Erythema induratum, nodular vasculitis, tuberculous erythema induratum, tuberculosis cutis indurativa and nodose tuberculid, tuberculosum.Bazin Disease remains a rarelyencountered tuberculid, but with the revival oftuberculosis and possible advent of new casesof erythema induratum, it is important thatthe medical practitioner is familiar with thisentity in order to offer appropriate referral andmanagement. There are lot of controversies over its relationship to tuberculosis, EIB now is generally accepted to be a true tuberculid and histologically classified as a subset of nodular vasculitis.Bazin Disease, a chronic form of nodular vasculitis, may be associated with chronic infections by Mycobacterium tuberculosis. However, the true origin of the disease is a subject of speculation and remains elusive.Erythema induratum is a rare condition that classically produces painful, firm and sometimes ulcerated nodules on the lower legs (usually of young women) in association with tuberculosis.This term is applied to an affection of the skin and subcutaneous tissue which bears certain resemblance to tuberculosis. It is met with almost exclusively between the knee and the ankle, and it usually affects both legs. It is commonest in girls of delicate constitution, in whose family history there is evidence of a tuberculous taint. The patient often presents other lesions of a tuberculous character, notably enlarged cervical glands, and phlyctenular ophthalmia. The tubercle bacillus has rarely been found, but we have always observed characteristic epithelioid cells and giant cells in sections made from the edge or floor of the ulcer.Etiology, pathogenesis:Unknown.Clinically, Bazin Disease can mimic a number of conditions presenting as chronic lower extremity nodules, including erythema nodosum, cutaneous polyarteritis nodosa, pancreatic panniculitis, lupus profundus, subcutaneous sarcoid, and cutaneous T-cell lymphoma.Symptoms:Clinical signs:Chronic disease.
Vasculitis, considered to be a deep tuberculid (deep inflammatory necrotizing nodules of the calves).
Symptoms include crops of small,tender, and painful erythematous or dusky nodules of 1 to 1.5 cm.diameter or less occurring on the lower legs. Some of thesenodules ulcerated, often with aggravation of pain. Theinfluence of cold and peripheral vascular stasis could be observedin half of those patients who were worse in winter and in whomnodules tended to occur particularly in the calves and back ofthe ankles. Females outnumbered men by 11 to 1.Diagnosis:Bazin Disease often remains undiagnosed or misdiagnosed because it can masquerade as other types of chronic nodules of the lower extremities. The clinical differential diagnosis of EIB includes erythema nodosum, cutaneous polyarteritis nodosa, pancreatic panniculitis, lupus profundus, subcutaneous sarcoid, and cutaneous T-cell lymphoma. Whereas the true prevalence of EIB is unknownThe diagnosis can be made through suggestive clinical andhistopathological features, positive epidemiology for tuberculosis,positive PPD test.PCR-based methods.A lesion may be biopsied and polymerase chain reaction (PCR) provides rapid and sensitive detection of M. tuberculosis in a formalin-fixed, paraffin-embedded specimen. This can differentiate tuberculous disease from other etiologies. A study from Spain used PCR amplification on skin biopsy specimens and found positive for M. tuberculosis in 77%. There was no correlation with clinical findings.
Mycobacterial DNA in 30-80% of cases.
FBC and ESR.
CXR (Chest radiographs)
If a Mantoux test is performed it should be at a 1:10,000 dilution as the response can be very marked. Unlike nodular vasculitis, erythema induratum is seen as a tuberculous disease and a strongly positive Mantoux response is regarded as an important diagnostic feature.
An excision biopsy is usually recommended, going down to an adequate level of subcutaneous fat. Stains for bacteria and fungi may be used and an attempt to culture the tubercle bacillus and other organisms. Histological features are characteristic.Specimens for culture must be sent to the laboratory without delay and they must not be placed in formalin.
Treatment:Treatment should be guided by the culture and histologic identification of the infective organism, as well as consideration of whether a direct infection or an immunologic response is involved.Disclaimer: The following tests, drugs and medications, surgical procedures are in some way related to, or used in the treatment. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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