Erythema induratum of Bazin and renal tuberculosis: report of an association

Abstract

Erythema induratum of Bazin is a disease that usually affects women, in whom erythematous subcutaneous nodules and plaques appear on the posterior part of the lower extremities, some of which ulcerate. In many countries, tuberculosis is still the main etiologic factor. We report a case of a 40-year-old woman who presented a course of protracted and recurrent episodes over five years of cutaneous lesions on her legs. These tend to involute, but new crops appear at irregular intervals. It was painful, erythematous-violaceous nodules, some of which drained a reddish secretion. The histopathologic features of the lesions demonstrated inflammatory infiltration, with predominance of neutrophils in dermis and hypodermis, necrotizing vasculitis in the arterioles and septal fibrosis. There was no granuloma. The Ziehl-Neelsen stain did not revealed acid-fast bacilli, and the culture of biopsy specimen was negative. The tuberculin skin test was strongly positive (17 mm). The chest X-ray was normal. Few months later she presented adynamia and urinary complaints, such as polacyuria and dysuria. It has been done an urynalysis, which demonstrated acid pH urine, sterile pyuria and microscopic hematuria. It was then raised the diagnostic hypothesis of renal tuberculosis. The urine culture for M. tuberculosis was positive in two out of ten samples. The treatment was instituted with rifampin, isoniazid and pyrazinamide, with complete regression. This case illustrates a clear association between erythema induratum and renal tuberculosis, demonstrated by the remission of the cutaneous lesions after the treatment of the renal tuberculosis.

Renal Tuberculosis in the Modern Era

“…We treated a 40-year-old woman ale who was given an established diagnosis of cutaneous TB (erythema induratum of Bazin). 24 She had nodular erythematous-violaceous lesions that were painful and showed some ulcerations ( Figure 5). Some months later, the patient had urinary symptoms, including dysuria and polaciuria.…”

“…Specific treatment was instituted (rifampicin, isoniazid, and pyrazinamide), and resulted in complete regression of cutaneous and renal symptoms. 24 …”

Unusual recurrent skin lesions: Bazin's disease

“…Histopathological study often presents with this pattern of findings: granulomas, septal panniculitis, fat necrosis and/or small or large vessel vasculitis, which was in agreement with our patient's pathological findings. 12 The granulomatous lesions were non-caseous, hence we investigated the serum calcium and ACE levels to exclude sarcoidosis.…”

Tuberculids as sentinel lesions of tuberculous epididymo‐orchitis

“…Visceral TB is described in 28–56% of cases 5 . In the English language literature, genitourinary TB has been described rarely with EI 29–31 . While EI has been associated with renal TB 29,30 and is described in one patient with endometrial TB, 31 to date, there is no documented association with TBEO.…”

“…The diagnosis of genitourinary tract TB is fraught with difficulties 30,47 . The diagnosis of genitourinary TB may be rendered difficult as urine samples may not yield acid‐fast bacilli and imaging studies may fail to confirm the presence of TB 30,47 …”