Erythema Induratum: Case Series Illustrating the Utility of the Interferon-γ Release Assay in Determining the Association with Tuberculosis

Prajapati, Vimal H.; Steed, McKay; Grewal, Parbeer; Mahmood, Muhammad Nateque; Verma, Geetika; Brassard, Alain

doi:10.2310/7750.2013.wound4

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…Xu et al reported on a 57-year-old Chinese female with EIB, whose tissue biopsy failed to detect M. tuberculosis DNA, yet the interferon-gamma release assay was positive (12). Other reports have supported the utility of the interferon-gamma release assay (IGRA) for erythema induratum of bazin (13).…”

Section: Discussionmentioning

confidence: 87%

Erythema Induratum of Bazin: A Rare Presentation of Tuberculosis

Hashemi¹,

Farshchian²,

Basir³

et al. 2018

Avicenna J Clin Microbiol Infect

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Erythema induratum of bazin (EIB) is a hypersensitivity reaction to Mycobacterium tuberculosis infection. The diagnosis can be difficult because tubercle bacilli are usually not found in smears or cultures of lesions. This study reports on a case of EIB in a 13-year-old female, who presented multiple tender nodules on her lower extremities. Biopsy of the nodule revealed histopathologic changes compatible with erythema induratum. QuantiFERON test was positive. The patient received a 6-month duration of anti-tuberculosis treatment. The lesions disappeared during therapy, and no pigmentation was observed at the end of treatment. After a year of follow up, there was no recurrence of the disease.

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Section: Discussionmentioning

confidence: 87%

Erythema Induratum of Bazin: A Rare Presentation of Tuberculosis

Hashemi¹,

Farshchian²,

Basir³

et al. 2018

Avicenna J Clin Microbiol Infect

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“…While the TST is the current standard in Ontario, Canada, to diagnose latent TB infection, the IGRA may be a more appropriate test for patients with EI, especially those patients who have received the BCG vaccination. 1 , 10 , 11 If a TB aetiology is established, it is recommended that patients be treated for 6 or 9 months with isoniazid, rifampin, ethambutol, and pyrazinamide. 2 , 3 Despite this, prior to presentation at our clinic, our patient was only treated with a 9-month course of isoniazid.…”

Section: Case Reportmentioning

confidence: 99%

“…It is thought to be a type-IV hypersensitivity reaction, most commonly to the tuberculosis (TB) antigen. 1 , 2 Other aetiologies reported in the literature include: Nocardia, Pseudomonas, Fusarium and hepatitis B infections, thrombophlebitis, hypothyroidism, leukemia, rheumatoid arthritis, Crohn’s disease, and propylthiouracil use. 3 EI may also be idiopathic and affects females with a ratio of 10:1.…”

Section: Introductionmentioning

confidence: 99%

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Use of QuantiFERON-TB Gold to determine the aetiology of idiopathic erythema induratum: A case report

Brandon

Mufti

Sibbald

2018

SAGE Open Medical Case Reports

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Although rare, erythema induratum is the most common entity presenting as lobular panniculitis with vasculitis. It is usually caused by a hypersensitivity reaction to Mycobacterium tuberculosis, although other aetiologies have been reported. We present a case of a 73-year-old male with multiple recurring tender erythematous nodules on the backs of both calves and shins. Prior to arrival in our clinic, the patient underwent a 9-month course of isoniazid with no improvement and subsequently received a diagnosis of idiopathic erythema induratum. We performed an interferon-gamma release assay QuantiFERON-TB Gold which was positive for M. tuberculosis infection. The patient was successfully treated with ethambutol 1.6 g for 1 month; pyrazinamide 2 g for 2 months; and isoniazid 300 mg, vitamin B6 25 mg, and rifampin 600 mg for 6 months. This case highlights the utility of using interferon-gamma release assay QuantiFERON-TB Gold and a multidrug regiment over isoniazid in erythema induratum.

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“…Other treatment modality includes systemic steroids, potassium iodide, 1 dapsone 6 and mycophenolate mofetil. 7 Methotrexate has been shown to be effective in a study done by prajapati et al 8 Methotrexate is a folate antagonist that competitively inhibits Dihdrofolate Reductase preventing the reduction of folate cofactors resulting in inhibition of thymidylate synthesis and thus preventing pyrimidine synthesis. 9 In addition methotrexate in low dose inhibits the enzyme aminomidazole-4-carboxamide ribonucletide (AICAR) transformylase enzyme that inhibits de novo purine synthesis and promotes the accumulation of AICAR.…”

Section: Case Historymentioning

confidence: 99%

Methotrexate in the Treatment of Recalcitrant Nodular Vasculitis

Parajuli

Dhital

2015

J Nepal Med Assoc

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We report a case of recalcitrant nodular vasculitis in a 23 years old male who was treated successfully with methotrexate. He presented to our Dermatology out Patient Department, Tribhuvan university teaching hospital with complaints of recurrent painful discharging ulcer over bilateral calf and lower legs of three years duration. The diagnosis of nodular vasculitis was made on the basis of the clinical presentation and the histopathological findings. The patient was treated with antituberculosis treatment with initial good response; however the lesions persisted later on, despite completing the course of ATT. The patient did not respond to treatment with systemic corticosteroids also. On starting methotrexate, the lesion started healing within a period of two weeks and therewas significant improvement in subsequent one month. This case report highlights the efficacy of methotrexate in the treatment of recalcitrant nodular vasculitis. Keywords: ATT; methotrexate; nodular vasculitis.

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Erythema Induratum: Case Series Illustrating the Utility of the Interferon-γ Release Assay in Determining the Association with Tuberculosis

Cited by 5 publications

References 21 publications

Erythema Induratum of Bazin: A Rare Presentation of Tuberculosis

Erythema Induratum of Bazin: A Rare Presentation of Tuberculosis

Use of QuantiFERON-TB Gold to determine the aetiology of idiopathic erythema induratum: A case report

Methotrexate in the Treatment of Recalcitrant Nodular Vasculitis

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