Mycobacterium tuberculosis Infection Is Associated with the Development of Erythema Nodosum and Nodular Vasculitis

Abstract

Background Mycobacterium tuberculosis (MTB) infection has been suggested to contribute to the pathogenesis of erythema nodosum (EN) and nodular vasculitis (NV), the classic forms of panniculitis. However, there is little evidence to demonstrate the presence of MTB in the skin lesions. This study is aimed at evaluating the association between MTB infection and the development of EN and NV in a Chinese population.MethodsA total of 107 patients (36 EN, 27 NV, and 44 others) with vasculitis and 40 control cases with other skin diseases were recruited and their skin lesion samples were subjected to real time polymerase chain reaction (PCR) analysis of the IS6110 and mpt64 gene fragments of MTB. Their blood mononuclear cells were tested for MTB antigen-specific IFN-γ responses by QuantiFERON®-TB Gold In-Tube (IT) assays.ResultsPCR analysis revealed that 7/23 (30.4%) and 7/18 (38.9%) of the EN and NV samples were positive for the IS6110 DNA, respectively, which were significantly higher than 3/34 (8.8%) of other vasculitis (OV) and 3/40 (7.5%) of the control samples (p<0.05). The nested Real-Time PCR assay indicated that 6/7 (86%) of the IS6110-positive EN samples, all of the IS6110-positive NV and control samples, but only 1/3 of the IS6110-positive OV samples, were positive for the mpt64 gene. Similarly, 19/32 (59.4%) of the EN patients, 20/26 (76.9%) of the NV patients, and 17/36 (47.2%) of the OV patients were positive for MTB antigen-specific IFN-γ responses, which were significantly higher than 6/40 (15%) of the controls (p<0.05).ConclusionOur data strongly suggest that MTB infection and active TB are associated with the development of NV and EN in Chinese.

Erythema Nodosum Caused by Mycobacterium tuberculosis in HTLV-1 Infected Patients

“…The histopathologic analysis of the nodular lesion showed a panicullitis typical of Erythema nodosum and in one case neutrophilia inflammatory infiltrate and granulomas with caseous necrosis were detected. Similar to other cases previously reported of Erythema nodosum in patients with tuberculosis, fast acid bacillus were not detected [24,25] and the culture for M. tuberculosis was negative in both patients.…”

Human Immunology of Tuberculosis

“…This suggests that acute infection is associated with a systemic innate inflammatory response that precedes the induction of a detectable adaptive immune response. Erythema nodosum is still a symptomatic trigger that may lead to investigation and diagnosis of human infection with M. tuberculosis (4)(5)(6) or Mycobacterium bovis (7).…”

Pulmonary tuberculosis presenting with oral aphthae

“…Erythema nodosum may also occur in drug-associated hypersensitivity reactions and malign disorders, but in our case, there was no drug that the patient had used and her tumor marker tests were normal. Erythema nodosum rarely occurs in adults with a tuberculosis infection (6). In 2012, Öz et al (7) conducted a 5-year retrospective epidemiologic study and found the rate of tuberculosis-associated erythema nodosum to be 3%.…”