Erythema induratum of Bazin and renal tuberculosis: report of an association.
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.
Daher
Elizabeth De Francesco
Ede F
Serviços de Dermatologia e Nefrologia, Hospital Universitário Walter Cantídio, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil. efdaher@for.terra.com.br
Silva Júnior
Geraldo Bezerra da
GB
Pinheiro
Hugo César Furtado
HC
Oliveira
Tatiane Roseno de
TR
Vilar
Maria do Livramento Leitão
Mdo L
Alcântara
Karlla Jordão de
KJ
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D004891:Erythema Induratum / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D014398:Tuberculosis, Renal / Q000150:complications* / Q000188:drug therapy
D000995:Antitubercular Agents; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin