title: Erythema induratum of Bazin and Ponçet's arthropathy as epiphenomena of hepatic tuberculosis.
abstract: A 42-year-old black woman presented with fever, polyarthritis, livedo reticularis, subcutaneous calf nodules and hepatomegaly. She had been diagnosed with depression 6 weeks prior. Blood analysis showed anaemia, elevated erythrocyte sedimentation rate and C reactive protein, elevated liver enzymes, and positive antinuclear and antiribonucleoprotein antibodies. Abdominal ultrasound revealed heterogeneous hepatomegaly with necrotic lymphadenopathy around the caeliac trunk and splenic hilum. We considered the following diagnoses: lymphoma, connective tissue disease, tuberculosis and sarcoidosis. Subcutaneous nodule histology was compatible with erythema induratum of Bazin, and liver biopsy evidenced granulomatous hepatitis. Although microbiological examinations were negative in tissue samples, a presumptive diagnosis of hepatic tuberculosis was admitted. Having excluded other causes, erythema of Bazin, livedo reticularis and polyarticular involvement (Ponçet's arthropathy) were accepted as immunological epiphenomena associated with tuberculosis. Empirical antituberculous treatment was started and after 3 weeks the patient improved substantially. This clinical response was a further confirmation of the diagnosis.
authors.affiliation: Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Ribeiro
authors.affiliation: Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Patrício
authors.affiliation: Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Pais da Silva
authors.affiliation: Department of Internal Medicine 2.3-Autoimmune Diseases Unit, Central Lisbon Hospital Centre-Santo António dos Capuchos Hospital, Lisboa, Lisboa, Portugal Chronic Diseases Research Center-CEDOC, NOVA Medical School/Faculdade de Ciências Médicas-Universidade Nova de Lisboa, Lisboa, Lisboa, Portugal.
authors.forename: Pedro Eduardo
authors.identifier: http://orcid.org/0000-0001-7042-0498
authors.initials: PE
authors.lastname: Silva
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004891:Erythema Induratum / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D054068:Livedo Reticularis / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome; D014386:Tuberculosis, Hepatic / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents