4 Cases of Erythema Indulatum

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  • バザン硬結性紅斑の4例
  • バザンコウケツセイコウ ハン ノ 4レイ

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We report four cases of erythema induratum (EI), which has been though to be an uncommon disorder in Japan. Histopathologically, all the cases showed lobular panniculitis with vasculitis, caseation necrosis, and typical tulercle formation. However, these clinical pictures, other than the consistent findings of strongly positive PPD tuberclin reactions, were not suggestive of EI. None of the cases had any ulcerative changes on the skin lesions. Case 1 developed pulmonary tuberculosis after indurated erythema of the lower extremities had disappeared spontaneously, so we reached the diagnosis of EI retrospectively. Only after the development of liches scroflosorum on the trunk in Case 2 could we make the diagnosis of indurated erythema on the legs, which had initially been considered to be subcutaneous sarcoidosis. These two cases made it possible for us to reach the correct diagnosis in the next two in spite of their unusual clinical presentation of EI. The acid-fast staining of the lesional skin biopsy specimens did not show any acid-fast baccili in any of the cases, and the polymerase chain reaction (PCR) from lesional skin biopsies also failed to amplify of M. tubercurosis specific sequence in any of them. Tuberculosis has been reported to be increasing in the past ten years in Japan. Our cases tell us that we should consider tuberculosis when we see patients with erythematous induration on the legs and a positive tuberculin skin test.

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