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A 29‐year‐old Caucasian woman presented with a 3‐month history of bilateral lower limb swelling with painful erythematous nodules on shins without ulceration. She had been taking minocycline for acne vulgaris for 3 years. Biochemical investigations showed deranged liver function test with positive ANA and mixed antinuclear factor (ANF) pattern. A skin biopsy was in keeping with a diagnosis of nodular vasculitis. Her skin lesions and liver function test improved within 3 months of stopping the minocycline treatment. This case report raises the awareness that minocycline could be a potential cause of nodular vasculitis, patients on minocycline should be closely monitored and minocycline should ideally not be prescribed for more than 12 weeks, given the possible adverse effects. [ABSTRACT FROM AUTHOR]

We present a case of disseminated cutaneous sporotrichosis in a 72-year-old male patient who has multiple ulcerated painless nodules over the left side of his chest and on his upper and lower left limbs for three years. He was initially diagnosed to have nodular vasculitis based on early repeated biopsies. Despite the patient's good compliance with his prednisolone medication, no significant clinical improvement was observed. Another biopsy, which was arranged after two years of treatment for nodular vasculitis, supported the diagnosis of sporotrichosis. Itraconazole was initiated, and all the lesions showed a remarkable response toward the treatment. The delay in finding the correct diagnosis unnecessarily exposed the patient to the side effects of steroid and caused the disease to worsen. [ABSTRACT FROM AUTHOR]

Nodular vasculitis (NV), first described by Montgomery in 1945 for erythema induratum-like lesions, is a rare form of panniculitis that is particularly localized on the calves. Characterized by plaques and erythematous nodules, NV may often show ulceration and draining. It is known as a reactive disease associated with many causative factors. Several NV cases due to infectious or non-infectious causative factors have been reported, but no case of NV due to sodium-glucose cotransporter-2 inhibitors (SGLT2i) has yet been reported. In this case report, we presented a case diagnosed with NV, who presented with tender, erythematous, eroded plaques with hemorrhagic-purulent discharge on both legs during treatment with dapagliflozin (an SGLT2i). [ABSTRACT FROM AUTHOR]

Erythema induratum (EI) is a rare chronic disease, which occurs with cutaneous tuberculosis (TB). Nodular vasculitis, much rarer than erythema induratum, describes the same condition but without cutaneous TB, with lesions usually in the lower legs and rarely on the breasts. We report the case of a 46-year-old female with a history of crusted skin and necrotic lesions two years before, which, once self-limited, multiplied one month before and transferred to uncommon sites of the body, such as the breast. There was no evidence of other clinical presentations, and a chest X-ray gave no pathological findings. A biopsy was taken from the lesions, and the patient was diagnosed with erythema induratum without cutaneous tuberculosis, that is, nodular vasculitis. After treatment with calcineurin-inhibiting tacrolimus ointment, topical corticosteroids, and immunosuppressive oral azathioprine, the lesions improved. [ABSTRACT FROM AUTHOR]

Nodular vasculitis (NV) refers to a chronic relapsing lobular panniculitis that is thought to be a hypersensitivity reaction to antigenic triggers. While it is commonly associated with tuberculosis, in many cases no underlying cause is found and the condition is difficult to manage. Here, we report three patients with refractory idiopathic NV effectively treated with colchicine, leading to a significant improvement or complete resolution of their symptoms. Colchicine was successfully used as a steroid-sparing agent, and in one patient its cessation was associated with a flare of disease. [ABSTRACT FROM AUTHOR]

Résumé Le terme panniculite est utilisé pour désigner une inflammation de l’hypoderme. Une biopsie profonde et large est nécessaire pour préciser le type d’atteinte de l’hypoderme et proposer une hypothèse diagnostique qui orientera la prise en charge. En effet, il existe 4 contextes nosologiques différents selon que l’inflammation prédomine dans les septums inter-adipocytaires ou directement dans les lobules adipeux ; qu’il s’y associe, ou non, une atteinte vasculaire. Il conviendra aussi d’adresser une partie du prélèvement biopsique pour analyse microbiologique pour ne pas méconnaître une cause infectieuse et pour rechercher une clonalité si un lymphome profond est suspecté. L’érythème noueux, principale hypodermite septale, a de nombreuses étiologies et est la seule hypodermite qui ne requiert pas de biopsie dans sa forme clinique typique. La périartérite noueuse (PAN) est une panniculite septale vasculaire avec un livedo et/ou des nodules et du purpura et impose de rechercher une atteinte systémique. Une thrombophlébite nodulaire doit faire rechercher une coagulopathie, une maladie de Behçet, une périartérite noueuse ou une maladie de Buerger. Les panniculites lobulaires sont classées selon l’infiltrat. Si l’infiltrat est lymphocytaire, il faudra discuter notamment le lupus érythémateux profond et les lymphomes T hypodermiques. S’il est histiocytaire, seront discutées la sarcoïdose, la panniculite histiocytaire cytophagique et chez le nouveau-né la cytostéatonécrose. La panniculite lobulaire neutrophilique est de diagnostic difficile et nécessite une confrontation anatomoclinique. En pratique, très souvent, le diagnostic étiologique d’une hypodermite ne peut pas être établi d’emblée, c’est souligner l’importance du suivi de ces malades qu’il ne faut pas hésiter à biopsier à nouveau. Panniculitis is an inflammation of the subcutaneous fat. Skin biopsy plays a critical role in the differential diagnosis of panniculitis. The most common approach to diagnosis relies on the differentiation between predominantly septal or lobular panniculitis, followed by the distinction between lesions with and without vasculitis. It is also very important to submit a part of the skin biopsy for microbiological analysis and for T-cell clonal expansion if T-cell lymphoma is suspected. Erythema nodosum, the most frequent septal panniculitis, has many causes and in its typical clinical presentation, does not require skin biopsy. In other panniculitis, diagnosis is based on the integration of the clinical and histological data, which renders a deep cutaneous biopsy necessary. Periarteritis nodosa, a septal panniculitis with vasculitis characterized by subcutaneous nodules and livedo racemosa, can be associated with systemic involvement. Nodular thrombophlebitis needs search for associated coagulopathy, Behçet's disease, periarteritis nodosa or Buerger's disease. Lobular panniculitis are classified according to the nature of cells present in the inflammatory infiltrate. If there is a lymphocytic infiltration, lupus panniculitis is difficult to differentiate from subcutaneous panniculitis-like T-cell lymphoma. If there are histiocytes, it can be a sarcoidosis, a cytophagic histiocytic panniculitis or, in newborn, a subcutaneous fat necrosis. Neutrophilic panniculitis needs careful clinic-pathologic correlation. Treatment of panniculitis can be challenging and is based on the histopathological findings. Frequently, the precise cause of panniculitis cannot be established from the outset, so it is important to follow-up patients and not hesitate to repeat the skin biopsy. [ABSTRACT FROM AUTHOR]

Although, erythema nodosum is a common skin manifestation associated with syphilis, nodular vasculitis is a rare feature. Here, we describe a case of a 22-year-old, human immunedeficiency virus negative, non-immunocompromised man who developed recurrent oral and scrotal ulcers with nodular lesions of the lower extremitie. Behçet's disease was initially suspected, however, his serologic test for syphilis was positive, and he was thus diagnosed with secondary syphilis, with a skin biopsy showing nodular vasculitis. The patient was treated with benzathine penicillin, and the skin lesions disappeared after treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT We report a chronic case of nodular vasculitis that responded to oral clofazimine 300 mg daily. The condition had previously responded to moderate dose oral prednisolone, 50 mg daily, but would recur with weaning. Multiple corticosteroid-sparing agents were trialled, however these were either ineffective or poorly tolerated. The introduction of clofazimine enabled prednisolone dose reduction, not achieved with other agents, to 22.5 mg daily, and was associated with complete suppression of disease activity. Unfortunately the patient developed a clofazimine-induced enteropathy and the treatment was ceased after almost 2 years of therapy. Cessation of clofazimine was associated with a flare of the condition. Clofazimine should be considered as a corticosteroid-sparing agent in resistant cases of nodular vasculitis. Clinicians should be aware of clofazimine-induced enteropathy as a potentially serious complication of the therapy. [ABSTRACT FROM AUTHOR]

Erythema nodosum is the most common type of panniculitis; it may be due to a variety of underlying infectious or otherwise antigenic stimuli. The pathogenesis remains to be elucidated, but both neutrophilic inflammation and granulomatous inflammation are implicated. Beyond treating underlying triggers, therapeutic options consist mainly of nonsteroidal anti-inflammatory drugs, symptomatic care, potassium iodide, and colchicine. Erythema induratum (nodular vasculitis) is a related but distinctly different clinicopathologic reaction pattern of the subcutaneous fat. It is classically caused by an antigenic stimulus from Mycobacterium tuberculosis but may be associated with several other underlying disorders. After appropriate antimicrobial treatment in tuberculous cases, therapy for erythema induratum is similar to options for erythema nodosum. [ABSTRACT FROM AUTHOR]

Abstract: Erythema induratum, or nodular vasculitis, was initially described as a type of cutaneous tuberculosis. Currently, it is considered a multifactorial syndrome of lobular panniculitis of unknown cause. An association between erythema induratum and hepatitis C virus (HCV) has been suggested in previous reports. We report the case of a 49-year-old male presenting with a 3-year history of itchy, painful red to violaceous cutaneous nodules and plaques on both legs that had been unresponsive to topical dermatologic treatments. Evaluation of persistent serum transaminase elevations led to a diagnosis of chronic hepatitis C with bridging liver fibrosis. A thorough evaluation to exclude mycobacterial infection was performed, and anti-tuberculosis treatment was started based on a positive QuantiFERON test. There was no improvement in the skin lesions with this treatment. The patient then received standard antiviral therapy with pegylated interferon and ribavirin for 48 weeks. Treatment produced an early virologic response with significant improvement in the skin lesions, pain and pruritus. Six months after antiviral treatment, virologic relapse occurred without recurrence of the cutaneous lesions. There appears to be an association between erythema induratum and hepatitis C infection, probably mediated by circulating immune complexes. Interestingly, lesions improve with antiviral treatment and, as shown in this case, the effect may be sustained after stopping treatment despite virologic relapse. [Copyright &y& Elsevier]

A 10-year-old Kenyan girl presented with a 9-month history of a persistent, painful eruption of multiple, tender, non-ulcerated, pigmented nodules involving the calves, shins and soles of the feet. She had recurring fevers particularly at night, lethargy, weight loss and a persistent non-productive cough. The Mantoux test was positive. Chest X-ray revealed mild peribronchial thickening in the hilar region but no evidence of hilar lymphadenopathy, consolidation and/or cavitation suggestive of tuberculosis. Sputum and gastric washings were negative for acid-fast bacilli. Histology on a skin biopsy showed a granulomatous panniculitis with no histological evidence of Mycobacterium tuberculosis, consistent with erythema induratum. In view of her constitutional symptoms, chronic non-productive cough and positive Mantoux test, she was diagnosed with pulmonary tuberculosis despite the non-specific chest X-ray and negative bacteriology. Anti-tuberculous therapy was initiated with pyrazinamide, isoniazid and rifampicin for 2 months followed by dual therapy with isoniazid and rifampicin for a further 4 months. Her constitutional and respiratory symptoms and skin eruption cleared within 6 months with treatment. [ABSTRACT FROM AUTHOR]