Abstract
A 52-year-old woman suffering from varicose syndrome on the right shin for over 26 years noted an indurative erythema with two punched-out ulcers on the thigh of the same side of the varicose syndrome. A histlogical examination indicated multiple epithelioid cell granulomas mixed with giant cells surrounded by a mild lymphocytic infiltration, and vasculitis of the small arteries in the fat tissue. Cultures from the affected skin specimen for mycobacteria failed to grow. Based on both clinical and histological data, a diagnosis of erythema induratum (EI) was made. There were no active extracutaneous foci of tuberculosis and PPD was strongly positive. The patient was treated with 450 mg rifampicin and 300 mg isoniazid a day, and the lesion cleared up after 3 months. During the last 16 years, 11 cases of EI have been treated in our department. Ten cases were women. Nine showed no active extracutaneous tuberculosis, 9 showed thrombotic and/or proliferative necrotizing vasculitis histologically, and 3 had the varicose syndrome on the shin. Only two patients, including the present case, showed EI lesions on the thigh. Four had ulcers in the cutaneous lesions of the indurated erythema, with 3 of them showing multiple epithelioid cell granulomas widely distributed from the entire dermis to fat tissue histologically. From these results, a few of the EI patients in which circulation disturbance and epithelioid granulomas are found, not only in the fat tissue but widely over the entire dermis as well, tended to show ulcerative lesions clinically.
