Cho K H, Lee D Y, Kim C W
Department of Dermatology, Seoul National University College of Medicine, Korea.
Int J Dermatol. 1996 Nov;35(11):802-8. doi: 10.1111/j.1365-4362.1996.tb02979.x.
There has been a long controversy about the tuberculous cause of erythema induratum, a chronic form of nodular vasculitis.
We investigated clinical, histopathologic, and immunohistochemical features of patients with erythema induratum who showed positive tuberculin hypersensitivity reactions or had associated active tuberculosis.
The ages of the 32 patients (M 7: W 25) ranged from 13 to 66 years (mean 36.6 years). All patients displayed recurrent crops of tender, painful, violaceous nodules or plaques. Most lesions presented on the legs, but they also occurred on thighs, feet, buttocks, and forearms. The skin lesions evolved for several weeks and healed with scarring and residual pigmentation. Twenty-two patients were treated with isoniazid alone and the remaining 10 patients received combinations of antituberculous drugs. Relapses were encountered in four patients who received isoniazid alone or stopped the medication against medical advice. In most biopsies, histologic examination revealed lobular or septolobular panniculitis with varying combinations of granulomatous inflammation, primary vasculitis, and necrosis. Immunohistochemical labeling revealed a preponderance of T lymphocytes, monocyte-macrophages, and Langerhans' cells, indicative of a type IV hypersensitivity reaction.
Erythema induratum of Bazin has distinct clinical, histopathologic, and immunohistochemical features. Erythema induratum of Bazin should be considered as a separate entity of nodular vasculitis caused by latent foci of tuberculous infection.
关于硬结性红斑（一种慢性结节性血管炎）的结核病因，长期以来一直存在争议。
我们对硬结性红斑患者的临床、组织病理学和免疫组化特征进行了研究，这些患者结核菌素超敏反应呈阳性或伴有活动性肺结核。
32例患者（男7例，女25例）年龄在13至66岁之间（平均36.6岁）。所有患者均反复出现压痛性、疼痛性、紫红色结节或斑块。大多数皮损出现在腿部，但也发生在大腿、足部、臀部和前臂。皮肤损害持续数周，愈合后留有瘢痕和色素沉着。22例患者仅接受异烟肼治疗，其余10例患者接受联合抗结核药物治疗。4例仅接受异烟肼治疗或自行停药的患者出现复发。在大多数活检中，组织学检查显示小叶性或小叶间隔性脂膜炎，伴有肉芽肿性炎症、原发性血管炎和坏死的不同组合。免疫组化标记显示T淋巴细胞、单核细胞-巨噬细胞和朗格汉斯细胞占优势，提示IV型超敏反应。
巴赞硬结性红斑具有独特的临床、组织病理学和免疫组化特征。巴赞硬结性红斑应被视为由结核感染潜伏灶引起的结节性血管炎的一个独立类型。
