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.

Poncet′s disease (tubercular rheumatism): a narrative review

“…24 The diagnosis of PD, when presented with history of watery diarrhea and symmetrical multiple joint (including small joints of hand) arthritis, may be difficult and requires careful exclusion of reactive and rheumatoid arthritis. 25 Paediatric cases are another underrepresented groups with few reports. In a large case pool of 462 cases of pediatric rheumatologic disorders from South Africa, only four cases of PD were described.…”

Non-ulcerative Variant of Erythema Induratum of Bazin in an Indian Female

“…Early response to ATT was seen in this case within 1 week of initiating ATT, whereas most studies showed response in 3–4 weeks after starting ATT. [ 1 5 ]…”