Nodular vasculitis associated with chronic hepatitis C

Journal of the European Academy of Dermatology and Venereology (Impact Factor: 2.83). 06/2002; 16(3):298-9. DOI: 10.1046/j.1468-3083.2002.00487_11.x
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    ABSTRACT: A 51-year-old female patient presented with typical lesions of nodular vasculitis, which was confirmed by histopathology, and was proved to be of non-tubercular etiology by the absence of mycobacterial DNA in tissue PCR. The patient was initially treated with saturated solution of potassium iodide which led to partial improvement, but it had to be discontinued due to gastric irritation. The patient was then put on dapsone, starting with 100 mg per day, following which good response was seen.
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    ABSTRACT: 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.
    International Journal of Dermatology 12/1996; 35(11):802-8. · 1.31 Impact Factor
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    ABSTRACT: Cases of red fingers syndrome and nodular vasculitis in patients with hepatitis C have rarely been described. Both red fingers syndrome and nodular vasculitis are characterized by microscopic vasculitis, and it has been hypothesized that hepatitis C plays a role in the pathogenesis of cutaneous disorders such as vasculitis, especially in cryoglobulinaemic vasculitis. We describe the case of a 75-year-old woman diagnosed with chronic hepatitis C who presented with nodular lesions on her right thigh and red fingers syndrome. A skin biopsy taken from a nodule showed infiltration of the vessel walls by mononuclear cells and septal and lobular panniculitis. The diagnosis of nodular vasculitis was established. In our opinion, red fingers syndrome and nodular vasculitis might be related to a vascular reaction of immune-mediated mechanisms induced by hepatitis C.
    Journal of the European Academy of Dermatology and Venereology 12/2003; 17(6):692-4. DOI:10.1046/j.1468-3083.2003.00839.x · 2.83 Impact Factor
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