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Erythema induratum in a Kenyan child
Author(s) -
Thoo Caroline HF,
Graf Nicole,
Hogan Peter
Publication year - 2008
Publication title -
australasian journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.67
H-Index - 53
eISSN - 1440-0960
pISSN - 0004-8380
DOI - 10.1111/j.1440-0960.2008.00455.x
Subject(s) - medicine , pyrazinamide , tuberculosis , rifampicin , ethambutol , mantoux test , dermatology , isoniazid , sputum , mycobacterium tuberculosis , tuberculin , pathology
SUMMARY 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.