Issue 11/2022
Department of Dermatology and Venereology, Military Medical Academy – Sofia
Tuberculosis is a multiorgan specific granulomatous infection caused by Mycobacterium tuberculosis. Dermatological involvement may be primary – by direct inoculation, forming micronodular granulomas, called lupomas, and adjacent to infected parenchymal organs or lymph node conglomerations, forming ulcerative lesions with colliquative exudation. Characteristic only of the dermatological domain is the autosensitization, presented as an immunological phenomenon of delayed hypersensitivity reaction, clinically manifested by symmetrically disseminated erythematous papules or nodules on the extremities, terminologically defined as tuberculoids. The most common form of tuberculoid reaction is erythema induratum Bazin. The clinical findings manifest ulcerating erythema-nodular lesions exuding purulent discharge, localized on the dorsal surface of the lower legs. This case report presents a 78-year-old woman with dermatological manifestations of Bazin indurative erythema, confirmed by a positive tuberculin test and specific immunological reactions. An increased index of suspicion for specific granulomatous infection is need in all patients with chronic non-healing ulcers.