A Diagnostic Challenge of A Two-Year Misdiagnosis of Erythema Induratum of Bazin As Erythema Nodosum
- 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
- 2Department of Pathological Anatomy, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
Abstract
Erythema induratum of Bazin (EIB) is an uncommon form of cutaneous tuberculosis (TB) associated with hypersensitivity to Mycobacterium tuberculosis (M. tb). EIB, a type of tuberculid, is characterized by recurrent sore nodules on the lower extremities, which can mimic other dermatologic disorders, such as erythema nodosum (EN), and may result in misdiagnosis and delayed treatment. The aim of this case report was to raise awareness of the diagnostic problem of EIB and the need for thorough diagnostic tools. We present a case of EIB in a 31-year-old woman who was misdiagnosed as EN for two years. On examination, she had several uncomfortable nodules on the distal anterior aspects of both lower legs and the dorsum of the right foot, some ulcerated and healing with hyperpigmentation. The tuberculin test was positive and histopathology showed lobular panniculitis with granulomatous inflammation, Langhans giant cells, epithelioid cells and caseous necrosis. Polymerase chain reaction testing revealed the presence of M. tb deoxyribonucleic acid. In addition, the sputum smear was positive for M. tb and the chest X-ray findings were consistent with pulmonary TB. The woman was diagnosed with EIB with pulmonary TB and her skin lesions improved significantly after two months of anti-tuberculosis treatment. This case highlights the importance of reconsidering the diagnosis of EN in patients with recurrent or ulcerating nodules despite treatment, particularly in TB-endemic settings, and emphasizes the role of histopathological evaluation in diagnosing EIB.
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BibTeX
@article{gunawan2026diagnostic,
title = {{A Diagnostic Challenge of A Two-Year Misdiagnosis of Erythema Induratum of Bazin As Erythema Nodosum}},
author = {Hendra Gunawan and Risa Miliawati Nurul Hidayah and Retno Hesty Maharani and Rafithia Anandita and Hermin Aminah Usman and Reti Hindritiani and Amalia Laksmi Saraswati},
journal = {Clinical, Cosmetic and Investigational Dermatology},
year = {2026},
month = oct,
doi = {10.2147/ccid.s643959},
url = {https://doi.org/10.2147/ccid.s643959},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - A Diagnostic Challenge of A Two-Year Misdiagnosis of Erythema Induratum of Bazin As Erythema Nodosum
AU - Hendra Gunawan
AU - Risa Miliawati Nurul Hidayah
AU - Retno Hesty Maharani
AU - Rafithia Anandita
AU - Hermin Aminah Usman
AU - Reti Hindritiani
AU - Amalia Laksmi Saraswati
PY - 2026
DA - 2026/10/27
JO - Clinical, Cosmetic and Investigational Dermatology
DO - 10.2147/ccid.s643959
UR - https://doi.org/10.2147/ccid.s643959
AB - Erythema induratum of Bazin (EIB) is an uncommon form of cutaneous tuberculosis (TB) associated with hypersensitivity to Mycobacterium tuberculosis (M. tb). EIB, a type of tuberculid, is characterized by recurrent sore nodules on the lower extremities, which can mimic other dermatologic disorders, such as erythema nodosum (EN), and may result in misdiagnosis and delayed treatment. The aim of this case report was to raise awareness of the diagnostic problem of EIB and the need for thorough diagnostic tools. We present a case of EIB in a 31-year-old woman who was misdiagnosed as EN for two years. On examination, she had several uncomfortable nodules on the distal anterior aspects of both lower legs and the dorsum of the right foot, some ulcerated and healing with hyperpigmentation. The tuberculin test was positive and histopathology showed lobular panniculitis with granulomatous inflammation, Langhans giant cells, epithelioid cells and caseous necrosis. Polymerase chain reaction testing revealed the presence of M. tb deoxyribonucleic acid. In addition, the sputum smear was positive for M. tb and the chest X-ray findings were consistent with pulmonary TB. The woman was diagnosed with EIB with pulmonary TB and her skin lesions improved significantly after two months of anti-tuberculosis treatment. This case highlights the importance of reconsidering the diagnosis of EN in patients with recurrent or ulcerating nodules despite treatment, particularly in TB-endemic settings, and emphasizes the role of histopathological evaluation in diagnosing EIB.
SN - 1178-7015
ER -