Clinicopathological conferene: an elderly man with erythema induratum

Abstract

<p>A 72-year-old man was admitted into the Department of Geriatrics for a 2-week history of painful skin nodules over both legs. He had been regularly followed up in our specialist out-patient clinic for ischaemic heart disease and paroxysmal atrial tachycardia. One and a half months prior to this admission, he was hospitalized in the private sector for a few days of fever and anal pain, diagnosed perianal abscess, and treated with incision and drainage, and excision of the associated sinus tract. Biopsy of the perianal abscess was diagnosed as “marked acute and chronic inflammation.” Post-operatively, he still had subjective feverishness and noted a weight loss of 6 kg. One week prior to admission, he coughed up a few mouthfuls of fresh blood during a morning walk. Examination on admission revealed an afebrile patient in good condition, with no lymphadenopathy nor abnormal chest signs. Tender erythematous nodular eruptions without ulcerations were found over both the anterior and posterior aspects of both legs. Active pulmonary tuberculosis with erythema induratum was diagnosed, as confirmed by the presence of acid-alcohol-fast bacilli on all three direct sputum smears and the histopathological findings of the skin biopsy taken from the nodular skin lesions. He improved with antituberculosis chemotherapy. <br></p>