Eritema indurato di Bazin: Considerazioni eziopatogenetiche e terapia

Erythema induratum of Bazin - nodular vasculitis - is a mostly tabular panniculitis with vasculitis, which affects almost exclusively adult females. Considered in the past to be a cutaneous manifestation of tuberculosis, this pathology is now thought more likely to be the result of a cell-mediated immune response to various exogenous or endogenous antigens, whose nature is always difficult to determine. Two female patients with a long history of recurrent erythematous nodular lesions of the lower limbs came to our observation; in both cases, the correlation between the clinical manifestations and the histological pattern led us to a diagnosis of erythema induratum of Bazin. Neither of the patients presented active tuberculosis, and the search for latent tuberculous foci gave negative results. We therefore commenced oral treatment with cyclosporin A, in order to suppress the immune response, with extremely encouraging results. Both patients were subsequently found to have malignant neoplasms. The parallel course of the neoplasia and the erythema induratum of Bazin in these 2 cases leads us to formulate the hypothesis that this pathology can sometimes manifest itself as a paraneoplastic syndrome. The appearance of the lesions would appear to be due to the presence in the blood circulation of antigens of neoplastic origin, which probably determine the development of the cell-mediated immune response.