背景:硬红斑(EI)是与结核分枝杆菌(TB)感染相关的结核。在台湾已使用PCR鉴定出具有高比例EI的TB。然而,这种病原体最近很少被发现。
目的:探讨EI,台湾结核病的年发病率,以及过去二十年的治疗结果。
方法:根据组织病理学纳入2001年至2020年诊断为EI的患者,组织培养,和TB-PCR测试。其他具有TB-PCR结果的脂膜炎病例用作对照。获得了他们的临床信息。结果与结核病的年发病率相关,并在组间进行比较。
结果:来自EI患者的55个标本符合纳入标准;3个(3/55,5%)的TBPCR阳性。对照组中一名诊断为结节性红斑的患者的TBPCR阳性(1/27,4%)。TB和EI之间没有显着关系(比值比=1.5,95%置信区间=-0.964至3.964,p=1)。结核病发病率与EI例数之间的相关性无统计学意义(r=-0.185,p=0.447)。只有4名患者接受了抗结核治疗。均表现为临床好转,无复发。1例PCR阳性EI患者未接受抗结核治疗;然而,3个月后皮损好转。在508人年的随访中,EI组中没有其他患者被诊断出患有结核病感染。
结论:台湾的大多数EI是结节性血管炎,而不是由于控制良好的结核病而引起的结核。这种情况可以在没有抗结核治疗的情况下缓解。
BACKGROUND: Erythema induratum (EI) is a tuberculid associated with Mycobacterium tuberculosis infection. Using polymerase chain reaction (PCR), M. tuberculosis has been identified in Taiwan with a high percentage of EI. However, this pathogen is now rarely detected in Taiwan.
OBJECTIVE: To explore the association between EI, the annual incidence of tuberculosis (TB) in Taiwan and treatment outcomes over the last two decades.
METHODS: Patients diagnosed with EI between 2001 and 2020 were enrolled based on histopathology, tissue culture and positive M. tuberculosis PCR tests. Other cases of panniculitis with positive M. tuberculosis PCR results were used as controls. The clinical information of participants was obtained. The results were correlated with the annual incidence of TB and compared between groups.
RESULTS: Fifty-five biopsy specimens from patients with EI met the inclusion criteria; three (5%) had positive M. tuberculosis PCR results. One patient diagnosed with erythema nodosum in the control group had a positive M. tuberculosis PCR (n = 1/27; 4%). There was no significant relationship between M. tuberculosis and EI (odds ratio 1.5, 95% confidence interval -0.964 to 3.964). The correlation between the incidence of M. tuberculosis and the number of EI cases was not statistically significant (r = -0.185, P = 0.45). Only four patients received anti-TB treatment; they all showed clinical improvement without recurrence. One patient with M. tuberculosis PCR-positive EI was not treated with anti-TB therapy; however, the skin lesion improved after 3 months. No other patients in the EI group were diagnosed with M. tuberculosis infection over a follow-up period of 508 person-years.
CONCLUSIONS: Most cases of EI in Taiwan are nodular vasculitis and not tuberculid, owing to well-controlled TB. This condition can be alleviated without anti-TB treatment.