UNC Medical Student Uses VisualDx to Identify Patient’s Lesions

Lindsey G., a medical student at the University of North Carolina, shares how she used VisualDx to identify her patient’s lesions:

I saw a young female patient with tender nodules on the posterior legs. I knew it was familiar but did not recall what the nodules were. Using VisualDx, I was able to think of erythema induratum, send for tuberculosis testing, and diagnose this patient!

What is erythema induratum?

Erythema induratum, also known as nodular vasculitis, is a form of lobular panniculitis with multiple etiologies. Tender erythematous to violaceous nodules and/or plaques are seen, usually on the calves. Lesions have also been seen on the feet, thighs, buttocks, and arms. Ulceration and drainage may occur. Lesions tend to heal with scarring and are prone to recurrence. Women are most commonly affected (80%-90% of patients), with peaks in incidence during early adolescence and around menopause.

What should we be aware of when making a diagnosis?

Diagnosis relies primarily on observing histopathological features of a lobular or mixed lobular / septal panniculitis with a granulomatous mixed infiltrate of lymphocytes, histiocytes, neutrophils, plasma cells, and multinucleated giant cells.

How can we treat this?

• Treat the underlying disease, if found. This includes multidrug antituberculous therapy for those cases associated with M tuberculosis, antimicrobial therapy as indicated for other infection-related cases, and discontinuation of possible inciting medications.
• Other helpful therapies include corticosteroids, NSAIDs, potassium iodide, tetracycline, gold, and mycophenolate mofetil.